In the Journals

Three doses of malaria treatment associated with higher birth weight

A three-dose or more regimen of sulfadoxine/pyrimethamine for malaria prevention was associated with a higher birth weight among pregnant women in Africa, researchers from the United Kingdom have found.

“Our study shows that by providing the drug sufadoxine/pyrimethamine more frequently during pregnancy, a period in a woman’s life when she and her baby are particularly vulnerable to harmful effects of malaria, the period of protection is greatly enhanced and the risk of malaria re-infection in women is reduced,” Feiko ter Kuile, PhD, professor at the Liverpool School of Tropical Medicine, told Infectious Disease News. “We are excited about these findings because there are not that many opportunities for such a cheap and relatively simple intervention to have such a large potential impact on pregnancy outcome.”

Feiko ter Kuile, PhD 

Feiko ter Kuile

The researchers conducted a systematic review and meta-analysis to compare outcomes on birth weight for regimens containing three or more doses and regimens of two doses. They identified 241 studies, and the analysis included seven trials and 6,281 pregnancies. The trials included women with and without HIV.

Pregnant women who received three or more doses of the treatment were more likely to have infants with low birth weight (RR=0.8; 95% CI, 0.69-0.94). The RR reduction was 20% (95% CI, 6-31). The median risk for low birth weight was 167 per 1,000 in the two-dose group compared with 134 per 1,000 in the group that received three or more doses. This translated to an absolute risk reduction of 33 per 1,000 women (95% CI, 10-52).

The median birth weight for women in the two-dose group was 2,870 g, which was 56 g (95% CI, 29-83) higher in the group that received three doses or more. In a subgroup analysis, the mean difference in birth weight was statistically significant among women with HIV (97 g; 95% CI, 22-172) and women without HIV (58 g; 95% CI, 26-90). The risk for neonatal icterus and congenital malformation were similar between the groups.

“This study has led the WHO to update its policy recommendations on recommendation on intermittent preventive treatment for the prevention of malaria in pregnant women who live in malaria-endemic regions of sub-Saharan Africa,” ter Kuile said. “Although these results are encouraging, this is certainly not the magic bullet for malaria control in pregnancy. Delivery of the two-dose regimen has proved difficult to deliver in practice. Three out of four women in malaria-endemic Africa received fewer than two doses, despite the fact that as many as 75% of women in Africa come for antenatal care at least twice during pregnancy.”

Ter Kuile said that the new WHO recommendations are better aligned with the WHO’s schedule for general antenatal care, so women can simply receive a protective dose at each scheduled antenatal visit in the second and third trimesters.

Disclosures: Kuile and other study researchers report relationships, financial or otherwise, with Pfizer.

A three-dose or more regimen of sulfadoxine/pyrimethamine for malaria prevention was associated with a higher birth weight among pregnant women in Africa, researchers from the United Kingdom have found.

“Our study shows that by providing the drug sufadoxine/pyrimethamine more frequently during pregnancy, a period in a woman’s life when she and her baby are particularly vulnerable to harmful effects of malaria, the period of protection is greatly enhanced and the risk of malaria re-infection in women is reduced,” Feiko ter Kuile, PhD, professor at the Liverpool School of Tropical Medicine, told Infectious Disease News. “We are excited about these findings because there are not that many opportunities for such a cheap and relatively simple intervention to have such a large potential impact on pregnancy outcome.”

Feiko ter Kuile, PhD 

Feiko ter Kuile

The researchers conducted a systematic review and meta-analysis to compare outcomes on birth weight for regimens containing three or more doses and regimens of two doses. They identified 241 studies, and the analysis included seven trials and 6,281 pregnancies. The trials included women with and without HIV.

Pregnant women who received three or more doses of the treatment were more likely to have infants with low birth weight (RR=0.8; 95% CI, 0.69-0.94). The RR reduction was 20% (95% CI, 6-31). The median risk for low birth weight was 167 per 1,000 in the two-dose group compared with 134 per 1,000 in the group that received three or more doses. This translated to an absolute risk reduction of 33 per 1,000 women (95% CI, 10-52).

The median birth weight for women in the two-dose group was 2,870 g, which was 56 g (95% CI, 29-83) higher in the group that received three doses or more. In a subgroup analysis, the mean difference in birth weight was statistically significant among women with HIV (97 g; 95% CI, 22-172) and women without HIV (58 g; 95% CI, 26-90). The risk for neonatal icterus and congenital malformation were similar between the groups.

“This study has led the WHO to update its policy recommendations on recommendation on intermittent preventive treatment for the prevention of malaria in pregnant women who live in malaria-endemic regions of sub-Saharan Africa,” ter Kuile said. “Although these results are encouraging, this is certainly not the magic bullet for malaria control in pregnancy. Delivery of the two-dose regimen has proved difficult to deliver in practice. Three out of four women in malaria-endemic Africa received fewer than two doses, despite the fact that as many as 75% of women in Africa come for antenatal care at least twice during pregnancy.”

Ter Kuile said that the new WHO recommendations are better aligned with the WHO’s schedule for general antenatal care, so women can simply receive a protective dose at each scheduled antenatal visit in the second and third trimesters.

Disclosures: Kuile and other study researchers report relationships, financial or otherwise, with Pfizer.