Nyirjesy P, Kavasya T, Axelrod P, Fischer P R
Centre Médical Evangélique, Nyankunde, Zaire.
Clin Infect Dis. 1993 Jan;16(1):127-32. doi: 10.1093/clinids/16.1.127.
In malaria-endemic regions, the impact of malaria upon pregnancy and the value of chemoprophylaxis for malaria for pregnant women remain controversial. We prospectively studied 302 pregnant women who presented in labor to Centre Médical Evangélique, Nyankunde, Zaire. We evaluated the incidence of malarial infection in mothers, placentas, and neonates and examined the effect of infection on birth weight and perinatal mortality. We analyzed the outcome of pregnancy in relation to prophylaxis with chloroquine, controlling for parity and prenatal clinic attendance. Peripartum smears of maternal blood (21%), placentas (33%), cord blood (9%), and neonatal blood (7%) were positive for Plasmodium falciparum. Maternal malaria increased the risk of perinatal death (relative risk [RR] = 12.4) and low birth weight (RR = 3.7). Neonatal malaria increased the risk of perinatal death (RR = 7.2). Chloroquine prophylaxis protected against maternal (RR = 0.4) and fetal malaria (RR = 0.2), low birth weight (RR = 0.39), and perinatal death (RR = 0.38). Peripartum malaria increases the risk of perinatal death and low birth weight. Chemoprophylaxis with chloroquine during pregnancy may have a protective effect, even in certain areas where chloroquine-resistant P. falciparum is endemic.
在疟疾流行地区，疟疾对妊娠的影响以及孕妇疟疾化学预防的价值仍存在争议。我们对302名在扎伊尔尼亚昆德福音医疗中心分娩的孕妇进行了前瞻性研究。我们评估了母亲、胎盘和新生儿中疟疾感染的发生率，并研究了感染对出生体重和围产期死亡率的影响。我们分析了与氯喹预防相关的妊娠结局，并对产次和产前门诊就诊情况进行了控制。产妇血液（21%）、胎盘（33%）、脐带血（9%）和新生儿血液（7%）的围产期涂片检测到恶性疟原虫呈阳性。产妇疟疾增加了围产期死亡风险（相对风险[RR]=12.4）和低出生体重风险（RR=3.7）。新生儿疟疾增加了围产期死亡风险（RR=7.2）。氯喹预防可预防产妇（RR=0.4）和胎儿疟疾（RR=0.2）、低出生体重（RR=0.39）和围产期死亡（RR=0.38）。围产期疟疾会增加围产期死亡和低出生体重的风险。孕期使用氯喹进行化学预防可能具有保护作用，即使在某些恶性疟原虫对氯喹耐药的流行地区也是如此。
