Division of Obstetrics and Gynaecology, School of Medicine and Health Sciences, Port Moresby General Hospital, University of Papua New Guinea, Port Moresby, Papua New Guinea.
Department of Obstetrics and Gynaecology, Canterbury Hospital, 575 Canterbury Road, Campsie 2194, NSW, Australia.
Malar J. 2024 Jul 5;23(1):201. doi: 10.1186/s12936-024-05010-0.
Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) reduces malaria-attributable adverse pregnancy outcomes and may also prevent low birth weight (< 2,500 g) through mechanisms independent of malaria. Malaria transmission in Papua New Guinea (PNG) is highly heterogeneous. The impact of IPTp-SP on adverse birth outcomes in settings with little or no malaria transmission, such as PNG's capital city Port Moresby, is unknown.
A retrospective cohort study was conducted amongst HIV-negative women with a singleton pregnancy who delivered at Port Moresby General Hospital between 18 July and 21 August 2022. The impact of IPTp-SP doses on adverse birth outcomes and anaemia was assessed using logistic and linear regression models, as appropriate.
Of 1,140 eligible women amongst 1,228 consecutive births, 1,110 had a live birth with a documented birth weight. A total of 156 women (13.7%) did not receive any IPTp-SP, 347 women (30.4%) received one, 333 (29.2%) received two, and 304 (26.7%) received the recommended ≥ 3 doses of IPTp-SP. A total of 65 of 1,110 liveborn babies (5.9%) had low birth weight and there were 34 perinatal deaths (3.0%). Anaemia (haemoglobin < 100 g/L) was observed in 30.6% (243/793) of women, and 14 (1.2%) had clinical malaria in pregnancy. Compared to women receiving 0-1 dose of IPTp-SP, women receiving ≥ 2 doses had lower odds of LBW (adjusted odds ratio [aOR] 0.50; 95% confidence interval [CI] 0.26, 0.96), preterm birth (aOR 0.58; 95% CI 0.32, 1.04), perinatal death (aOR 0.49; 95% CI 0.18, 1.38), LBW/perinatal death (aOR 0.55; 95% CI 0.27, 1.12), and anaemia (OR 0.50; 95% CI 0.36, 0.69). Women who received 2 doses versus 0-1 had 45% lower odds of LBW (aOR 0.55, 95% CI 0.27, 1.10), and a 16% further (total 61%) reduction with ≥ 3 doses (aOR 0.39, 95% CI 0.14, 1.05). Birth weights for women who received 2 or ≥ 3 doses versus 0-1 were 81 g (95% CI -3, 166) higher, and 151 g (58, 246) higher, respectively.
Provision of IPTp-SP in a low malaria-transmission setting in PNG appears to translate into substantial health benefits, in a dose-response manner, supporting the strengthening IPTp-SP uptake across all transmission settings in PNG.
在妊娠期间间歇性预防治疗使用磺胺多辛-乙胺嘧啶（IPTp-SP）可降低疟疾相关的不良妊娠结局，并且可能通过与疟疾无关的机制预防低出生体重（<2500 克）。巴布亚新几内亚（PNG）的疟疾传播高度异质。在疟疾传播很少或没有的情况下，如 PNG 首都莫尔斯比港，IPTp-SP 对不良出生结局的影响尚不清楚。
对 2022 年 7 月 18 日至 8 月 21 日期间在莫尔斯比港总医院分娩的 HIV 阴性单胎妊娠妇女进行了一项回顾性队列研究。使用逻辑回归和线性回归模型评估 IPTp-SP 剂量对不良出生结局和贫血的影响。
在连续分娩的 1228 名产妇中，有 1140 名符合条件的产妇，其中 1110 名产妇分娩出了有记录的出生体重的活产儿。共有 156 名（13.7%）妇女未接受任何 IPTp-SP，347 名（30.4%）妇女接受了 1 剂，333 名（29.2%）妇女接受了 2 剂，304 名（26.7%）妇女接受了推荐的≥3 剂 IPTp-SP。1110 名活产婴儿中共有 65 名（5.9%）体重低，有 34 例围产期死亡（3.0%）。306 名（30.6%）妇女出现贫血（血红蛋白<100g/L），14 名（1.2%）孕妇在妊娠期间患有临床疟疾。与接受 0-1 剂 IPTp-SP 的妇女相比，接受≥2 剂 IPTp-SP 的妇女发生低出生体重的可能性较低（调整后的优势比[aOR]0.50；95%置信区间[CI]0.26，0.96）、早产（aOR 0.58；95%CI 0.32，1.04）、围产期死亡（aOR 0.49；95%CI 0.18，1.38）、低出生体重/围产期死亡（aOR 0.55；95%CI 0.27，1.12）和贫血（OR 0.50；95%CI 0.36，0.69）。与 0-1 剂量相比，接受 2 剂的妇女发生低出生体重的可能性低 45%（aOR 0.55，95%CI 0.27，1.10），如果接受≥3 剂，可能性进一步降低 16%（总共 61%）（aOR 0.39，95%CI 0.14，1.05）。与 0-1 剂量相比，接受 2 剂或≥3 剂的妇女的出生体重分别高 81g（95%CI-3，166）和 151g（58，246）。
在 PNG 疟疾传播很少的环境中提供 IPTp-SP 似乎会带来实质性的健康益处，呈剂量反应关系，支持在 PNG 所有传播环境中加强 IPTp-SP 的应用。
