Albadrani Muayad, Eltahir Heba M, Mahmoud Ahmad Bakur, Abouzied Mekky M
Department of Family and Community Medicine and Medical Education, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia.
Health and Life Research Center, Taibah University, Madinah 42353, Saudi Arabia.
J Clin Med. 2025 May 13;14(10):3396. doi: 10.3390/jcm14103396.
Malaria poses significant threats to pregnant women, particularly in endemic regions. Preventive measures against it include insecticide-treated bed nets, intermittent preventive treatment, and various supplements. We aimed to assess and compare the safety and effectiveness of malaria preventive measures in pregnant women, considering their HIV status. We conducted a systematic search of PubMed, the Cochrane Library, Scopus, Embase, and Web of Science through January 2024. A network meta-analysis was performed using R 4.3.3 software on 35 studies (50,103 participants). In HIV-positive pregnant women, Co-trimoxazole with dihydroartemisinin significantly reduced malaria incidence compared to Co-trimoxazole alone (RR = 0.45, 95% CI [0.30; 0.68]) and sulfadoxine-pyrimethamine (SP) (RR = 0.14, 95% CI [0.04; 0.48]). Mefloquine was also effective compared to controls and SP. In HIV-negative women, azithromycin-piperaquine significantly reduced infections compared to SP, bed nets, and controls (RR = 0.03, 95% CI [0.00; 0.83]; RR = 0.03, 95% CI [0.00; 0.86]; and RR = 0.03, 95% CI [0.00; 0.77], respectively). Different combinations of preventive measures show varying effectiveness based on HIV status. Co-trimoxazole with dihydroartemisinin and mefloquine are effective for HIV-infected pregnant women, while azithromycin-piperaquine and mefloquine work well for those without HIV. Customized prevention strategies considering HIV status are crucial for optimal protection.
疟疾对孕妇构成重大威胁，尤其是在流行地区。针对疟疾的预防措施包括使用杀虫剂处理过的蚊帐、间歇性预防治疗以及各种补充剂。我们旨在评估和比较考虑到孕妇艾滋病毒感染状况的疟疾预防措施的安全性和有效性。我们对截至2024年1月的PubMed、考克兰图书馆、Scopus、Embase和科学网进行了系统检索。使用R 4.3.3软件对35项研究（50103名参与者）进行了网络荟萃分析。在艾滋病毒呈阳性的孕妇中，与单独使用复方新诺明相比，复方新诺明联合双氢青蒿素显著降低了疟疾发病率（风险比=0.45，95%置信区间[0.30；0.68]），与磺胺多辛-乙胺嘧啶（SP）相比也是如此（风险比=0.14，95%置信区间[0.04；0.48]）。与对照组和SP相比，甲氟喹也有效。在艾滋病毒呈阴性的女性中，与SP、蚊帐和对照组相比，阿奇霉素-哌喹显著降低了感染率（风险比分别为0.03，95%置信区间[0.00；0.83]；0.03，95%置信区间[0.00；0.86]；以及0.03，95%置信区间[0.00；0.77]）。基于艾滋病毒感染状况，不同的预防措施组合显示出不同的有效性。复方新诺明联合双氢青蒿素和甲氟喹对感染艾滋病毒的孕妇有效，而阿奇霉素-哌喹和甲氟喹对未感染艾滋病毒的孕妇效果良好。考虑到艾滋病毒感染状况制定定制化的预防策略对于实现最佳保护至关重要。
