Ades Veronica
University of California, San Francisco, CA, USA.
Infect Dis Rep. 2011 May 27;3(1):e8. doi: 10.4081/idr.2011.e8. eCollection 2011 Mar 8.
Malaria in pregnancy can lead to serious maternal and fetal morbidity and mortality. Access to the most effective antimalarials in pregnancy is essential. Resistance to current therapies is high for all antimalarial therapies except artemisinins. Artemisinin-based combination therapy is current the first line of malaria treatment recommended by the WHO for children, adults and pregnant women in second or third trimester. Due to potential embryotoxicity of artemisinins identified in animal studies, artemisinins are not considered safe for use in first trimester of pregnancy. Artemisinins are more rapidly metabolized in pregnant women, but it is not clear whether this reduces efficacy. Most studies show very high cure rates for pregnant women. Areas for further research include the safety profile in first trimester of pregnancy, the effect of HIV infection on artemisinin use in pregnancy, the relationship between the pharmacokinetic profile and efficacy, the effect of newly emerging artemisinin resistance on treatment in pregnancy and the use of artemisinin-based combination therapy for intermittent preventive treatment in pregnancy.
妊娠疟疾可导致严重的母婴发病和死亡。孕期能够使用最有效的抗疟药物至关重要。除青蒿素外，目前所有抗疟疗法的耐药性都很高。以青蒿素为基础的联合疗法是世界卫生组织目前推荐用于儿童、成人以及孕中期或孕晚期孕妇疟疾治疗的一线疗法。由于在动物研究中发现青蒿素有潜在胚胎毒性，青蒿素被认为在妊娠早期使用不安全。青蒿素在孕妇体内代谢更快，但尚不清楚这是否会降低疗效。大多数研究表明孕妇的治愈率非常高。进一步研究的领域包括妊娠早期的安全性、艾滋病毒感染对孕期使用青蒿素的影响、药代动力学特征与疗效之间的关系、新出现的青蒿素耐药性对孕期治疗的影响以及以青蒿素为基础的联合疗法用于孕期间歇性预防治疗。
