Impact of Intermittent Presumptive Treatment for Malaria in Pregnancy on Hospital Birth Outcomes on the Kenyan Coast

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 resi...

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Bibliographic Details
Published in:Clinical infectious diseases 2023-02, Vol.76 (3), p.e875-e883
Main Authors: Kamau, Alice, Musau, Moses, Mwakio, Stella, Amadi, David, Nyaguara, Amek, Bejon, Philip, Seale, Anna C, Berkley, James A, Snow, Robert W
Format: Article
Language:English
Subjects:
Antimalarials - therapeutic use
Drug Combinations
Female
Humans
Kenya - epidemiology
Major
Malaria - drug therapy
Malaria - epidemiology
Malaria - prevention & control
Pregnancy
Pregnancy Complications
Pregnancy Complications, Parasitic - drug therapy
Pregnancy Complications, Parasitic - epidemiology
Pregnancy Complications, Parasitic - prevention & control
Pregnancy Outcome
Pyrimethamine - therapeutic use
Stillbirth - epidemiology
Sulfadoxine - therapeutic use
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Summary: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.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciac509