Effectiveness of Intermittent Preventive Treatment With Sulfadoxine-Pyrimethamine During Pregnancy on Maternal and Birth Outcomes in Machinga District, Malawi

Details

• Alternative Title:
  J Infect Dis
• Personal Author:
  Gutman, Julie ; Mwandama, Dyson ; Wiegand, Ryan E. ; Ali, Doreen ; Mathanga, Don P. ; Skarbinski, Jacek
• Description:
  Background
  
  Malaria during pregnancy is associated with low birth weight and increased perinatal mortality, especially among primigravidae. Despite increasing prevalence of malarial parasite resistance to sulfadoxine-pyrimethamine (SP), SP continues to be recommended for intermittent preventive treatment in pregnancy (IPTp).
  
  Methods
  
  Women without human immunodeficiency virus infection were enrolled upon delivery. Data on the number of SP doses received during pregnancy were recorded. The primary outcome was placental infection demonstrated by histologic analysis. Secondary outcomes included malaria parasitemia (in peripheral, placental, cord blood specimens) at delivery and composite birth outcome (small for gestational age, preterm delivery, or low birth weight).
  
  Results
  
  Of 703 women enrolled, 22% received <2 SP doses. Receipt of ≥2 SP doses had no impact on histologically confirmed placental infection. IPTp-SP was associated with a dose-dependent protective effect on composite birth outcome in primigravidae, with an adjusted prevalence ratio of 0.50 (95% confidence interval [CI], .30–.82), 0.30 (95% CI, .19–.48), and 0.18 (95% CI, .05–.61) for 1, 2, and ≥3 doses, respectively, compared with 0 doses.
  
  Conclusions
  
  IPTp-SP did not reduce the frequency of placental infection but was associated with improved birth outcomes. Few women received no SP, so the true effect of IPTp-SP may be underestimated. Malawian pregnant women should continue to receive IPTp-SP, but alternative strategies and antimalarials for preventing malaria during pregnancy should be investigated.
  
  
• Subjects:
  Adult Antimalarials Article Dose-Response Relationship, Drug Drug Combinations Female HIV Infections Humans Infant, Low Birth Weight Infant, Newborn Malaria, Falciparum Placenta Pregnancy Pregnancy Complications, Parasitic Pregnancy Outcome Prevalence Pyrimethamine Sulfadoxine Young Adult

  More +
• Source:
  J Infect Dis. 208(6):907-916.
• Pubmed ID:
  23801600
• Pubmed Central ID:
  PMC4714544
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States ; U01 CI000189/CI/NCPDCID CDC HHS/United States ; 5 U01 CI000189/CI/NCPDCID CDC HHS/United States
• Place as Subject:
  Malawi
• Volume:
  208
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:b03b71acf3ae07cfd7228c715ed8273908e72e9fecad877448e73aa44d6a2b97
• Download URL:
  https://stacks.cdc.gov/view/cdc/37549/cdc_37549_DS1.pdf
• File Type:
  [PDF - 428.29 KB ]