Antenatal receipt of sulfadoxine-pyrimethamine does not exacerbate pregnancy-associated malaria despite the expansion of drug-resistant Plasmodium falciparum: clinical outcomes from the QuEERPAM study.

Abstract

BACKGROUND:

Antenatal intermittent preventive therapy with 2 doses of sulfadoxine-pyrimethamine (IPTp-SP) is the mainstay of efforts in sub-Saharan Africa to prevent pregnancy-associated malaria (PAM). Recent studies report that drug resistance may cause IPTp-SP to exacerbate PAM morbidity, raising fears that current policies will cause harm as resistance spreads.

METHODS:

We conducted a serial, cross-sectional analysis of the relationships between IPTp-SP receipt, SP-resistant Plasmodium falciparum, and PAM morbidity in delivering women during a period of 9 years at a single site in Malawi. PAM morbidity was assessed by parasite densities, placental histology, and birth outcomes.

RESULTS:

The prevalence of parasites with highly SP-resistant haplotypes increased from 17% to 100% (P < .001), and the proportion of women receiving full IPTp (≥2 doses) increased from 25% to 82% (P < .001). Women who received full IPTp with SP had lower peripheral (P = .018) and placental (P < .001) parasite densities than women who received suboptimal IPTp (<2 doses). This effect was not significantly modified by the presence of highly SP-resistant haplotypes. After adjustment for covariates, the receipt of SP in the presence of SP-resistant P. falciparum did not exacerbate any parasitologic, histologic, or clinical measures of PAM morbidity.

CONCLUSIONS:

In this longitudinal study of malaria at delivery, the receipt of SP as IPTp did not potentiate PAM morbidity despite the increasing prevalence and fixation of SP-resistant P. falciparum haplotypes. Even when there is substantial resistance, SP may be used in modified IPTp regimens as a component of comprehensive antenatal care.

• Authors: Steve M Taylor, Alejandro L Antonia, Ebbie Chaluluka, Victor Mwapasa, Gaoqian Feng, Malcolm E Molyneux, Feiko O ter Kuile, Steven R Meshnick, Stephen J Rogerson
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 55 Issue 1 Pg. 42-50 (Jul 2012) ISSN: 1537-6591 [Electronic] United States
• PMID: 22441649 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Drug Combinations
• Hemoglobins
• fanasil, pyrimethamine drug combination
• Sulfadoxine
• Pyrimethamine

Topics

• Adolescent
• Adult
• Antibiotic Prophylaxis
• Antimalarials (administration & dosage)
• Cross-Sectional Studies
• Drug Combinations
• Drug Resistance
• Female
• Haplotypes
• Hemoglobins (metabolism)
• Humans
• Malaria, Falciparum (blood, drug therapy, parasitology, prevention & control)
• Parasitemia (blood, drug therapy, parasitology, prevention & control)
• Plasmodium falciparum (isolation & purification)
• Pregnancy
• Pregnancy Complications, Parasitic (blood, drug therapy, parasitology, prevention & control)
• Pregnancy Outcome
• Prenatal Care (methods)
• Pyrimethamine (administration & dosage)
• Sulfadoxine (administration & dosage)
• Treatment Outcome