Abstract
Effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine (IPTp-SP) for prevention of malaria and adverse birth outcomes can be compromised by parasites-resistance to sulfadoxine–pyrimethamine. This study prospectively evaluated the effectiveness of IPTp-SP in Southeast Tanzania. From January 2017 to May 2019, HIV-negative and malaria-negative (mRDT) pregnant women attending their first antenatal-care visit in the second or third trimester (n = 500) were enrolled to receive monthly IPTp-SP and followed the protocol till delivery. The primary outcome was the prevalence of histopathological placental malaria. Secondary outcomes were anemia, malaria parasites detected during pregnancy and at delivery, adverse birth outcomes (low-birth-weight [LBW], premature birth, fetal anemia, still birth, and spontaneous abortion). Rates of histopathological placental malaria, any parasitemia at delivery (placental, cord or maternal), and any adverse birth outcome were 9.4%, 20.9%, and 26.5%, respectively. Rates of symptomatic malaria and parasitemia during pregnancy were 2.8% and 16%, respectively. Histopathological placental malaria significantly increased the odds of any adverse birth outcomes, particularly LBW. IPTp-SP with more than or equal to three doses significantly improved birth weight and reduced the risk of LBW by 56% compared to <3 SP doses (p = 0.009). IPTp-SP with more than or equal to three doses is still effective in improving birth weight. However, the detection of histopathological placental-malaria in one-tenth and parasitemia in one-fifth of pregnant women reflects the need to optimize the prevention of malaria during pregnancy.
Highlights
Malaria during pregnancy is a public health problem causing maternal anemia and placental insufficiency leading to preterm delivery, stillbirth and low birth weight (LBW) [1,2,3]
A total of 417 (83.4%) malaria-free women at enrolment were followed throughout pregnancy and had placental biopsies collected at delivery (Figure 1)
The women had a median of three antenatal care (ANC) visits at which screening of malaria parasites and determination of hemoglobin concentration were done followed by administration of SP under directly observed therapy (DOT)
Summary
Malaria during pregnancy is a public health problem causing maternal anemia and placental insufficiency leading to preterm delivery, stillbirth and low birth weight (LBW) [1,2,3]. More than 30 million of all women who become pregnant in Sub-Saharan Africa are at risk of malaria [4]. Due to the high risk and burden of malaria among pregnant women in endemic areas, the. World Health Organization (WHO) has developed prevention strategies to improve pregnancy outcomes. The strategic package includes sleeping under insecticide-treated nets, indoor residual spraying, effective case management, and intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine (IPTp-SP) starting early in the second trimester [7]. IPTp-SP is recommended throughout pregnancy in endemic countries [8]
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