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Impact of Sulfadoxine-Pyrimethamine Resistance on Effectiveness of Intermittent Preventive Therapy for Malaria in Pregnancy at Clearing Infections and Preventing Low Birth Weight.

Publication ,  Journal Article
Desai, M; Gutman, J; Taylor, SM; Wiegand, RE; Khairallah, C; Kayentao, K; Ouma, P; Coulibaly, SO; Kalilani, L; Mace, KE; Arinaitwe, E; Ades, V ...
Published in: Clin Infect Dis
February 1, 2016

BACKGROUND: Owing to increasing sulfadoxine-pyrimethamine (SP) resistance in sub-Saharan Africa, monitoring the effectiveness of intermittent preventive therapy in pregnancy (IPTp) with SP is crucial. METHODS: Between 2009 and 2013, both the efficacy of IPTp-SP at clearing existing peripheral malaria infections and the effectiveness of IPTp-SP at reducing low birth weight (LBW) were assessed among human immunodeficiency virus-uninfected participants in 8 sites in 6 countries. Sites were classified as high, medium, or low resistance after measuring parasite mutations conferring SP resistance. An individual-level prospective pooled analysis was conducted. RESULTS: Among 1222 parasitemic pregnant women, overall polymerase chain reaction-uncorrected and -corrected failure rates by day 42 were 21.3% and 10.0%, respectively (39.7% and 21.1% in high-resistance areas; 4.9% and 1.1% in low-resistance areas). Median time to recurrence decreased with increasing prevalence of Pfdhps-K540E. Among 6099 women at delivery, IPTp-SP was associated with a 22% reduction in the risk of LBW (prevalence ratio [PR], 0.78; 95% confidence interval [CI], .69-.88; P < .001). This association was not modified by insecticide-treated net use or gravidity, and remained significant in areas with high SP resistance (PR, 0.81; 95% CI, .67-.97; P = .02). CONCLUSIONS: The efficacy of SP to clear peripheral parasites and prevent new infections during pregnancy is compromised in areas with >90% prevalence of Pfdhps-K540E. Nevertheless, in these high-resistance areas, IPTp-SP use remains associated with increases in birth weight and maternal hemoglobin. The effectiveness of IPTp in eastern and southern Africa is threatened by further increases in SP resistance and reinforces the need to evaluate alternative drugs and strategies for the control of malaria in pregnancy.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

February 1, 2016

Volume

62

Issue

3

Start / End Page

323 / 333

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Sulfadoxine
  • Pyrimethamine
  • Prospective Studies
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Plasmodium falciparum
  • Mutant Proteins
  • Microbiology
 

Citation

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Desai, M., Gutman, J., Taylor, S. M., Wiegand, R. E., Khairallah, C., Kayentao, K., … Ter Kuile, F. O. (2016). Impact of Sulfadoxine-Pyrimethamine Resistance on Effectiveness of Intermittent Preventive Therapy for Malaria in Pregnancy at Clearing Infections and Preventing Low Birth Weight. Clin Infect Dis, 62(3), 323–333. https://doi.org/10.1093/cid/civ881
Desai, Meghna, Julie Gutman, Steve M. Taylor, Ryan E. Wiegand, Carole Khairallah, Kassoum Kayentao, Peter Ouma, et al. “Impact of Sulfadoxine-Pyrimethamine Resistance on Effectiveness of Intermittent Preventive Therapy for Malaria in Pregnancy at Clearing Infections and Preventing Low Birth Weight.Clin Infect Dis 62, no. 3 (February 1, 2016): 323–33. https://doi.org/10.1093/cid/civ881.
Desai M, Gutman J, Taylor SM, Wiegand RE, Khairallah C, Kayentao K, Ouma P, Coulibaly SO, Kalilani L, Mace KE, Arinaitwe E, Mathanga DP, Doumbo O, Otieno K, Edgar D, Chaluluka E, Kamuliwo M, Ades V, Skarbinski J, Shi YP, Magnussen P, Meshnick S, Ter Kuile FO. Impact of Sulfadoxine-Pyrimethamine Resistance on Effectiveness of Intermittent Preventive Therapy for Malaria in Pregnancy at Clearing Infections and Preventing Low Birth Weight. Clin Infect Dis. 2016 Feb 1;62(3):323–333.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

February 1, 2016

Volume

62

Issue

3

Start / End Page

323 / 333

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Sulfadoxine
  • Pyrimethamine
  • Prospective Studies
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Plasmodium falciparum
  • Mutant Proteins
  • Microbiology