De Beaudrap Pierre, Turyakira Eleanor, Nabasumba Carolyn, Tumwebaze Benon, Piola Patrice, Boum Ii Yap, McGready Rose
Epicentre, Paris, France.
Ceped, Institut de Recherche pour le Développement, Paris, France.
Malar J. 2016 Feb 16;15:92. doi: 10.1186/s12936-016-1135-7.
Malaria in pregnancy (MiP) is a major cause of fetal growth restriction and low birth weight in endemic areas of sub-Saharan Africa. Understanding of the impact of MiP on infant growth and infant risk of malaria or morbidity is poorly characterized. The objective of this study was to describe the impact of MIP on subsequent infant growth, malaria and morbidity.
Between 2006 and 2009, 82 % (832/1018) of pregnant women with live-born singletons and ultrasound determined gestational age were enrolled in a prospective cohort with active weekly screening and treatment for malaria. Infants were followed monthly for growth and morbidity and received active monthly screening and treatment for malaria during their first year of life. Multivariate analyses were performed to analyse the association between malaria exposure during pregnancy and infants' growth, malaria infections, diarrhoea episodes and acute respiratory infections.
Median time of infant follow-up was 12 months and infants born to a mother who had MiP were at increased risk of impaired height and weight gain (-2.71 cm, 95 % CI -4.17 to -1.25 and -0.42 kg, 95 % CI -0.76 to -0.08 at 12 months for >1 MiP compared to no MiP) and of malaria infection (relative risk 10.42, 95 % CI 2.64-41.10 for infants born to mothers with placental malaria). The risks of infant growth restriction and infant malaria infection were maximal when maternal malaria occurred in the 12 weeks prior to delivery. Recurrent MiP was also associated with acute respiratory infection (RR 1.96, 95 % CI 1.25-3.06) and diarrhoea during infancy (RR 1.93, 95 % CI 1.02-3.66).
This study shows that despite frequent active screening and prompt treatment of MiP, impaired growth and an increased risk of malaria and non-malaria infections can be observed in the infants. Effective preventive measures in pregnancy remain a research priority. This study was registered with ClinicalTrials.gov, number NCT00495508.
妊娠疟疾（MiP）是撒哈拉以南非洲流行地区胎儿生长受限和低出生体重的主要原因。关于MiP对婴儿生长以及婴儿患疟疾或发病风险的影响，目前了解甚少。本研究的目的是描述MiP对后续婴儿生长、疟疾和发病情况的影响。
2006年至2009年期间，82%（832/1018）有活产单胎且经超声确定孕周的孕妇被纳入一个前瞻性队列，该队列对疟疾进行每周一次的主动筛查和治疗。婴儿每月接受生长和发病情况随访，并在其出生后第一年每月接受疟疾的主动筛查和治疗。进行多变量分析以分析孕期疟疾暴露与婴儿生长、疟疾感染、腹泻发作和急性呼吸道感染之间的关联。
婴儿随访的中位时间为12个月，母亲患有MiP的婴儿身高和体重增长受损的风险增加（与无MiP相比，>1次MiP的婴儿在12个月时身高减少-2.71厘米，95%可信区间为-4.17至-1.25；体重减少-0.42千克，95%可信区间为-0.76至-0.08），患疟疾感染的风险也增加（胎盘疟疾母亲所生婴儿的相对风险为10.42，95%可信区间为2.64-41.10）。当母亲在分娩前12周发生疟疾时，婴儿生长受限和婴儿疟疾感染的风险最大。复发性MiP也与婴儿期急性呼吸道感染（相对风险1.96，95%可信区间为1.25-3.06）和腹泻（相对风险1.93，95%可信区间为1.02-3.66）有关。
本研究表明，尽管对MiP进行了频繁的主动筛查和及时治疗，但在婴儿中仍可观察到生长受损以及患疟疾和非疟疾感染的风险增加。孕期有效的预防措施仍然是研究的重点。本研究已在ClinicalTrials.gov注册，注册号为NCT00495508。
