Mlugu Eulambius M, Minzi Omary, Asghar Muhammad, Färnert Anna, Kamuhabwa Appolinary A R, Aklillu Eleni
Department of Pharmaceutics, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam 0702172, Tanzania.
Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital, 141 86 Stockholm, Sweden.
Pathogens. 2020 Mar 11;9(3):207. doi: 10.3390/pathogens9030207.
Effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) for prevention of malaria and adverse birth outcomes can be compromised by parasites-resistance to sulfadoxine-pyrimethamine. This study prospectively evaluated the effectiveness of IPTp-SP in Southeast Tanzania. From January 2017 to May 2019, HIV-negative and malaria-negative (mRDT) pregnant women attending their first antenatal-care visit in the second or third trimester (n = 500) were enrolled to receive monthly IPTp-SP and followed the protocol till delivery. The primary outcome was the prevalence of histopathological placental malaria. Secondary outcomes were anemia, malaria parasites detected during pregnancy and at delivery, adverse birth outcomes (low-birth-weight [LBW], premature birth, fetal anemia, still birth, and spontaneous abortion). Rates of histopathological placental malaria, any parasitemia at delivery (placental, cord or maternal), and any adverse birth outcome were 9.4%, 20.9%, and 26.5%, respectively. Rates of symptomatic malaria and parasitemia during pregnancy were 2.8% and 16%, respectively. Histopathological placental malaria significantly increased the odds of any adverse birth outcomes, particularly LBW. IPTp-SP with more than or equal to three doses significantly improved birth weight and reduced the risk of LBW by 56% compared to <3 SP doses ( = 0.009). IPTp-SP with more than or equal to three doses is still effective in improving birth weight. However, the detection of histopathological placental-malaria in one-tenth and parasitemia in one-fifth of pregnant women reflects the need to optimize the prevention of malaria during pregnancy.
磺胺多辛-乙胺嘧啶间歇性预防治疗（IPTp-SP）用于预防疟疾和不良分娩结局的有效性可能会受到寄生虫对磺胺多辛-乙胺嘧啶耐药性的影响。本研究前瞻性评估了IPTp-SP在坦桑尼亚东南部的有效性。2017年1月至2019年5月，纳入在孕中期或孕晚期首次进行产前检查的HIV阴性且疟疾阴性（mRDT）孕妇（n = 500），每月接受IPTp-SP治疗，并按照方案随访至分娩。主要结局是组织病理学胎盘疟疾的患病率。次要结局包括贫血、孕期和分娩时检测到的疟原虫、不良分娩结局（低出生体重[LBW]、早产、胎儿贫血、死产和自然流产）。组织病理学胎盘疟疾、分娩时任何寄生虫血症（胎盘、脐带或母体）以及任何不良分娩结局的发生率分别为9.4%、20.9%和26.5%。孕期有症状疟疾和寄生虫血症的发生率分别为2.8%和16%。组织病理学胎盘疟疾显著增加了任何不良分娩结局的几率，尤其是低出生体重。与<3剂SP相比，≥3剂IPTp-SP显著提高了出生体重，并将低出生体重风险降低了56%（P = 0.009）。≥3剂IPTp-SP在改善出生体重方面仍然有效。然而，十分之一的孕妇检测到组织病理学胎盘疟疾，五分之一的孕妇检测到寄生虫血症，这反映出需要优化孕期疟疾的预防措施。
