title: A systematic review of the impact of malaria prevention in pregnancy on low birth weight and maternal anemia.
abstract: BACKGROUND
  Malaria in pregnancy is a significant contributor to adverse pregnancy outcome, especially in Sub-Saharan Africa. Prevention with sulfadoxine/pyrimethamine (SP) during pregnancy has been recommended in malaria-endemic areas but concerns remain about its benefit.
  
  
  OBJECTIVE
  To evaluate the association between recommended preventative SP programs in pregnancy and low birth weight (LBW) and maternal anemia through available clinical trial, observational, and programmatic evaluation studies.
  
  
  METHODS
  Systematic review of published studies on malaria in pregnancy and pregnancy outcomes.
  
  
  METHODS
  Clinical studies from Sub-Saharan Africa from the past 10 years were included.
  
  
  METHODS
  English articles published since 2002 and listed in PubMed were identified using defined keywords, and their source documents were reviewed. Thirty-three studies involving malaria in pregnancy that recorded treatment rates and birth outcomes were included.
  
  
  RESULTS
  SP use among primigravidae was consistently associated with decreased LBW and anemia rates in clinical trials. Effects were less consistent in observational studies.
  
  
  CONCLUSIONS
  Although randomized trials have demonstrated the efficacy of SP, studies evaluating scale-up programs found less consistent reductions in LBW and maternal anemia. Additional strategies to improve SP coverage may reduce the LBW and maternal anemia associated with malaria in pregnancy.
authors.affiliation: Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA. mcclure@rti.org
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Arlene E
authors.initials: AE
authors.lastname: Dent
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000740:Anemia / Q000453:epidemiology / Q000517:prevention & control; D000962:Antimalarials / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011739:Pyrimethamine / Q000008:administration & dosage; D013413:Sulfadoxine / Q000008:administration & dosage
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine