title: Intermittent treatment to prevent pregnancy malaria does not confer benefit in an area of widespread drug resistance.
abstract: BACKGROUND
  Millions of African women receive sulfadoxine-pyrimethamine (SP) as intermittent preventive treatment during pregnancy (IPTp) to avoid poor outcomes that result from malaria. However, parasites resistant to SP are widespread in parts of Africa, and IPTp may perversely exacerbate placental infections that contain SP-resistant parasites.
  
  
  METHODS
  The study used a cross-sectional design. We determined IPTp use in a delivery cohort of 880 pregnant women in Muheza, Tanzania, by report and by plasma sulfa measurements, and we examined its effects on maternal and fetal delivery outcomes.
  
  
  RESULTS
  In the overall cohort, IPTp was not associated with decreased odds of placental malaria or with increased mean maternal hemoglobin or mean birth weight. Unexpectedly, IPTp was associated with decreased cord hemoglobin level and increased risk of fetal anemia, which may be related to in utero SP exposure.
  
  
  CONCLUSIONS
  IPTp does not improve overall pregnancy outcomes in Muheza, Tanzania, where SP-resistant parasites predominate and may increase the odds of fetal anemia. As parasite resistance increases in a community, the overall effect of IPTp may transition from net benefit to neutral or net harm.
authors.affiliation: Malaria Program, Seattle Biomedical Research Institute, Seattle, Washington, USA.
authors.forename: Whitney E
authors.initials: WE
authors.lastname: Harrington
authors.forename: Theonest K
authors.initials: TK
authors.lastname: Mutabingwa
authors.forename: Edward
authors.initials: E
authors.lastname: Kabyemela
authors.forename: Michal
authors.initials: M
authors.lastname: Fried
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Duffy
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage* / Q000494:pharmacology; D018890:Chemoprevention / Q000379:methods*; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000469:parasitology / Q000517:prevention & control*; D008297:Male; D010961:Plasmodium / Q000187:drug effects*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000469:parasitology / Q000517:prevention & control*; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000494:pharmacology; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000494:pharmacology; D013636:Tanzania; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine