Owusu Ruth, Asante Kwaku Poku, Mahama Emmanuel, Awini Elizabeth, Anyorigiya Thomas, Dosoo David, Amu Alberta, Jakpa Gabriel, Ofei Emmanuel, Segbaya Sylvester, Oduro Abraham Rexford, Gyapong Margaret, Hodgson Abraham, Bart-Plange Constance, Owusu-Agyei Seth
Kintampo Health Research Centre, Ghana Health service, Kintampo, Ghana.
Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana.
PLoS One. 2015 Sep 1;10(9):e0136828. doi: 10.1371/journal.pone.0136828. eCollection 2015.
Sulphadoxine-Pyrimethamine (SP) is still the only recommended antimalarial for use in intermittent preventive treatment of malaria during pregnancy (IPTp) in some malaria endemic countries including Ghana. SP has the potential to cause acute haemolysis in G6PD deficient people resulting in significant haemoglobin (Hb) drop but there is limited data on post SP-IPTp Hb drop. This study determined the difference, if any in proportions of women with significant acute haemoglobin drop between G6PD normal, partial deficient and full deficient women after SP-IPTp.
Prospectively, 1518 pregnant women who received SP for IPTp as part of their normal antenatal care were enrolled. Their G6PD status were determined at enrollment followed by assessments on days 3, 7,14 and 28 to document any adverse effects and changes in post-IPTp haemoglobin (Hb) levels. The three groups were comparable at baseline except for their mean Hb (10.3 g/dL for G6PD normal, 10.8 g/dL for G6PD partial deficient and 10.8 g/dL for G6PD full defect women).The prevalence of G6PD full defect was 2.3% and 17.0% for G6PD partial defect. There was no difference in the proportions with fractional Hb drop ≥ 20% as compared to their baseline value post SP-IPTp among the 3 groups on days 3, 7, 14. The G6PD full defect group had the highest median fractional drop at day 7. There was a weak negative correlation between G6PD activity and fractional Hb drop. There was no statistical difference between the three groups in the proportions of those who started the study with Hb ≥ 8g/dl whose Hb level subsequently fell below 8g/dl post-SP IPTp. No study participant required transfusion or hospitalization for severe anaemia.
There was no significant difference between G6PD normal and deficient women in proportions with significant acute haemoglobin drop post SP-IPTp and lower G6PD enzyme activity was not strongly associated with significant acute drug-induced haemoglobin drop post SP-IPTp but a larger study is required to confirm consistency of findings.
在包括加纳在内的一些疟疾流行国家，磺胺多辛-乙胺嘧啶（SP）仍是孕期疟疾间歇性预防治疗（IPTp）中唯一推荐使用的抗疟药物。SP有可能在葡萄糖-6-磷酸脱氢酶（G6PD）缺乏的人群中引起急性溶血，导致血红蛋白（Hb）显著下降，但关于SP-IPTp后Hb下降的数据有限。本研究确定了SP-IPTp后G6PD正常、部分缺乏和完全缺乏的女性中出现显著急性血红蛋白下降的女性比例是否存在差异。
前瞻性地纳入了1518名接受SP进行IPTp作为其正常产前护理一部分的孕妇。在入组时确定她们的G6PD状态，随后在第3、7、14和28天进行评估，以记录任何不良反应和IPTp后血红蛋白（Hb）水平的变化。除了平均Hb水平外，三组在基线时具有可比性（G6PD正常女性为10.3g/dL，G6PD部分缺乏女性为10.8g/dL，G6PD完全缺乏女性为10.8g/dL）。G6PD完全缺乏的患病率为2.3%，G6PD部分缺乏的患病率为17.0%。在第3、7、14天，三组中与SP-IPTp后基线值相比Hb下降分数≥20%的比例没有差异。G6PD完全缺乏组在第7天的中位数下降分数最高。G6PD活性与Hb下降分数之间存在弱负相关。在研究开始时Hb≥8g/dl且SP-IPTp后Hb水平随后降至8g/dl以下的人群比例中，三组之间没有统计学差异。没有研究参与者因严重贫血需要输血或住院治疗。
SP-IPTp后出现显著急性血红蛋白下降的比例在G6PD正常和缺乏的女性之间没有显著差异，较低的G6PD酶活性与SP-IPTp后显著的急性药物性血红蛋白下降没有强烈关联，但需要更大规模的研究来证实研究结果的一致性。
