Garner P, Brabin B
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, England.
Bull World Health Organ. 1994;72(1):89-99.
Current global recommendations for routine malaria chemoprophylaxis in pregnant women living in endemic malarious areas are not clear. To assist in policy formulation, the evidence from randomized controlled trials was reviewed. The literature was extensively searched, and studies identified were systematically analysed in relation to outcomes in the mother and the baby. Routine chemoprophylaxis appears to have an effect on antenatal morbid episodes and packed cell volume. There is a trend towards higher birth-weight values in chemoprophylaxis groups, which reached statistical significance in some studies. Evidence of an effect on gestation was only examined in one study. The effects on perinatal and neonatal mortality have only been examined in a few studies, with small sample sizes. The analysis questions whether routine malaria chemoprophylaxis is the best use of scarce resources in developing countries, and suggests that chemoprophylaxis might be targeted at anaemic women and primigravidae. Large controlled trials, with treatment available to placebo groups, are required to test whether routine chemoprophylaxis has advantages over early, effective treatment of clinical malaria.
目前，对于生活在疟疾流行地区的孕妇进行常规疟疾化学预防的全球建议并不明确。为协助制定政策，对随机对照试验的证据进行了审查。广泛检索了文献，并对所确定的研究进行了系统分析，涉及母亲和婴儿的结局。常规化学预防似乎对产前发病情况和红细胞压积有影响。化学预防组的出生体重有升高趋势，在一些研究中达到了统计学意义。仅在一项研究中检验了对妊娠影响的证据。对围产期和新生儿死亡率的影响仅在少数样本量较小的研究中进行了检验。分析质疑常规疟疾化学预防是否是发展中国家稀缺资源的最佳利用方式，并建议化学预防可能应以贫血妇女和初产妇为目标人群。需要进行大型对照试验，为安慰剂组提供治疗，以检验常规化学预防是否比早期有效治疗临床疟疾具有优势。
