Effectiveness of Intermittent Preventive Treatment With Sulfadoxine-Pyrimethamine During Pregnancy on Maternal and Birth Outcomes in Machinga District, Malawi
Published Date:Jun 24 2013
Source:J Infect Dis. 208(6):907-916.
Dose-Response Relationship, Drug
Infant, Low Birth Weight
Intermittent Preventive Treatment
Pregnancy Complications, Parasitic
Pubmed Central ID:PMC4714544
Funding:5 U01 CI000189/CI/NCPDCID CDC HHS/United States
CC999999/Intramural CDC HHS/United States
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).
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).
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.
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.
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