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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.

Publication ,  Journal Article
Taylor, SM; Antonia, AL; Chaluluka, E; Mwapasa, V; Feng, G; Molyneux, ME; ter Kuile, FO; Meshnick, SR; Rogerson, SJ
Published in: Clin Infect Dis
July 2012

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.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

July 2012

Volume

55

Issue

1

Start / End Page

42 / 50

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Sulfadoxine
  • Pyrimethamine
  • Prenatal Care
  • Pregnancy Outcome
  • Pregnancy Complications, Parasitic
  • Pregnancy
  • Plasmodium falciparum
  • Parasitemia
  • Microbiology
 

Citation

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Taylor, S. M., Antonia, A. L., Chaluluka, E., Mwapasa, V., Feng, G., Molyneux, M. E., … Rogerson, S. J. (2012). 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. Clin Infect Dis, 55(1), 42–50. https://doi.org/10.1093/cid/cis301
Taylor, Steve M., Alejandro L. Antonia, Ebbie Chaluluka, Victor Mwapasa, Gaoqian Feng, Malcolm E. Molyneux, Feiko O. ter Kuile, Steven R. Meshnick, and Stephen J. Rogerson. “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.Clin Infect Dis 55, no. 1 (July 2012): 42–50. https://doi.org/10.1093/cid/cis301.
Taylor SM, Antonia AL, Chaluluka E, Mwapasa V, Feng G, Molyneux ME, ter Kuile FO, Meshnick SR, Rogerson SJ. 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. Clin Infect Dis. 2012 Jul;55(1):42–50.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

July 2012

Volume

55

Issue

1

Start / End Page

42 / 50

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Sulfadoxine
  • Pyrimethamine
  • Prenatal Care
  • Pregnancy Outcome
  • Pregnancy Complications, Parasitic
  • Pregnancy
  • Plasmodium falciparum
  • Parasitemia
  • Microbiology