Department of Infectious Diseases, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne.
Department of Medicine (RMH), The University of Melbourne, 4 Floor, Clinical Sciences Building, Royal Melbourne Hospital, Royal Parade, Parkville.
Curr Opin Infect Dis. 2024 Oct 1;37(5):320-326. doi: 10.1097/QCO.0000000000001037. Epub 2024 Jul 10.
Malaria threatens pregnant women and their babies, particularly in Africa.
This century, the number of women at risk of malaria in pregnancy has decreased globally, apart from in Africa, where it has increased. Low and sub microscopic infections are increasingly documented but remain hard to diagnose with current point-of-care tests, and their contribution to morbidity and transmission are unclear. Artemether-lumefantrine has been endorsed for treatment in first trimester, but many women attend antenatal clinics later in pregnancy, and reaching high-risk young, first-time mothers is particularly difficult. Small-for-gestational-age babies frequently result from malaria, which affects the placenta's development and its functions such as nutrient transport. Resistance to continues to increase to sulphadoxine-pyrimethamine, the mainstay of intermittent preventive treatment in pregnancy. The alternative, dihydroartemisinin-piperaquine controls malaria better, but does not improve pregnancy outcomes, suggesting that sulphadoxine-pyrimethamine may have nonmalarial effects including improving gut function or reducing dangerous inflammation. Understanding of how the malaria parasite uses the VAR2CSA protein to bind to its placental receptor is increasing, informing the search for a vaccine to prevent pregnancy malaria.
Progress in several areas increases optimism that improved prevention and control of malaria in pregnancy is possible, but obstacles remain.
疟疾威胁着孕妇及其婴儿的健康，在非洲尤其如此。
本世纪，除非洲外，全球孕妇疟疾风险人数有所减少，而在非洲这一数字却有所增加。越来越多的低和亚微观感染被记录下来，但目前的即时检测仍难以诊断，其对发病率和传播的影响尚不清楚。青蒿琥酯-甲氟喹已被推荐用于妊娠早期治疗，但许多孕妇在妊娠晚期才去产前诊所就诊，而且很难接触到高危的年轻初产妇。胎儿生长受限常由疟疾引起，这会影响胎盘的发育及其营养运输等功能。对磺胺多辛-乙胺嘧啶的耐药性继续增加，磺胺多辛-乙胺嘧啶是妊娠期间间歇性预防治疗的主要药物。替代药物二氢青蒿素-哌喹能更好地控制疟疾，但不能改善妊娠结局，这表明磺胺多辛-乙胺嘧啶可能具有非疟疾作用，包括改善肠道功能或减少危险的炎症。人们对疟原虫如何利用 VAR2CSA 蛋白与胎盘受体结合的理解正在加深，这为寻找预防妊娠疟疾的疫苗提供了信息。
在几个领域取得的进展增加了人们对改善妊娠期间疟疾预防和控制的乐观情绪，但仍存在障碍。
