Public Health Research, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
Epidemiology and Demography, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
Clin Infect Dis. 2023 Feb 8;76(3):e875-e883. doi: 10.1093/cid/ciac509.
Intermittent preventive treatment (IPTp) for pregnant women with sulfadoxine-pyrimethamine (SP) is widely implemented for the prevention of malaria in pregnancy and adverse birth outcomes. The efficacy of SP is declining, and there are concerns that IPTp may have reduced impact in areas of high resistance. We sought to determine the protection afforded by SP as part of IPTp against adverse birth outcomes in an area with high levels of SP resistance on the Kenyan coast.
A secondary analysis of surveillance data on deliveries at the Kilifi County Hospital between 2015 and 2021 was undertaken in an area of low malaria transmission and high parasite mutations associated with SP resistance. A multivariable logistic regression model was developed to estimate the effect of SP doses on the risk of low birthweight (LBW) deliveries and stillbirths.
Among 27 786 deliveries, 3 or more doses of IPTp-SP were associated with a 27% reduction in the risk of LBW (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], .64-.83; P < .001) compared with no dose. A dose-response association was observed with increasing doses of SP from the second trimester linked to increasing protection against LBW deliveries. Three or more doses of IPTp-SP were also associated with a 21% reduction in stillbirth deliveries (aOR, 0.79; 95% CI, .65-.97; P = .044) compared with women who did not take any dose of IPTp-SP.
The continued significant association of SP on LBW deliveries suggests that the intervention may have a non-malaria impact on pregnancy outcomes.
孕妇间歇性预防治疗（IPTp）用磺胺多辛-乙胺嘧啶（SP）广泛用于预防妊娠疟疾和不良出生结局。SP 的疗效正在下降，人们担心 IPTp 在高耐药地区的影响可能会降低。我们试图确定在肯尼亚沿海高耐药地区，作为 IPTp 一部分的 SP 对不良出生结局的保护作用。
在低疟疾传播地区和与 SP 耐药相关的高寄生虫突变地区，对 2015 年至 2021 年 Kilifi 县医院分娩的监测数据进行了二次分析。建立了多变量逻辑回归模型，以估计 SP 剂量对低出生体重（LBW）分娩和死产风险的影响。
在 27786 例分娩中，与没有剂量相比，接受 3 剂或更多剂 IPTp-SP 与 LBW 风险降低 27%相关（调整后的优势比 [aOR]，0.73；95%置信区间 [CI]，0.64-0.83；P<0.001）。从第二个三个月开始，随着 SP 剂量的增加，观察到与 LBW 分娩相关的剂量反应关系，与 LBW 分娩的保护作用增加相关。与未接受任何剂量 IPTp-SP 的女性相比，接受 3 剂或更多剂 IPTp-SP 也与死产分娩风险降低 21%相关（aOR，0.79；95%CI，0.65-0.97；P=0.044）。
SP 与 LBW 分娩持续显著相关，表明该干预措施可能对妊娠结局产生非疟疾影响。
