National Institute for Medical Research, Tanga Centre, Tanga, United Republic of Tanzania.
Emerg Infect Dis. 2013;19(9):1446-54. doi: 10.3201/eid1909.130133.
Intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is a key strategy in the control of pregnancy-associated malaria. However, this strategy is compromised by widespread drug resistance from single-nucleotide polymorphisms in the Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthetase genes. During September 2008-October 2010, we monitored a cohort of 924 pregnant women in an area of Tanzania with declining malaria transmission. P. falciparum parasites were genotyped, and the effect of infecting haplotypes on birthweight was assessed. Of the genotyped parasites, 9.3%, 46.3%, and 44.4% had quadruple or less, quintuple, and sextuple mutated haplotypes, respectively. Mutant haplotypes were unrelated to SP doses. Compared with infections with the less-mutated haplotypes, infections with the sextuple haplotype mutation were associated with lower (359 g) birthweights. Continued use of the suboptimal IPTp-SP regimen should be reevaluated, and alternative strategies (e.g., intermittent screening and treatment or intermittent treatment with safe and effective alternative drugs) should be evaluated.
孕妇磺胺多辛-乙胺嘧啶间歇性预防疗法（IPTp-SP）是控制妊娠相关性疟疾的重要策略。然而，由于恶性疟原虫二氢叶酸还原酶和二氢蝶酸合成酶基因的单核苷酸多态性导致药物广泛耐药，这一策略受到了影响。2008 年 9 月至 2010 年 10 月，我们在坦桑尼亚一个疟疾传播逐渐减少的地区监测了 924 名孕妇队列。对疟原虫进行了基因分型，并评估了感染单倍型对出生体重的影响。在基因分型的寄生虫中，分别有 9.3%、46.3%和 44.4%的寄生虫具有四分之一或更少、五分之一和六分之一突变的单倍型。突变单倍型与 SP 剂量无关。与感染突变较少的单倍型相比，感染六倍突变单倍型与较低的出生体重（359 克）相关。应重新评估继续使用次优 IPTp-SP 方案的效果，并评估替代策略（例如间歇性筛查和治疗或间歇性使用安全有效的替代药物）。
