间日疟原虫在孕期的负担及影响：一项多中心前瞻性观察性研究。
Burden and impact of Plasmodium vivax in pregnancy: A multi-centre prospective observational study.
作者信息
Bardají Azucena, Martínez-Espinosa Flor Ernestina, Arévalo-Herrera Myriam, Padilla Norma, Kochar Swati, Ome-Kaius Maria, Bôtto-Menezes Camila, Castellanos María Eugenia, Kochar Dhanpat Kumar, Kochar Sanjay Kumar, Betuela Inoni, Mueller Ivo, Rogerson Stephen, Chitnis Chetan, Hans Dhiraj, Menegon Michela, Severini Carlo, Del Portillo Hernando, Dobaño Carlota, Mayor Alfredo, Ordi Jaume, Piqueras Mireia, Sanz Sergi, Wahlgren Mats, Slutsker Laurence, Desai Meghna, Menéndez Clara
机构信息
Barcelona Center for International Health Research, CRESIB, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
出版信息
PLoS Negl Trop Dis. 2017 Jun 12;11(6):e0005606. doi: 10.1371/journal.pntd.0005606. eCollection 2017 Jun.
BACKGROUND
Despite that over 90 million pregnancies are at risk of Plasmodium vivax infection annually, little is known about the epidemiology and impact of the infection in pregnancy.
METHODOLOGY AND PRINCIPAL FINDINGS
We undertook a health facility-based prospective observational study in pregnant women from Guatemala (GT), Colombia (CO), Brazil (BR), India (IN) and Papua New Guinea PNG). Malaria and anemia were determined during pregnancy and fetal outcomes assessed at delivery. A total of 9388 women were enrolled at antennal care (ANC), of whom 53% (4957) were followed until delivery. Prevalence of P. vivax monoinfection in maternal blood at delivery was 0.4% (20/4461) by microscopy [GT 0.1%, CO 0.5%, BR 0.1%, IN 0.2%, PNG 1.2%] and 7% (104/1488) by PCR. P. falciparum monoinfection was found in 0.5% (22/4463) of women by microscopy [GT 0%, CO 0.5%, BR 0%, IN 0%, PNG 2%]. P. vivax infection was observed in 0.4% (14/3725) of placentas examined by microscopy and in 3.7% (19/508) by PCR. P. vivax in newborn blood was detected in 0.02% (1/4302) of samples examined by microscopy [in cord blood; 0.05% (2/4040) by microscopy, and 2.6% (13/497) by PCR]. Clinical P. vivax infection was associated with increased risk of maternal anemia (Odds Ratio-OR, 5.48, [95% CI 1.83-16.41]; p = 0.009), while submicroscopic vivax infection was not associated with increased risk of moderate-severe anemia (Hb<8g/dL) (OR, 1.16, [95% CI 0.52-2.59]; p = 0.717), or low birth weight (<2500g) (OR, 0.52, [95% CI, 0.23-1.16]; p = 0.110).
CONCLUSIONS
In this multicenter study, the prevalence of P. vivax infection in pregnancy by microscopy was overall low across all endemic study sites; however, molecular methods revealed a significant number of submicroscopic infections. Clinical vivax infection in pregnancy was associated with maternal anemia, which may be deleterious for infant's health. These results may help to guide maternal health programs in settings where vivax malaria is endemic; they also highlight the need of addressing a vulnerable population such as pregnant women while embracing malaria elimination in endemic countries.
背景
尽管每年有超过9000万例妊娠面临间日疟原虫感染风险，但关于该感染在妊娠期间的流行病学及影响却知之甚少。
方法与主要发现
我们在危地马拉（GT）、哥伦比亚（CO）、巴西（BR）、印度（IN）和巴布亚新几内亚（PNG）的孕妇中开展了一项基于医疗机构的前瞻性观察性研究。在孕期确定疟疾和贫血情况，并在分娩时评估胎儿结局。共有9388名妇女在孕期接受了保健（ANC），其中53%（4957名）被随访至分娩。分娩时孕妇血液中间日疟原虫单一感染的显微镜检查患病率为0.4%（20/4461）[危地马拉0.1%，哥伦比亚0.5%，巴西0.1%，印度0.2%，巴布亚新几内亚1.2%]，PCR检测患病率为7%（104/1488）。显微镜检查发现0.5%（22/4463）的妇女感染恶性疟原虫单一感染[危地马拉0%，哥伦比亚0.5%，巴西0%，印度0%，巴布亚新几内亚2%]。显微镜检查发现0.4%（14/3725）的胎盘感染间日疟原虫，PCR检测患病率为3.7%（19/508）。显微镜检查在0.02%（1/4302）的检测样本中检测到新生儿血液中间日疟原虫[脐血中；显微镜检查为0.05%（2/4040），PCR检测为2.6%（13/497）]。临床间日疟原虫感染与孕妇贫血风险增加相关（比值比-OR，5.48，[95%可信区间1.83-16.41]；p = 0.009），而亚显微镜间日疟原虫感染与中度至重度贫血（血红蛋白<8g/dL）风险增加无关（OR，1.16，[95%可信区间0.52-2.59]；p = 0.717），与低出生体重（<2500g）也无关（OR，0.52，[95%可信区间，0.23-1.16]；p = 0.110）。
结论
在这项多中心研究中，通过显微镜检查，所有地方性研究地点妊娠期间间日疟原虫感染的总体患病率较低；然而，分子方法揭示了大量亚显微镜感染。妊娠期间临床间日疟原虫感染与孕妇贫血相关，这可能对婴儿健康有害。这些结果可能有助于指导间日疟流行地区的孕产妇保健项目；它们还强调了在流行国家消除疟疾的同时关注孕妇等弱势群体的必要性。
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