【Cochrane简语概要】甲氟喹预防孕妇疟疾

本综述的目的是什么?

这篇Cochrane综述的目的是发现抗疟药甲氟喹对生活在疟疾流行地区的孕妇是否有效和安全。为回答这个问题，我们找到了六项相关研究。

关键信息

抗疟药甲氟喹对预防孕妇疟疾有效。已发现该药物在不良的妊娠结局方面（例如低体重、早产、死产和流产以及先天性畸形）是安全的。但是，它的耐受性比其他抗疟药差。

本综述的研究内容是什么?

孕妇易感染疟疾，特别是感染了艾滋病毒后。妊娠期间的疟疾可能会有严重的后果，包括对女性及其子女的不良健康影响。孕妇易感染疟疾，特别是感染了艾滋病毒后。妊娠期间的疟疾可能会有严重的后果，包括对女性及其子女的不良健康影响。因此，在稳定传播的疟疾流行地区，建议妇女在怀孕期间睡在蚊帐下，并服用有效的药物（如磺胺嘧啶-乙胺嘧啶或复方磺胺甲恶唑）来预防整个孕期的疟疾感染。

这篇Cochrane综述研究了甲氟喹在未感染艾滋病毒和感染艾滋病毒的孕妇中预防疟疾的作用。

本综述的主要结果是什么?

我们发现1987年至2013年之间，在撒哈拉以南非洲地区进行了五项相关研究，在泰国进行了一项相关研究。这些研究将甲氟喹与安慰剂或目前推荐用于预防孕妇疟疾的其他抗疟药物进行了比较。本综述结果显示:

与磺胺多辛-乙胺嘧啶相比，甲氟喹在未感染艾滋病毒的女性中有化学预防的作用:

降低分娩时孕妇外周寄生虫血症（妇女血液中存在疟疾虫）和贫血的风险；
不良妊娠结局的发生率（如低出生体重、早产、死产和流产、先天性畸形）和妊娠期间临床疟疾发作的发病率没有差异；
增加与药物相关的不良事件（包括呕吐、疲劳或无力和头晕）的风险；

与单独使用复方磺胺甲恶唑预防相比，甲氟喹化学预防加复方磺胺甲恶唑在艾滋病毒感染的女性中能够：

降低分娩时产妇周围寄生虫血症和胎盘疟疾的风险；
不良妊娠结局的发生率（如低出生体重、早产、死产和流产以及先天性畸形）和妊娠期间临床疟疾发作的发病率没有差异；
增加与药物相关的不良事件（如呕吐和头晕）的风险。

总的来说，甲氟喹高比例的相关不良事件成为其预防治疗孕妇疟疾有效性的重要障碍。

本综述的时效性如何？

本综述的作者检索了截止2018年1月31日前的研究。

（图片来源unsplash.com）

结论: 

对于未感染艾滋病病毒的女性，甲氟喹比磺胺多辛-乙胺嘧啶更有效；对于已感染艾滋病病毒的孕妇，甲氟喹比每日用复方磺胺甲恶唑在预防疟疾感染方面更有效，且孕产妇贫血风险较低，对妊娠结局无不良影响（如死胎和流产），对低出生体重和早产也没有影响。但是，甲氟喹高比例的不良事件构成了其有效预防孕妇疟疾的重要障碍。

译者：唐宇；审校：张帆，重庆医科大学公共卫生与管理学院循证医学中心，Cochrane中国协作网重庆医科大学分支机构；编辑排版：郑偌祥、张晓雯，北京中医药大学循证医学中心

相关文章链接

【Cochrane Plain Language Summary】Mefloquine for preventing malaria in pregnant women

What is the aim of this review?

The aim of this Cochrane Review was to find out whether the antimalarial drug mefloquine is efficacious and safe for prevention of malaria in pregnant women living in stable transmission areas. We found six relevant studies to help us answer this question.

Key messages

The antimalarial drug mefloquine is efficacious for malaria prevention in pregnant women. The drug has been found to be safe in terms of adverse pregnancy outcomes, such as low birth weight, prematurity, stillbirths and abortions, and congenital malformations. However, it is worse tolerated than other antimalarial drugs.

What was studied in the review?

Pregnant women are vulnerable to malaria infection, especially if they are living with HIV. The consequences of malaria during pregnancy can be severe and include poor health outcomes for both women and their children. For this reason, in malaria-endemic areas of stable transmission, women are recommended to prevent malaria infection by sleeping under mosquito bed-nets and by taking effective drugs (such as sulphadoxine-pyrimethamine or cotrimoxazole in case of HIV infection) as chemoprevention against malaria throughout pregnancy.

This Cochrane Review looked at the effects of mefloquine for prevention of malaria in both HIV-uninfected and HIV-infected pregnant women.

What are the main results of the review?

We found five relevant studies conducted in sub-Saharan Africa and one in Thailand between 1987 and 2013. These studies compared mefloquine with placebo or other antimalarial drugs currently recommended for prevention of malaria in pregnant women. The review shows the following:

• Compared with sulfadoxine-pyrimethamine, mefloquine chemoprevention in HIV-uninfected women:

◦reduces risks of maternal peripheral parasitaemia (presence of malaria parasites in the blood of women) and anaemia at delivery;
◦ makes no difference in the prevalence of adverse maternal outcomes (such as low birth weight, prematurity, stillbirths and abortions, and congenital malformations) and in the incidence of clinical malaria episodes during pregnancy; and
◦ increases risks of drug-related adverse events including vomiting, fatigue/weakness, and dizziness.

• Compared with cotrimoxale prophylaxis alone, mefloquine chemoprevention plus cotrimoxazole in HIV-infected women:

◦ reduces the risk of maternal peripheral parasitaemia at delivery and the risk of placental malaria;
◦ makes no difference in the prevalence of adverse pregnancy outcomes (such as low birth weight, prematurity, stillbirths and abortions, and congenital malformations) and in the incidence of clinical malaria episodes during pregnancy; and
◦ increases the risk of drug-related adverse events such as vomiting and dizziness.

Overall, the high proportion of mefloquine-related adverse events constitutes an important barrier to its effectiveness for malaria preventive treatment in pregnant women.

How up-to-date is this review?

The review authors searched for studies up to 31 January 2018.

Authors' conclusions: 

Mefloquine was more efficacious than sulfadoxine-pyrimethamine in HIV-uninfected women or daily cotrimoxazole prophylaxis in HIV-infected pregnant women for prevention of malaria infection and was associated with lower risk of maternal anaemia, no adverse effects on pregnancy outcomes (such as stillbirths and abortions), and no effects on low birth weight and prematurity. However, the high proportion of mefloquine-related adverse events constitutes an important barrier to its effectiveness for malaria preventive treatment in pregnant women.

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