间歇性治疗以预防妊娠疟疾在耐药广泛的地区没有益处。
Intermittent treatment to prevent pregnancy malaria does not confer benefit in an area of widespread drug resistance.
机构信息
Malaria Program, Seattle Biomedical Research Institute, Seattle, Washington, USA.
出版信息
Clin Infect Dis. 2011 Aug 1;53(3):224-30. doi: 10.1093/cid/cir376.
Abstract
BACKGROUND
Millions of African women receive sulfadoxine-pyrimethamine (SP) as intermittent preventive treatment during pregnancy (IPTp) to avoid poor outcomes that result from malaria. However, parasites resistant to SP are widespread in parts of Africa, and IPTp may perversely exacerbate placental infections that contain SP-resistant parasites.
METHODS
The study used a cross-sectional design. We determined IPTp use in a delivery cohort of 880 pregnant women in Muheza, Tanzania, by report and by plasma sulfa measurements, and we examined its effects on maternal and fetal delivery outcomes.
RESULTS
In the overall cohort, IPTp was not associated with decreased odds of placental malaria or with increased mean maternal hemoglobin or mean birth weight. Unexpectedly, IPTp was associated with decreased cord hemoglobin level and increased risk of fetal anemia, which may be related to in utero SP exposure.
CONCLUSIONS
IPTp does not improve overall pregnancy outcomes in Muheza, Tanzania, where SP-resistant parasites predominate and may increase the odds of fetal anemia. As parasite resistance increases in a community, the overall effect of IPTp may transition from net benefit to neutral or net harm.
摘要
背景
数百万非洲妇女在怀孕期间接受磺胺多辛-乙胺嘧啶（SP）作为间歇性预防治疗（IPTp），以避免疟疾导致的不良后果。然而，在非洲部分地区，寄生虫对 SP 的耐药性广泛存在，而 IPTp 可能会恶化含有 SP 耐药寄生虫的胎盘感染。
方法
该研究采用了横断面设计。我们通过报告和血浆磺胺测量来确定坦桑尼亚穆希扎 880 名孕妇分娩队列中的 IPTp 使用情况，并研究了它对母婴分娩结局的影响。
结果
在整个队列中，IPTp 与降低胎盘疟疾的几率、增加平均产妇血红蛋白或平均出生体重无关。出乎意料的是，IPTp 与脐血血红蛋白水平降低和胎儿贫血风险增加有关，这可能与宫内 SP 暴露有关。
结论
在 SP 耐药寄生虫占主导地位的坦桑尼亚穆希扎，IPTp 并没有改善整体妊娠结局，反而可能增加胎儿贫血的几率。随着社区中寄生虫耐药性的增加，IPTp 的总体效果可能从净收益转变为中性或净危害。
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