Department of Infectious Diseases.
Department of Medicine (RMH), The University of Melbourne, The Doherty Institute, Melbourne, Australia.
Curr Opin Infect Dis. 2022 Oct 1;35(5):410-416. doi: 10.1097/QCO.0000000000000859. Epub 2022 Jul 22.
Malaria in pregnancy continues to exert a toll on pregnant women and their offspring.
The burden of Plasmodium falciparum infection is especially large in Africa, and new data show lasting effects of maternal infection on the infant's neurocognitive development. Elsewhere, P. vivax infection causes relapsing infections that are challenging to prevent. Infection in first trimester of pregnancy is an area of increasing focus, and its adverse effects on pregnancy outcome are increasingly recognised. First-trimester infection is common and frequently acquired prior to conception. Although newer rapid diagnostic tests still have limited sensitivity, they may be useful in detection of early pregnancy malaria for treatment. Artemisinin-based combination therapies are efficacious in later pregnancy but have yet to be recommended in first trimester because of limited safety data. In Africa, intermittent preventive treatment in pregnancy (IPTp) with monthly sulfadoxine-pyrimethamine improves pregnancy outcomes, but sulfadoxine-pyrimethamine resistance is worsening. The alternative, IPTp with dihydroartemisinin-piperaquine, has greater antimalarial efficacy, but does not appear to improve pregnancy outcomes, because sulfadoxine-pyrimethamine has poorly understood nonmalarial benefits on birthweight.
Novel IPTp regimens must be combined with interventions to strengthen protection from malaria infection acquired before and in early pregnancy.
妊娠疟疾仍然对孕妇及其后代造成严重影响。
在非洲，恶性疟原虫感染的负担尤其沉重，新数据显示母体感染对婴儿神经认知发育的持久影响。在其他地方，间日疟原虫感染会导致复发性感染，难以预防。妊娠早期感染是一个日益受到关注的领域，其对妊娠结局的不良影响也越来越受到认识。妊娠早期感染很常见，并且常常在受孕前发生。虽然较新的快速诊断测试仍然灵敏度有限，但它们可能有助于检测早期妊娠疟疾进行治疗。青蒿素为基础的联合疗法在妊娠后期有效，但由于安全性数据有限，尚未推荐在妊娠早期使用。在非洲，每月用磺胺多辛-乙胺嘧啶进行间歇性预防治疗（IPTp）可改善妊娠结局，但磺胺多辛-乙胺嘧啶耐药性正在恶化。另一种选择是用青蒿琥酯-哌喹进行 IPTp，其抗疟效果更好，但似乎并没有改善妊娠结局，因为磺胺多辛-乙胺嘧啶对出生体重有尚未明确的非疟疾益处。
新型 IPTp 方案必须与干预措施相结合，以加强对妊娠前和妊娠早期获得的疟疾感染的保护。
