title: Lack of inhibition of the anti-malarial action of sulfadoxine-pyrimethamine by folic acid supplementation when used for intermittent preventive treatment in Gambian primigravidae.
abstract: Folic acid is frequently given to pregnant women at the same time as intermittent preventive treatment (IPTp) with sulfadoxine/pyrimethamine (SP), but it is not known if it interferes with the anti-malarial activity of SP. To investigate this concern, 1,035 Gambian primigravidae were randomized to receive either folic acid (500-1,500 microg/day) together with oral iron (522) or oral iron alone (513) for 14 days at the same time as they received IPTp with SP. On presentation, 261 women (25%) had Plasmodium falciparum asexual parasitemia. Prevalences of parasitemia on day 14 after treatment were similar in both groups: 5.7% (26 of 458) in the iron plus folic acid group and 4.9% (22 of 446) in the iron alone group (risk difference = 0.74%, 95% confidence interval [CI] = -2.2% to 3.7%). Parasitologic cure was observed in 116 (91%) of 128 of women who were parasitemic on presentation and who received iron and folic acid and in 122 (92%) of 133 women who received iron alone (difference = 1.1%, 95% CI = -5.6% to 8.0%). Women who received folic acid and iron had a slightly higher mean hemoglobin concentration at day 14 than women who had received iron alone (difference = 0.14 g/dL, 95% CI = 0.01-0.27 g/dL). The results of this study suggest that in an area of low SP resistance, administration of folic acid to pregnant women in a dose of 500-1,500 mug/day will not interfere with the protective effect of SP when used for IPTp.
authors.affiliation: Medical Research Council Laboratories, Banjul, The Gambia.
authors.forename: Amadou
authors.initials: A
authors.lastname: Mbaye
authors.forename: Keshena
authors.initials: K
authors.lastname: Richardson
authors.forename: Baba
authors.initials: B
authors.lastname: Balajo
authors.forename: Sam
authors.initials: S
authors.lastname: Dunyo
authors.forename: Caroline
authors.initials: C
authors.lastname: Shulman
authors.forename: Paul
authors.initials: P
authors.lastname: Milligan
authors.forename: Brian
authors.initials: B
authors.lastname: Greenwood
authors.forename: Gijs
authors.initials: G
authors.lastname: Walraven
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000517:prevention & control; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000037:antagonists & inhibitors / Q000627:therapeutic use*; D019587:Dietary Supplements; D004338:Drug Combinations; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D005714:Gambia; D020073:Gravidity; D006397:Hematinics / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000517:prevention & control*; D018512:Parasitemia / Q000188:drug therapy / Q000517:prevention & control; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000517:prevention & control*; D011739:Pyrimethamine / Q000008:administration & dosage / Q000037:antagonists & inhibitors / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000008:administration & dosage / Q000037:antagonists & inhibitors / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D006397:Hematinics; D006454:Hemoglobins; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D005492:Folic Acid; D011739:Pyrimethamine