在疟疾低传播地区接受磺胺多辛-乙胺嘧啶间歇性预防治疗的母亲所生婴儿的不良出生结局。
Adverse birth outcomes among mothers who received intermittent preventive treatment with Sulphadoxine-Pyrimethamine in the low malaria transmission region.
机构信息
Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital-Huddinge C1:68, SE-141 86, Stockholm, Sweden.
出版信息
BMC Pregnancy Childbirth. 2019 Jul 8;19(1):236. doi: 10.1186/s12884-019-2397-1.
BACKGROUND
Malaria in pregnancy increases the risk of adverse birth outcomes such as low birth weight (LBW), maternal and foetal anemia. In Tanzania, some areas have attained low malaria transmission. However, data on the burden of preterm delivery, LBW, maternal and foetal anemia following substantial reduction of malaria transmission in recent years is still scarce in these settings.
METHODS
A study involving 631 pregnant women was conducted at Mwananyamala referral hospital in Dar es Salaam from April to August, 2018. Study enrollment was done prior to delivery. Structured interview and antenatal clinic cards were used to obtain data including the use of intermittent preventive therapy in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP). Infants birth weights were recorded, maternal venous and cord blood were taken for testing of malaria and determination of haemoglobin (Hb) levels. Chi-square test and regression analysis were done to identify risk factors for preterm delivery, LBW, maternal and foetal anemia.
RESULTS
The prevalence of malaria among mothers who used at least one dose of IPTp-SP was 0.6% (4/631). Fourteen mothers (2.2%) did not use IPTp-SP and had no malaria infection. The prevalence of maternal anemia, LBW, foetal anemia and preterm delivery was 40.6, 6.5, 5.9 and 9.2% respectively. Participants who were malaria positive had 11 times more risk of LBW compared to those who were negative (AOR, 11; 95%, CI 1.07-132.2; p = 0.04). The risk of delivering babies with LBW was 1.12 times high among mothers who were ≤ 36 weeks of gestation (AOR, 1.12; 95% CI, 0.06-0.25; p = < 0.001). The use of ≥3 doses of IPTp-SP was associated with 83% decrease in risk of LBW compared to those who did not use any dose of IPTp-SP (AOR, 0.17; 95% CI, 0.03-0.88; p = 0.05). Severe anaemia at delivery was associated with seven times increased risk of preterm delivery compared to non-anemic participants (AOR, 6.5; 95% CI, 1.49-28.16; p = 0.013).
CONCLUSION
Despite the reduced malaria transmission and use of IPTp-SP, prevalence of preterm delivery, maternal anemia, LBW and foetal anemia is still high in Tanzania. The recommended ≥3 doses of IPTp-SP should continue be provided even in areas with substantial reduction of malaria.
背景
妊娠疟疾会增加低出生体重（LBW）、母婴贫血等不良分娩结局的风险。在坦桑尼亚，一些地区的疟疾传播已经很低。然而，在疟疾传播近年来大幅减少的情况下，这些地区早产儿、LBW、母婴贫血的数据仍然很缺乏。
方法
2018 年 4 月至 8 月，在达累斯萨拉姆的姆万尼亚马拉转诊医院进行了一项涉及 631 名孕妇的研究。研究在分娩前进行。采用结构式访谈和产前检查卡收集数据，包括使用磺胺多辛-乙胺嘧啶（IPTp-SP）进行妊娠期间歇性预防治疗（IPTp）。记录婴儿的出生体重，采集产妇静脉血和脐血，检测疟疾并测定血红蛋白（Hb）水平。采用卡方检验和回归分析，确定早产、LBW、母婴贫血的危险因素。
结果
至少使用一剂 IPTp-SP 的母亲中，疟疾的患病率为 0.6%（4/631）。14 名母亲（2.2%）未使用 IPTp-SP 且无疟疾感染。母亲贫血、LBW、胎儿贫血和早产的患病率分别为 40.6%、6.5%、5.9%和 9.2%。与疟疾阴性的母亲相比，疟疾阳性的母亲发生 LBW 的风险高 11 倍（优势比，11；95%置信区间，1.07-132.2；p=0.04）。孕 36 周及以下的母亲分娩 LBW 的风险高 1.12 倍（优势比，1.12；95%置信区间，0.06-0.25；p<0.001）。与未使用任何剂量 IPTp-SP 的母亲相比，使用≥3 剂 IPTp-SP 可使 LBW 的风险降低 83%（优势比，0.17；95%置信区间，0.03-0.88；p=0.05）。与非贫血参与者相比，分娩时严重贫血的母亲早产风险增加 7 倍（优势比，6.5；95%置信区间，1.49-28.16；p=0.013）。
结论
尽管疟疾传播减少和使用 IPTp-SP，但坦桑尼亚早产、母婴贫血、LBW 和胎儿贫血的患病率仍然很高。即使在疟疾传播大幅减少的地区，也应继续提供建议的≥3 剂 IPTp-SP。
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