title: The effect of antenatal monthly sulphadoxine-pyrimethamine, alone or with azithromycin, on foetal and neonatal growth faltering in Malawi: a randomised controlled trial.
abstract: OBJECTIVE
  To examine the potential to reduce foetal and neonatal growth faltering through intermittent preventive treatment in pregnancy (IPTp) of malaria and reproductive tract infections with monthly sulphadoxine-pyrimethamine (SP), alone or with two doses of azithromycin.
  
  
  METHODS
  We enrolled 1320 women with uncomplicated second trimester pregnancies into a randomised, partially placebo controlled, outcome assessor-blinded clinical trial in Malawi. The participants received either two doses of SP (control), SP monthly (monthly SP) or SP monthly and azithromycin (1 g) twice (AZI-SP). Newborn size was measured within two days of birth and infant growth at four weeks of age.
  
  
  RESULTS
  Babies in the AZI-SP group were on average (95% CI) 140 g (70-200) heavier at birth and 0.6 cm (0.2-0.9) longer at four weeks of age than control group babies. Corresponding differences between the monthly SP and control groups were 80 g (20-140) and 0.3 cm (-0.0 to 0.6). Compared with controls, babies in the AZI-SP group had a relative risk of 0.61 (0.40-0.93) for low birthweight, 0.60 (0.44-0.81) for stunting and 0.48 (0.29-0.79) for underweight at four weeks of age. Corresponding differences were similar but smaller between the monthly SP and control groups.
  
  
  CONCLUSIONS
  An IPTp regimen with monthly SP given to all pregnant women is likely to increase mean birthweight and length at four weeks of age in malaria holoendemic areas. Adding azithromycin to the regimen appears to offer further benefits in reducing foetal and neonatal growth faltering.
authors: Department of International Health, University of Tampere School of Medicine, Tampere, Finland.
authors: Mari
authors: M
authors: Luntamo
authors: Teija
authors: T
authors: Kulmala
authors: Yin Bun
authors: YB
authors: Cheung
authors: Kenneth
authors: K
authors: Maleta
authors: Per
authors: P
authors: Ashorn
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000962:Antimalarials / Q000008:administration & dosage; D017963:Azithromycin / Q000008:administration & dosage*; D001724:Birth Weight / Q000187:drug effects*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D047109:Fetal Development / Q000187:drug effects*; D006801:Humans; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000517:prevention & control*; D008295:Malawi; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011739:Pyrimethamine / Q000008:administration & dosage*; D060737:Reproductive Tract Infections / Q000188:drug therapy; D013413:Sulfadoxine / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D017963:Azithromycin; D013413:Sulfadoxine; D011739:Pyrimethamine