Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand.
Lancet Infect Dis. 2012 May;12(5):388-96. doi: 10.1016/S1473-3099(11)70339-5. Epub 2011 Dec 12.
The effects of malaria and its treatment in the first trimester of pregnancy remain an area of concern. We aimed to assess the outcome of malaria-exposed and malaria-unexposed first-trimester pregnancies of women from the Thai-Burmese border and compare outcomes after chloroquine-based, quinine-based, or artemisinin-based treatments.
We analysed all antenatal records of women in the first trimester of pregnancy attending Shoklo Malaria Research Unit antenatal clinics from May 12, 1986, to Oct 31, 2010. Women without malaria in pregnancy were compared with those who had a single episode of malaria in the first trimester. The association between malaria and miscarriage was estimated using multivariable logistic regression.
Of 48,426 pregnant women, 17,613 (36%) met the inclusion criteria: 16,668 (95%) had no malaria during the pregnancy and 945 (5%) had a single episode in the first trimester. The odds of miscarriage increased in women with asymptomatic malaria (adjusted odds ratio 2·70, 95% CI 2·04-3·59) and symptomatic malaria (3·99, 3·10-5·13), and were similar for Plasmodium falciparum and Plasmodium vivax. Other risk factors for miscarriage included smoking, maternal age, previous miscarriage, and non-malaria febrile illness. In women with malaria, additional risk factors for miscarriage included severe or hyperparasitaemic malaria (adjusted odds ratio 3·63, 95% CI 1·15-11·46) and parasitaemia (1·49, 1·25-1·78 for each ten-fold increase in parasitaemia). Higher gestational age at the time of infection was protective (adjusted odds ratio 0·86, 95% CI 0·81-0·91). The risk of miscarriage was similar for women treated with chloroquine (92 [26%] of 354), quinine (95 [27%) of 355), or artesunate (20 [31%] of 64; p=0·71). Adverse effects related to antimalarial treatment were not observed.
A single episode of falciparum or vivax malaria in the first trimester of pregnancy can cause miscarriage. No additional toxic effects associated with artesunate treatment occurred in early pregnancy. Prospective studies should now be done to assess the safety and efficacy of artemisinin combination treatments in early pregnancy.
疟疾及其在妊娠早期的治疗仍存在一些令人担忧的问题。我们旨在评估泰国-缅甸边境地区孕妇在妊娠早期感染疟疾和未感染疟疾的结局，并比较氯喹、奎宁和青蒿素为基础的治疗方案的结局。
我们分析了 1986 年 5 月 12 日至 2010 年 10 月 31 日期间在肖克利疟疾研究单位产前诊所就诊的所有妊娠早期孕妇的产前记录。将无妊娠疟疾的孕妇与妊娠早期有单一疟疾发作的孕妇进行比较。采用多变量逻辑回归估计疟疾与流产之间的关联。
在 48426 名孕妇中，17613 名（36%）符合纳入标准：16668 名（95%）孕妇妊娠期间无疟疾，945 名（5%）孕妇妊娠早期有单一疟疾发作。无症状疟疾（调整后的优势比 2.70，95%CI 2.04-3.59）和有症状疟疾（3.99，3.10-5.13）的孕妇流产风险增加，且间日疟原虫和恶性疟原虫之间的流产风险相似。其他流产的危险因素包括吸烟、母亲年龄、既往流产和非疟疾发热性疾病。在疟疾孕妇中，流产的其他危险因素包括严重疟疾或高寄生虫血症（调整后的优势比 3.63，95%CI 1.15-11.46）和寄生虫血症（寄生虫血症每增加十倍，调整后的优势比为 1.49，95%CI 1.25-1.78）。感染时的妊娠龄较高具有保护作用（调整后的优势比 0.86，95%CI 0.81-0.91）。氯喹（354 例中的 92 例[26%]）、奎宁（355 例中的 95 例[27%]）或青蒿琥酯（64 例中的 20 例[31%]）治疗的孕妇流产风险相似（p=0.71）。未观察到与抗疟治疗相关的不良反应。
妊娠早期的恶性疟原虫或间日疟原虫单一发作可导致流产。青蒿琥酯在妊娠早期治疗未发生与毒性相关的额外不良事件。现在应进行前瞻性研究，以评估青蒿素联合治疗在妊娠早期的安全性和疗效。
