Oberlin Austin, Kim Tesia G, Erlinger Adrienne Pettiette, Joshi Avina, Diawara Halimatou, Healy Sara A, Dicko Alassane, Duffy Patrick E, Hacker Michele, Wylie Blair J
Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.
Department of Obstetrics and Gynecology, Mass General Brigham Medical Center, Boston, Massachusetts.
Am J Trop Med Hyg. 2024 Oct 29;112(2):253-265. doi: 10.4269/ajtmh.24-0435. Print 2025 Feb 5.
Malaria in pregnancy increases maternal and perinatal morbidity and mortality. Indoor residual spraying (IRS) is a core vector control strategy used to reduce transmission in endemic areas; however, its efficacy in reducing the sequelae of malaria in pregnancy is not well described. PubMed, Embase, Cochrane, and Web of Science were searched for all studies assessing IRS exposure during pregnancy. Abstracts and full texts were reviewed independently by two researchers, with discrepancies adjudicated by a third. Of 3,319 studies that met the search criteria, 17 met the inclusion criteria. Thirteen studies reported on the effect of IRS on malaria endpoints during pregnancy, five on birth outcomes, and one on a fetal anomaly. Twelve of the 13 studies exploring maternal malaria and 3 of 3 studies reporting on placental malaria demonstrated a reduction among those exposed to IRS during pregnancy. Results were more mixed for obstetric outcomes. Two of the best-quality studies showed reductions in preterm birth, low birthweight, and fetal/neonatal mortality; a third high-quality study did not demonstrate a reduction in perinatal mortality but did not evaluate preterm birth. One study found a significantly increased risk of preterm birth in those exposed to IRS, although the study was of lower quality. A final study demonstrated a small, although statistically significant, association between IRS and male urogenital birth defects. In malaria-endemic areas, the published literature suggests that IRS during pregnancy reduces the incidence of malaria parasitemia. However, without high-quality prospective studies directly examining IRS in pregnancy, the impact on birth outcomes is less clear.
妊娠疟疾会增加孕产妇和围产期发病率及死亡率。室内滞留喷洒（IRS）是用于减少流行地区疟疾传播的一项核心病媒控制策略；然而，其在降低妊娠疟疾后遗症方面的效果尚无充分描述。我们检索了PubMed、Embase、Cochrane和Web of Science数据库，查找所有评估孕期暴露于室内滞留喷洒情况的研究。两名研究人员独立审阅摘要和全文，如有分歧则由第三名研究人员裁决。在符合检索标准的3319项研究中，有17项符合纳入标准。13项研究报告了室内滞留喷洒对孕期疟疾相关终点的影响，5项报告了对出生结局的影响，1项报告了对胎儿异常的影响。在探索孕产妇疟疾的13项研究中，有12项以及在报告胎盘疟疾的3项研究中有3项表明，孕期暴露于室内滞留喷洒的人群中疟疾发病率有所降低。产科结局的结果则更为复杂。两项质量最高的研究显示早产、低出生体重和胎儿/新生儿死亡率有所降低；第三项高质量研究未显示围产期死亡率降低，但未评估早产情况。一项研究发现，暴露于室内滞留喷洒的人群早产风险显著增加，不过该研究质量较低。最后一项研究表明，室内滞留喷洒与男性泌尿生殖系统出生缺陷之间存在虽小但具有统计学意义的关联。在疟疾流行地区，已发表的文献表明孕期进行室内滞留喷洒可降低疟原虫血症的发病率。然而，由于缺乏直接研究孕期室内滞留喷洒情况的高质量前瞻性研究，其对出生结局的影响尚不清楚。
