Jafari-Guemouri Sayeh, Dégbègni Robinson, Courtois Laura, Accrombessi Manfred, Massougbodji Achille, Ding Xavier C, Ndam Nicaise Tuikue, Mama Atika, Fievet Nadine, Sarrasin-Hubert Véronique, Cotrell Gilles, Briand Valérie
UMR261 MERIT, Université Paris Cité, IRD, Paris, France.
Clinical Research Institute of Benin (IRCB), Abomey-Calavi, Benin.
Open Forum Infect Dis. 2025 Jan 6;12(1):ofae762. doi: 10.1093/ofid/ofae762. eCollection 2025 Jan.
Malaria infections in pregnancy are a major cause of maternal morbidity and neonatal mortality in sub-Saharan Africa. A high proportion of these infections are submicroscopic, which are usually asymptomatic and therefore untreated during pregnancy. Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) aims to prevent and treat all potential infections whether submicroscopic or not. However, the resistance of parasites to SP is steadily increasing. The dynamic of microscopic and submicroscopic infections in a cohort of Beninese women throughout their pregnancy and its relation to IPTp-SP has been assessed.
As a subsample of the RECIPAL project, 130 women with at least 2 infections detected by polymerase chain reaction during their pregnancy were included. Infections were categorized as new (isolated) or persistent based on genotyping, where persistent infections had identical genotypes in all studied time points. Submicroscopic infections were defined as polymerase chain reaction-positive and thick blood smear-negative. The persistence of infections according to IPTp-SP uptake was assessed.
A total of 73.1% of women (95 women of 130) had exclusively persistent infections throughout their pregnancy, whereas only 7.7% (10 of 130) had exclusively new infections. During pregnancy, the median time spent with 1 persistent infection was 7.2 weeks. A considerable proportion of these persistent infections 64.3% (72 of 113) was only submicroscopic. Approximately 20% of these persistent infections occurred despite the use of IPTp-SP.
Using new antimalarial combinations could contribute to limit the persistence of submicroscopic infections and their probable negative effects on the mother and the fetus.
妊娠疟疾感染是撒哈拉以南非洲地区孕产妇发病和新生儿死亡的主要原因。这些感染中有很大一部分是亚显微镜下的，通常没有症状，因此在孕期未得到治疗。磺胺多辛-乙胺嘧啶间歇性预防治疗（IPTp-SP）旨在预防和治疗所有潜在感染，无论是否为亚显微镜下感染。然而，寄生虫对乙胺嘧啶的耐药性正在稳步增加。本研究评估了一群贝宁妇女在整个孕期显微镜下和亚显微镜下感染的动态变化及其与IPTp-SP的关系。
作为RECIPAL项目的一个子样本，纳入了130名在孕期通过聚合酶链反应检测到至少2次感染的妇女。根据基因分型将感染分为新感染（孤立感染）或持续感染，持续感染在所有研究时间点具有相同的基因型。亚显微镜下感染定义为聚合酶链反应阳性且厚血涂片阴性。评估了根据IPTp-SP使用情况的感染持续性。
共有73.1%的妇女（130名中的95名）在整个孕期仅有持续感染, 而仅有7.7%（130名中的10名）仅有新感染。孕期，1次持续感染的中位持续时间为7.2周。这些持续感染中有相当一部分64.3%（113名中的72名）仅是亚显微镜下的。尽管使用了IPTp-SP，仍有大约20%的这些持续感染发生。
使用新的抗疟联合用药可能有助于限制亚显微镜下感染的持续存在及其对母亲和胎儿可能产生的负面影响。
