Malaria Research & Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali.
Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA.
Clin Infect Dis. 2021 Oct 20;73(8):1355-1361. doi: 10.1093/cid/ciab301.
In malaria-endemic areas, pregnant women and especially first-time mothers are more susceptible to Plasmodium falciparum. Malaria diagnosis is often missed during pregnancy, because many women with placental malaria remain asymptomatic or have submicroscopic parasitemia, masking the association between malaria and pregnancy outcomes. Severe maternal anemia and low birthweight deliveries are well-established sequelae, but few studies have confirmed the relationship between malaria infection and severe outcomes like perinatal mortality in high transmission zones.
Pregnant women of any gestational age enrolled at antenatal clinic into a longitudinal cohort study in Ouelessebougou, Mali, an area of high seasonal malaria transmission. Follow-up visits included scheduled and unscheduled visits throughout pregnancy. Blood smear microscopy and polymerase chain reaction (PCR) analysis were employed to detect both microscopic and submicroscopic infections, respectively. Intermittent preventative treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) was documented and prompt treatment regardless of symptoms given upon malaria diagnosis.
Of the 1850 women followed through delivery, 72.6% of women received 2 or more IPTp-SP doses, 67.2% of women experienced at least 1 infection between enrollment up to and including delivery. Malaria infection increased the risks of stillbirth (adjusted hazard ratio [aHR] 3.87, 95% confidence interval [CI]: 1.18-12.71) and preterm delivery (aHR 2.41, 95% CI: 1.35-4.29) in primigravidae, and early neonatal death (death within 7 days) in secundigravidae and multigravidae (aHR 6.30, 95% CI: 1.41-28.15).
Malaria treatment after diagnosis, alongside IPTp-SP, is insufficient to prevent malaria-related stillbirth, early neonatal death and preterm delivery (PTD). Although IPTp-SP was beneficial in Mali during the study period, new tools are needed to improve pregnancy outcomes.
NCT01168271.
在疟疾流行地区，孕妇，尤其是初产妇更容易感染恶性疟原虫。由于许多患有胎盘疟疾的妇女仍然无症状或出现亚临床寄生虫血症，因此疟疾诊断常常在怀孕期间被漏诊，掩盖了疟疾与妊娠结局之间的关联。严重的母亲贫血和低出生体重分娩是公认的后遗症，但很少有研究证实疟疾感染与高传播地区围产期死亡率等严重后果之间的关系。
在马里 Ouelessebougou 的产前诊所，对任何孕龄的孕妇进行了一项纵向队列研究，该地区季节性疟疾传播率较高。随访包括整个孕期的计划和非计划访问。采用血涂片显微镜检查和聚合酶链反应（PCR）分析分别检测微观和亚临床感染。记录了孕妇的间歇性预防治疗（IPTp-SP），并在疟疾诊断后无论症状如何都给予及时治疗。
在 1850 名分娩的妇女中，72.6%的妇女接受了 2 次或更多次 IPTp-SP 剂量，67.2%的妇女在入组至分娩期间至少经历了 1 次感染。在初产妇中，疟疾感染增加了死产（调整后的危险比[aHR]3.87，95%置信区间[CI]：1.18-12.71）和早产（aHR 2.41，95%CI：1.35-4.29）的风险，而在经产妇和多产妇中则增加了早期新生儿死亡（7 天内死亡）的风险（aHR 6.30，95%CI：1.41-28.15）。
在诊断后进行疟疾治疗，同时使用 IPTp-SP，不足以预防与疟疾相关的死产、早期新生儿死亡和早产（PTD）。尽管在研究期间，IPTp-SP 在马里是有益的，但需要新的工具来改善妊娠结局。
NCT01168271。
