Bouvier P, Doumbo O, Breslow N, Robert C F, Mauris A, Picquet M, Kouriba B, Dembele H K, Delley V, Rougemont A
Institute of Social and Preventive Medicine, University of Geneva, Switzerland.
Am J Trop Med Hyg. 1997 Apr;56(4):378-83. doi: 10.4269/ajtmh.1997.56.378.
The importance of malaria as a cause of anemia in pregnancy in endemic areas remains controversial. The prevalence of anemia in pregnant women following the dry (May) and the rainy (November) seasons was compared in two successive years in Bougoula village (region of Sikasso, Mali). Phase I (1992) was observational and included 172 pregnant women and 208 controls. In Phase II (1993, 174 pregnant women and 206 controls), malaria prophylaxis with proguanil (200 mg/day) and chloroquine (300 mg/week) was offered to pregnant women. A strong seasonal variation in the prevalence of moderate to severe anemia in pregnant women (hematocrit < 30%) occurred in Phase I (dry season = 8.7%, rainy season = 41.2%). This variation was present only in women of parity lower than five, and paralleled variation in parasitemia. In Phase II, the seasonal variation of anemia was suppressed in women under malaria prophylaxis (presence of antimalarial metabolites in urine), and the overall prevalence of moderate to severe anemia in pregnancy decreased by 55.5% (22.8-74.3%). We conclude that malaria is the major cause of anemia in pregnancy in this region. A high priority should be given to prevention of malaria in pregnancy.
在疟疾流行地区，疟疾作为孕期贫血病因的重要性仍存在争议。在布古拉村（马里锡卡索地区）连续两年比较了旱季（5月）和雨季（11月）后孕妇贫血的患病率。第一阶段（1992年）为观察性研究，包括172名孕妇和208名对照。在第二阶段（1993年，174名孕妇和206名对照），为孕妇提供了用氯胍（200毫克/天）和氯喹（300毫克/周）进行疟疾预防。在第一阶段，孕妇中重度贫血（血细胞比容<30%）的患病率出现强烈的季节性变化（旱季=8.7%，雨季=41.2%）。这种变化仅存在于胎次低于5次的妇女中，且与疟原虫血症的变化平行。在第二阶段，接受疟疾预防的妇女（尿中有抗疟代谢产物）中贫血的季节性变化得到抑制，孕期中重度贫血的总体患病率下降了55.5%（22.8 - 74.3%）。我们得出结论，疟疾是该地区孕期贫血的主要原因。孕期疟疾预防应被高度重视。
