Antenatal Receipt of Sulfadoxine-Pyrimethamine Does Not Exacerbate Pregnancy-Associated Malaria Despite the Expansion of Drug-Resistant Plasmodium falciparum: Clinical Outcomes From the QuEERPAM Study

• Published in: Clinical infectious diseases Vol. 55; no. 1; pp. 42 - 50
• Main Authors: Taylor, Steve M., Antonia, Alejandro L., Chaluluka, Ebbie, Mwapasa, Victor, Feng, Gaoqian, Molyneux, Malcolm E., Kuile, Feiko O. ter, Meshnick, Steven R., Rogerson, Stephen J.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.07.2012
• Subjects: Adolescent; Adult; and Commentaries; Antibacterial agents; Antibiotic Prophylaxis; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimalarials - administration & dosage; Antiparasitic agents; ARTICLES AND COMMENTARIES; Biological and medical sciences; Birth weight; Clinical outcomes; Cross-Sectional Studies; Dosage; Drug Combinations; Drug Resistance; Drug therapy; Female; Haplotypes; Hemoglobins; Hemoglobins - metabolism; Histology; Human protozoal diseases; Humans; Infectious diseases; Malaria; Malaria, Falciparum - blood; Malaria, Falciparum - drug therapy; Malaria, Falciparum - parasitology; Malaria, Falciparum - prevention & control; Medical sciences; Morbidity; Parasitemia - blood; Parasitemia - drug therapy; Parasitemia - parasitology; Parasitemia - prevention & control; Parasites; Parasitic diseases; Parasitic protozoa; Parasitism; Pharmacology. Drug treatments; Plasmodium falciparum; Plasmodium falciparum - isolation & purification; Pregnancy; Pregnancy Complications, Parasitic - blood; Pregnancy Complications, Parasitic - drug therapy; Pregnancy Complications, Parasitic - parasitology; Pregnancy Complications, Parasitic - prevention & control; Pregnancy Outcome; Prenatal Care - methods; Protozoal diseases; Pyrimethamine - administration & dosage; Sulfadoxine - administration & dosage; Treatment Outcome; Malawi; Protozoa; Antimalarial; Apicomplexa; Protozoal disease; Prognosis; Malaria; Pyrimethamine; Parasitosis; Infection; Pregnancy; Resistance; Plasmodium falciparum; Symptomatology; Sulfonamides; Parasiticide; Antiinfectious; Sulfadoxine; Antibacterial agent
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cis301

Background. Antenatal intermittent preventive therapy with 2 doses of sulfadoxine-pyrimethamine (IPTp-SP) is the mainstay of efforts in sub-Saharan Africa to prevent pregnancy-associated malaria (PAM). Recent studies report that drug resistance may cause IPTp-SP to exacerbate PAM morbidity, raising fears that current policies will cause harm as resistance spreads. Methods. We conducted a serial, cross-sectional analysis of the relationships between IPTp-SP receipt, SP-resistant Plasmodium falciparum, and PAM morbidity in delivering women during a period of 9 years at a single site in Malawi. PAM morbidity was assessed by parasite densities, placental histology, and birth outcomes. Results. The prevalence of parasites with highly SP-resistant haplotypes increased from 17% to 100% (P < .001), and the proportion of women receiving full IPTp (≥2 doses) increased from 25% to 82% (P < .001). Women who received full IPTp with SP had lower peripheral (P = .018) and placental (P < .001) parasite densities than women who received suboptimal IPTp (<2 doses). This effect was not significantly modified by the presence of highly SP-resistant haplotypes. After adjustment for covariates, the receipt of SP in the presence of SP-resistant P. falciparum did not exacerbate any parasitologic, histologic, or clinical measures of PAM morbidity. Conclusions. In this longitudinal study of malaria at delivery, the receipt of SP as IPTp did not potentiate PAM morbidity despite the increasing prevalence and fixation of SP-resistant P. falciparum haplotypes. Even when there is substantial resistance, SP may be used in modified IPTp regimens as a component of comprehensive antenatal care.