A systematic review of the impact of malaria prevention in pregnancy on low birth weight and maternal anemia

Abstract

BACKGROUND: Malaria in pregnancy is a significant contributor to adverse pregnancy outcome, especially in Sub-Saharan Africa. Prevention with sulfadoxine/pyrimethamine (SP) during pregnancy has been recommended in malaria-endemic areas but concerns remain about its benefit. OBJECTIVES: To evaluate the association between recommended preventative SP programs in pregnancy and low birth weight (LBW) and maternal anemia through available clinical trial, observational, and programmatic evaluation studies. SEARCH STRATEGY: Systematic review of published studies on malaria in pregnancy and pregnancy outcomes. SELECTION CRITERIA: Clinical studies from Sub-Saharan Africa from the past 10 years were included. DATA COLLECTION AND ANALYSIS: English articles published since 2002 and listed in PubMed were identified using defined keywords, and their source documents were reviewed. Thirty-three studies involving malaria in pregnancy that recorded treatment rates and birth outcomes were included. MAIN RESULTS: SP use among primigravidae was consistently associated with decreased LBW and anemia rates in clinical trials. Effects were less consistent in observational studies. CONCLUSIONS: Although randomized trials have demonstrated the efficacy of SP, studies evaluating scale-up programs found less consistent reductions in LBW and maternal anemia. Additional strategies to improve SP coverage may reduce the LBW and maternal anemia associated with malaria in pregnancy.