Abstract
BackgroundMaternal infections are associated with maternal and foetal adverse outcomes. Nutrient supplementation during pregnancy may reduce the occurrence of infections by improving maternal immunity. We aimed to investigate the impact of small-quantity lipid-based nutrient supplement (SQ-LNS) on the occurrence of Plasmodium falciparum parasitaemia during pregnancy and trichomoniasis, vaginal candidiasis and urinary tract infection (UTI) after delivery.MethodsPregnant Malawian women enrolled in the iLiNS-DYAD trial receiving daily supplementation with SQ-LNS, multiple micronutrients (MMN) or iron & folic acid (IFA) from <20 gestation weeks (gw) were assessed for P. falciparum parasitaemia at 32 gw using rapid diagnostic testing (RDT), at 36 gw using polymerase chain reaction (PCR) and at delivery using both RDT and PCR; and at one week after delivery for trichomoniasis and vaginal candidiasis using wet mount microscopy and for UTI using urine dipstick analysis. The prevalence of each infection by intervention group was estimated at the prescribed time points and the global null hypothesis was tested using logistic regression. Adjusted analyses were performed using preselected covariates.ResultsThe prevalence of P. falciparum parasitaemia was 10.7% at 32 gw, 9% at 36 gw, and 8.3% by RDT and 20.2% by PCR at delivery. After delivery the prevalence of trichomoniasis was 10.5%, vaginal candidiasis was 0.5%, and UTI was 3.1%. There were no differences between intervention groups in the prevalence of any of the infections.ConclusionIn this population, SQ-LNS did not influence the occurrence of maternal P. falciparum parasitaemia, trichomoniasis, vaginal candidiasis or UTI.Trial registrationIdentifier: NCT01239693 (10 November 2010).
Highlights
Maternal infections are associated with maternal and foetal adverse outcomes
Follow up data for P. falciparum parasitaemia were available from 79.6% of the women at 32 gw, 76.9% at 36 gw, and from 81.4 and 78.7% at delivery by rapid diagnostic testing (RDT) and polymerase chain reaction (PCR) respectively
Loss to follow up was similar between the groups (P = 0.805 at 32 gw, 0.638 at 36 gw, 0.180 and 0.393 for P. falciparum parasitaemia RDT and PCR at delivery)
Summary
Maternal infections are associated with maternal and foetal adverse outcomes. Nutrient supplementation during pregnancy may reduce the occurrence of infections by improving maternal immunity. LBW and preterm birth have adverse consequences for neonatal survival, subsequent childhood mortality and impaired motor and cognitive development [10,11,12] Both P. falciparum infection and RTIs may be modified by preventive measures or presumptive treatment during pregnancy [13, 14]. While there are no recommendations for the prevention of RTIs during pregnancy, programs that screen and treat RTIs early in pregnancy have been associated with a decline in the occurrence of preterm birth and LBW [16] These prevention approaches have their own challenges including vector resistance to pyrethroid, the main insecticide used in malaria control [17]; P. falciparum resistance to SP [18]; and the risk of the development of widespread antibiotic resistance by bacterial organisms [19] if routine antibiotic use for the prevention of RTIs was adopted. No study has looked at the impact of antenatal provision of SQ-LNS on maternal infections
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