Intermittent treatment to prevent pregnancy malaria does not confer benefit in an area of widespread drug resistance
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BACKGROUND: Millions of African women receive sulfadoxine-pyrimethamine (SP) as intermittent preventive treatment during pregnancy (IPTp) to avoid poor outcomes that result from malaria. However, parasites resistant to SP are widespread in parts of Africa, and IPTp may perversely exacerbate placental infections that contain SP-resistant parasites. METHODS: The study used a cross-sectional design. We determined IPTp use in a delivery cohort of 880 pregnant women in Muheza, Tanzania, by report and by plasma sulfa measurements, and we examined its effects on maternal and fetal delivery outcomes. RESULTS: In the overall cohort, IPTp was not associated with decreased odds of placental malaria or with increased mean maternal hemoglobin or mean birth weight. Unexpectedly, IPTp was associated with decreased cord hemoglobin level and increased risk of fetal anemia, which may be related to in utero SP exposure. CONCLUSIONS: IPTp does not improve overall pregnancy outcomes in Muheza, Tanzania, where SP-resistant parasites predominate and may increase the odds of fetal anemia. As parasite resistance increases in a community, the overall effect of IPTp may transition from net benefit to neutral or net harm.
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Increasing SP resistance in SSA may have compromised the efficacy of IPTp-SP.
“Concerns that increasing SP resistance in SSA [13] may have compromised the efficacy of this chemoprophylactic control measure [14], makes WHO’s call for enhanced regular monitoring of IPTp effectiveness ever more relevant in all malaria-endemic ecosystems.”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [14]
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- Authors
- Harrington, W. E., Mutabingwa, T. K., Kabyemela, E., Fried, M., & Duffy, P. E.
- Affiliations
- Center for Infectious Disease Research (US)
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-07-11
- Volume
- 53
- Issue
- 3
- Pages
- 224-230
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC3202321
- OpenAlex
- W2141917084
- Cited by
- 156
- References
- 31
- Citations by year
- 2026: 2 · 2025: 6 · 2023: 12 · 2022: 10 · 2021: 13 · 2020: 14 · 2019: 2 · 2018: 14 · 2017: 7 · 2016: 5 · 2015: 24 · 2014: 14 · 2013: 14 · 2012: 15
- FWCI
- 14.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Foundation for the National Institutes of Health
- Bill and Melinda Gates Foundation (29202)
- National Institutes of Health (7f30hl096298-03)
- National Heart, Lung, and Blood Institute (F30 HL096298, 1F30HL096298)
- National Institute of Allergy and Infectious Diseases (R01AI052059, R01AI52059)
- Fogarty International Center (D43TW005509)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Keywords
- intermittent preventive treatment in pregnancy, sulfadoxine-pyrimethamine, antimalarial drug resistance, placental malaria, fetal anemia, cord blood hemoglobin, birth weight, maternal hemoglobin, pregnancy outcomes
- MeSH terms
- Adult, Antimalarials, Cross-Sectional Studies, Drug Combinations, Drug Resistance, Female, Humans, Infant, Infant, Newborn, Malaria, Male, Plasmodium, Pregnancy, Pregnancy Complications, Infectious, Pyrimethamine, Sulfadoxine, Tanzania, Treatment Outcome, Chemoprevention
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