Infectious Diseases Research Collaboration, P.O Box 7475, Kampala, Uganda.
London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Malar J. 2019 Sep 3;18(1):304. doi: 10.1186/s12936-019-2943-3.
Studies of the association between malaria in pregnancy (MiP) and malaria during infancy have provided mixed results. A systematic review was conducted to evaluate available evidence on the impact of Plasmodium falciparum malaria infection during pregnancy, and intermittent preventive treatment of malaria during pregnancy (IPTp), on the risk of clinical malaria or parasitaemia during infancy.
MEDLINE, EMBASE, Global Health, and Malaria in Pregnancy Library databases were searched from inception to 22 May 2018 for articles published in English that reported on associations between MiP and malaria risk in infancy. Search terms included malaria, Plasmodium falciparum, pregnancy, placenta, maternal, prenatal, foetal, newborn, infant, child or offspring or preschool. Randomized controlled trials and prospective cohort studies, which followed infants for at least 6 months, were included if any of the following outcomes were reported: incidence of clinical malaria, prevalence of parasitaemia, and time to first episode of parasitaemia or clinical malaria. Substantial heterogeneity between studies precluded meta-analysis. Thus, a narrative synthesis of included studies was conducted.
The search yielded 14 published studies, 10 prospective cohort studies and four randomized trials; all were conducted in sub-Saharan Africa. Infants born to mothers with parasitaemia during pregnancy were at higher risk of malaria in three of four studies that assessed this association. Placental malaria detected by microscopy or histology was associated with a higher risk of malaria during infancy in nine of 12 studies, but only one study adjusted for malaria transmission intensity. No statistically significant associations between the use of IPTp or different IPTp regimens and the risk of malaria during infancy were identified.
Evidence of an association between MiP and IPTp and risk of malaria in infancy is limited and of variable quality. Most studies did not adequately adjust for malaria transmission intensity shared by mothers and their infants. Further research is needed to confirm or exclude an association between MiP and malaria in infancy. Randomized trials evaluating highly effective interventions aimed at preventing MiP, such as IPTp with dihydroartemisinin-piperaquine, may help to establish a causal association between MiP and malaria in infancy.
关于妊娠疟疾（MiP）与婴儿期疟疾之间关联的研究结果不一。我们进行了一项系统评价，以评估现有的关于妊娠期间感染恶性疟原虫疟疾和妊娠期间间歇性预防治疗疟疾（IPTp）对婴儿期临床疟疾或寄生虫血症风险的影响的证据。
从建库至 2018 年 5 月 22 日，我们检索了 MEDLINE、EMBASE、全球卫生和妊娠疟疾文库数据库，以获取发表在英文期刊上的关于 MiP 与婴儿期疟疾风险之间关联的文章。检索词包括疟疾、恶性疟原虫、妊娠、胎盘、母亲、产前、胎儿、新生儿、婴儿、儿童或后代或学龄前儿童。如果报告了以下任何一种结局，我们纳入了随机对照试验和前瞻性队列研究：临床疟疾发病率、寄生虫血症患病率、首次寄生虫血症或临床疟疾发作时间。由于研究之间存在很大的异质性，因此我们无法进行荟萃分析。因此，我们对纳入的研究进行了叙述性综合分析。
检索结果得到了 14 篇已发表的研究，其中 10 项为前瞻性队列研究，4 项为随机试验；所有研究均在撒哈拉以南非洲进行。在评估这种关联的四项研究中有三项显示，母亲妊娠期存在寄生虫血症的婴儿患疟疾的风险更高。在 12 项研究中有 9 项研究显示，镜检或组织学检测到胎盘疟疾与婴儿期疟疾的风险增加相关，但只有一项研究对疟疾传播强度进行了调整。未发现 IPTp 的使用或不同的 IPTp 方案与婴儿期疟疾风险之间存在统计学显著关联。
MiP 与 IPTp 以及婴儿期疟疾风险之间存在关联的证据有限，且质量参差不齐。大多数研究没有充分调整母亲及其婴儿之间共同存在的疟疾传播强度。需要进一步研究来证实或排除 MiP 与婴儿期疟疾之间的关联。评估旨在预防 MiP 的高效干预措施（如 IPTp 联合双氢青蒿素-哌喹）的随机试验可能有助于确定 MiP 与婴儿期疟疾之间的因果关联。
