Mutabingwa Theonest K, Bolla Melissa C, Li Jin-Long, Domingo Gonzalo J, Li Xiaohong, Fried Michal, Duffy Patrick E
Malaria Antigen Discovery Program, Seattle Biomedical Research Institute, Seattle, Washington, USA.
PLoS Med. 2005 Dec;2(12):e407. doi: 10.1371/journal.pmed.0020407. Epub 2005 Nov 8.
In endemic areas, placental malaria due to Plasmodium falciparum is most frequent and severe in first-time mothers, and increases the risk of infant mortality in their offspring. Placental malaria may increase the susceptibility of infants to malaria parasitemia, but evidence for this effect is inconclusive.
During 2002-2004, we monitored parasitemia in 453 infants, including 69 who were born to mothers with placental malaria, in a region of northeastern Tanzania where malaria transmission is intense. We used a Cox proportional hazards model to evaluate the time from birth to first parasitemia, and a generalized estimating equations logistic regression model to evaluate risk of any parasitemia throughout the first year of life. Compared with infants whose mothers did not have placental malaria at delivery ("PM-negative"), offspring of mothers with placental malaria at delivery ("PM-positive") were 41% more likely to experience their first parasitemia at a younger age (adjusted hazard ratio [AHR] = 1.41, 95% confidence interval [CI] 1.01-1.99). The odds of parasitemia throughout infancy were strongly modified by the interaction between placental malaria and gravidity (p for interaction = 0.008, Type 3 likelihood ratio test). Offspring of PM-negative primigravidae had lower odds of parasitemia during infancy (adjusted odds ratio [AOR] = 0.67, 95% CI 0.50-0.91) than offspring of PM-negative multigravidae, and offspring of PM-positive primigravidae had the lowest odds (AOR = 0.21, 95% CI 0.09-0.47). In contrast, offspring of PM-positive multigravidae had significantly higher odds of parasitemia (AOR = 1.59, 95% CI 1.16-2.17).
Although parasitemia is more frequent in primigravid than multigravid women, the converse is true in their offspring, especially in offspring of PM-positive women. While placental malaria is known to increase mortality risk for first-born infants, it surprisingly reduced their risk of parasitemia in this study. Placental malaria of multigravidae, on the other hand, is a strong risk factor for parasitemia during infancy, and therefore preventive antimalarial chemotherapy administered to multigravid women close to term may reduce the frequency of parasitemia in their offspring.
在疟疾流行地区，首次怀孕的母亲感染恶性疟原虫导致的胎盘疟疾最为常见且严重，会增加其后代婴儿死亡的风险。胎盘疟疾可能会增加婴儿对疟疾寄生虫血症的易感性，但这一影响的证据尚无定论。
在2002年至2004年期间，我们在坦桑尼亚东北部疟疾传播强烈的一个地区监测了453名婴儿的寄生虫血症，其中包括69名母亲患有胎盘疟疾的婴儿。我们使用Cox比例风险模型评估从出生到首次出现寄生虫血症的时间，并使用广义估计方程逻辑回归模型评估生命第一年中出现任何寄生虫血症的风险。与分娩时母亲没有胎盘疟疾的婴儿（“胎盘疟疾阴性”）相比，分娩时母亲患有胎盘疟疾的婴儿（“胎盘疟疾阳性”）在较年轻时出现首次寄生虫血症的可能性高41%（调整后风险比[AHR]=1.41，95%置信区间[CI]1.01-1.99）。胎盘疟疾与妊娠次数之间的相互作用对整个婴儿期寄生虫血症的几率有强烈影响（相互作用p值=0.008，Ⅲ型似然比检验）。胎盘疟疾阴性初产妇的后代在婴儿期出现寄生虫血症的几率较低（调整后优势比[AOR]=0.67，95%CI 0.50-0.91），低于胎盘疟疾阴性经产妇的后代，而胎盘疟疾阳性初产妇的后代几率最低（AOR=0.21，95%CI 0.09-0.47）。相比之下，胎盘疟疾阳性经产妇的后代出现寄生虫血症的几率显著更高（AOR=1.59，95%CI 1.16-2.17）。
虽然初产妇比经产妇更容易出现寄生虫血症，但在她们的后代中情况相反，尤其是胎盘疟疾阳性女性的后代。虽然已知胎盘疟疾会增加头胎婴儿的死亡风险，但在本研究中，它出人意料地降低了他们出现寄生虫血症的风险。另一方面，经产妇的胎盘疟疾是婴儿期寄生虫血症的一个强烈风险因素，因此在接近足月时对经产妇进行预防性抗疟化疗可能会降低其后代出现寄生虫血症的频率。
Zotero 插件
