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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.

Duke Scholars

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

APA
Chicago
ICMJE
MLA
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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
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