UMR 216 Institut de Recherche pour le Développement, MERIT - Mère et enfant face aux infections tropicales, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Université Pierre et Marie Curie, Paris, France.
Trop Med Int Health. 2018 Jun;23(6):582-588. doi: 10.1111/tmi.13064. Epub 2018 May 21.
To investigate whether high-dosed folate supplements might diminish the efficacy of malaria intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) in a cohort of pregnant women in Benin, where malaria is holoendemic.
We followed 318 women during the entire pregnancy and analysed haematological and Plasmodium falciparum indicators in the context of an intermittent preventive treatment trial in Benin. During the follow-up, women received two-dose IPTp (1500/75 mg of SP per dose) at the maternity clinic and 600 mg of albendazole, 200 mg ferrous sulphate and 5 mg folic acid per day for home treatment.
High folate levels were not associated with increased malaria risk (adjusted OR (aOR) = 0.51 (95% CI: 0.17; 1.56, P-value = 0.24)), nor with increased P. falciparum density (beta coefficient = -0.26 (95% CI: -0.53; 0.02), P-value = 0.07) in a randomised trial of IPTp in Benin. On the contrary, higher iron levels were statistically associated with increased odds of a positive blood smear (aOR = 1.7 95% CI (1.2; 2.3), P-value < 0.001) and P. falciparum parasite density (beta coefficient = 0.2 95% CI (0.1; 0.3), P-value < 0.001). High folate levels were statistically associated with decreased odds of anaemia (aOR = -0.30 95% CI (0.10; 0.88), P-value = 0.03).
High folate levels are not associated with increased malarial risk in a prospective longitudinal cohort in the context of both iron and high-dosed folate supplements and IPTp. They are associated with reduced risk of anaemia, which is particularly important because iron, also given to treat anaemia, might be associated with increased malaria risk.
在贝宁进行的一项间歇性预防治疗试验中，调查高剂量叶酸补充剂是否会降低疟疾与磺胺多辛-乙胺嘧啶（SP）联合用于妊娠期间（IPTp）的疗效，因为该地区疟疾呈全流行态势。
我们对 318 名孕妇进行了整个孕期的随访，并分析了贝宁间歇性预防治疗试验中的血液学和恶性疟原虫指标。在随访期间，孕妇在妇产科诊所接受两剂 IPTp（每剂 1500/75mg SP），并在家中每天接受 600mg 阿苯达唑、200mg 硫酸亚铁和 5mg 叶酸治疗。
高叶酸水平与增加疟疾风险无关（调整后的比值比（aOR）=0.51（95%CI：0.17；1.56，P 值=0.24）），也与增加恶性疟原虫密度无关（贝宁 IPTp 随机试验中的β系数=-0.26（95%CI：-0.53；0.02），P 值=0.07））。相反，更高的铁水平与增加血涂片阳性的几率呈统计学相关（aOR=1.7 95%CI（1.2；2.3），P 值<0.001）和恶性疟原虫寄生虫密度（β系数=0.2 95%CI（0.1；0.3），P 值<0.001）。高叶酸水平与贫血几率降低呈统计学相关（aOR=-0.30 95%CI（0.10；0.88），P 值=0.03）。
在铁和高剂量叶酸补充剂以及 IPTp 的背景下，高叶酸水平与前瞻性纵向队列中增加的疟疾风险无关。它们与贫血风险降低相关，这一点尤为重要，因为也用于治疗贫血的铁可能与增加的疟疾风险有关。
