Barcelona Centre for International Health Research (CRESIB), Hospital Clinic, Institut d'Investigacions Biomedicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
PLoS One. 2010 Feb 26;5(2):e9438. doi: 10.1371/journal.pone.0009438.
In the global context of a reduction of under-five mortality, neonatal mortality is an increasingly relevant component of this mortality. Malaria in pregnancy may affect neonatal survival, though no strong evidence exists to support this association.
In the context of a randomised, placebo-controlled trial of intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine (SP) in 1030 Mozambican pregnant women, 997 newborns were followed up until 12 months of age. There were 500 live borns to women who received placebo and 497 to those who received SP.
There were 58 infant deaths; 60.4% occurred in children born to women who received placebo and 39.6% to women who received IPTp (p = 0.136). There were 25 neonatal deaths; 72% occurred in the placebo group and 28% in the IPTp group (p = 0.041). Of the 20 deaths that occurred in the first week of life, 75% were babies born to women in the placebo group and 25% to those in the IPTp group (p = 0.039). IPTp reduced neonatal mortality by 61.3% (95% CI 7.4%, 83.8%); p = 0.024].
Malaria prevention with SP in pregnancy can reduce neonatal mortality. Mechanisms associated with increased malaria infection at the end of pregnancy may explain the excess mortality in the malaria less protected group. Alternatively, SP may have reduced the risk of neonatal infections. These findings are of relevance to promote the implementation of IPTp with SP, and provide insights into the understanding of the pathophysiological mechanisms through which maternal malaria affects fetal and neonatal health.
ClinicalTrials.gov NCT00209781.
在全球降低五岁以下儿童死亡率的背景下，新生儿死亡率是该死亡率的一个日益重要的组成部分。妊娠疟疾可能会影响新生儿的生存，但没有强有力的证据支持这种关联。
在一项针对 1030 名莫桑比克孕妇的随机、安慰剂对照的磺胺多辛-乙胺嘧啶（SP）间歇性预防治疗（IPTp）试验中，对 997 名新生儿进行了随访，直到 12 个月大。在接受安慰剂的妇女中有 500 名活产儿，在接受 SP 的妇女中有 497 名活产儿。
有 58 例婴儿死亡；接受安慰剂的妇女所生婴儿中有 60.4%死亡，接受 IPTp 的妇女中有 39.6%死亡（p = 0.136）。有 25 例新生儿死亡；安慰剂组有 72%，IPTp 组有 28%（p = 0.041）。在生命的第一周发生的 20 例死亡中，75%是安慰剂组妇女所生婴儿，25%是 IPTp 组妇女所生婴儿（p = 0.039）。
妊娠期间用 SP 预防疟疾可降低新生儿死亡率。与妊娠晚期疟疾感染增加相关的机制可能解释了疟疾保护较少的组死亡率过高的原因。或者，SP 可能降低了新生儿感染的风险。这些发现对于促进 SP 间歇性预防治疗的实施具有重要意义，并为理解母体疟疾如何影响胎儿和新生儿健康的病理生理机制提供了新的认识。
ClinicalTrials.gov NCT00209781。
