Antenatal Receipt of Sulfadoxine-Pyrimethamine Does Not Exacerbate Pregnancy-Associated Malaria Despite the Expansion of Drug-Resistant Plasmodium falciparum: Clinical Outcomes From the QuEERPAM Study

作者：Taylor Steve M^*; Antonia Alejandro L; Chaluluka Ebbie; Mwapasa Victor; Feng Gaoqian; Molyneux Malcolm E; ter Kuile Feiko O; Meshnick Steven R; Rogerson Stephen J

来源：Clinical Infectious Diseases, 2012, 55(1): 42-50.

DOI：10.1093/cid/cis301

Background. Antenatal intermittent preventive therapy with 2 doses of sulfadoxine-pyrimethamine (IPTp-SP) is the mainstay of efforts in sub-Saharan Africa to prevent pregnancy-associated malaria (PAM). Recent studies report that drug resistance may cause IPTp-SP to exacerbate PAM morbidity, raising fears that current policies will cause harm as resistance spreads. %26lt;br%26gt;Methods. We conducted a serial, cross-sectional analysis of the relationships between IPTp-SP receipt, SP-resistant Plasmodium falciparum, and PAM morbidity in delivering women during a period of 9 years at a single site in Malawi. PAM morbidity was assessed by parasite densities, placental histology, and birth outcomes. %26lt;br%26gt;Results. The prevalence of parasites with highly SP-resistant haplotypes increased from 17% to 100% (P %26lt; .001), and the proportion of women receiving full IPTp (%26gt;= 2 doses) increased from 25% to 82% (P %26lt; .001). Women who received full IPTp with SP had lower peripheral (P = .018) and placental (P %26lt; .001) parasite densities than women who received suboptimal IPTp (%26lt; 2 doses). This effect was not significantly modified by the presence of highly SP-resistant haplotypes. After adjustment for covariates, the receipt of SP in the presence of SP-resistant P. falciparum did not exacerbate any parasitologic, histologic, or clinical measures of PAM morbidity. %26lt;br%26gt;Conclusions. In this longitudinal study of malaria at delivery, the receipt of SP as IPTp did not potentiate PAM morbidity despite the increasing prevalence and fixation of SP-resistant P. falciparum haplotypes. Even when there is substantial resistance, SP may be used in modified IPTp regimens as a component of comprehensive antenatal care.

• 出版日期2012-7-1