Mockenhaupt Frank P, Bedu-Addo George, von Gaertner Christiane, Boyé Renate, Fricke Katrin, Hannibal Iris, Karakaya Filiz, Schaller Marieke, Ulmen Ulrike, Acquah Patrick A, Dietz Ekkehart, Eggelte Teunis A, Bienzle Ulrich
Institute of Tropical Medicine and International Health, Charité--University Medicine, Berlin, Germany.
Malar J. 2006 Dec 13;5:119. doi: 10.1186/1475-2875-5-119.
Plasmodium falciparum can be detected by microscopy, histidine-rich-protein-2 (HRP2) capture test or PCR but the respective clinical relevance of the thereby diagnosed infections in pregnant women is not well established.
In a cross-sectional, year-round study among 839 delivering women in Agogo, Ghana, P. falciparum was screened for in both, peripheral and placental blood samples, and associations with maternal anaemia, low birth weight (LBW) and preterm delivery (PD) were analysed.
In peripheral blood, P. falciparum was observed in 19%, 34%, and 53% by microscopy, HRP2 test, and PCR, respectively. For placental samples, these figures were 35%, 41%, and 59%. Irrespective of diagnostic tool, P. falciparum infection increased the risk of anaemia. Positive peripheral blood results of microscopy and PCR were not associated with LBW or PD. In contrast, the HRP2 test performed well in identifying women at increased risk of poor pregnancy outcome, particularly in case of a negative peripheral blood film. Adjusting for age, parity, and antenatal visits, placental HRP2 was the only marker of infection associated with LBW (adjusted odds ratio (aOR), 1.5 (95%CI, 1.0-2.2)) and, at borderline statistical significance, PD (aOR, 1.4 (1.0-2.1)) in addition to anaemia (aOR, 2.3 (1.7-3.2)). Likewise, HRP2 in peripheral blood of seemingly aparasitaemic women was associated with PD (aOR, 1.7 (1.0-2.7)) and anaemia (aOR, 2.1 (1.4-3.2)).
Peripheral blood film microscopy not only underestimates placental malaria. In this highly endemic setting, it also fails to identify malaria as a cause of foetal impairment. Sub-microscopic infections detected by a HRP2 test in seemingly aparasitaemic women increase the risks of anaemia and PD. These findings indicate that the burden of malaria in pregnancy may be even larger than thought and accentuate the need for effective anti-malarial interventions in pregnancy.
恶性疟原虫可通过显微镜检查、富含组氨酸蛋白-2（HRP2）捕获试验或聚合酶链反应（PCR）检测，但由此诊断出的孕妇感染的临床相关性尚未明确。
在加纳阿戈戈对839名分娩妇女进行的一项全年横断面研究中，对其外周血和胎盘血样本进行恶性疟原虫筛查，并分析其与孕产妇贫血、低出生体重（LBW）和早产（PD）的相关性。
在外周血中，通过显微镜检查、HRP2试验和PCR检测到恶性疟原虫的比例分别为19%、34%和53%。对于胎盘样本，这些数字分别为35%、41%和59%。无论采用何种诊断工具，恶性疟原虫感染都会增加贫血风险。显微镜检查和PCR在外周血中的阳性结果与低出生体重或早产无关。相比之下，HRP2试验在识别妊娠结局不良风险增加的妇女方面表现良好，尤其是在外周血涂片阴性的情况下。在调整年龄、产次和产前检查次数后，胎盘HRP2是除贫血（调整优势比（aOR），2.3（95%置信区间，1.7-3.2））外，与低出生体重（aOR，,1.5（95%置信区间，1.0-2.2））以及在临界统计学意义上与早产（aOR，1.4（1.0-2.1））相关的唯一感染标志物。同样，看似无寄生虫血症妇女外周血中的HRP2与早产（aOR，1.7（1.0-2.7））和贫血（aOR，2.1（1.4-3.2））相关。
外周血涂片显微镜检查不仅低估了胎盘疟疾。在这种高度流行地区，它也无法将疟疾识别为胎儿损害的原因。在看似无寄生虫血症的妇女中，通过HRP2试验检测到的亚显微感染会增加贫血和早产的风险。这些发现表明，妊娠疟疾的负担可能比想象的更大，并突出了在孕期进行有效抗疟干预的必要性。
