Glucose-6-Phosphate Dehydrogenase Deficiency and Haemoglobin Drop after Sulphadoxine-Pyrimethamine Use for Intermittent Preventive Treatment of Malaria during Pregnancy in Ghana - A Cohort Study.
BACKGROUND
Sulphadoxine-Pyrimethamine (SP) is still the only recommended antimalarial for use in intermittent preventive treatment of malaria during pregnancy (IPTp) in some malaria endemic countries including Ghana. SP has the potential to cause acute haemolysis in G6PD deficient people resulting in significant haemoglobin (Hb) drop but there is limited data on post SP-IPTp Hb drop. This study determined the difference, if any in proportions of women with significant acute haemoglobin drop between G6PD normal, partial deficient and full deficient women after SP-IPTp.


RESULTS
Prospectively, 1518 pregnant women who received SP for IPTp as part of their normal antenatal care were enrolled. Their G6PD status were determined at enrollment followed by assessments on days 3, 7,14 and 28 to document any adverse effects and changes in post-IPTp haemoglobin (Hb) levels. The three groups were comparable at baseline except for their mean Hb (10.3 g/dL for G6PD normal, 10.8 g/dL for G6PD partial deficient and 10.8 g/dL for G6PD full defect women).The prevalence of G6PD full defect was 2.3% and 17.0% for G6PD partial defect. There was no difference in the proportions with fractional Hb drop ≥ 20% as compared to their baseline value post SP-IPTp among the 3 groups on days 3, 7, 14. The G6PD full defect group had the highest median fractional drop at day 7. There was a weak negative correlation between G6PD activity and fractional Hb drop. There was no statistical difference between the three groups in the proportions of those who started the study with Hb ≥ 8g/dl whose Hb level subsequently fell below 8g/dl post-SP IPTp. No study participant required transfusion or hospitalization for severe anaemia.


CONCLUSIONS
There was no significant difference between G6PD normal and deficient women in proportions with significant acute haemoglobin drop post SP-IPTp and lower G6PD enzyme activity was not strongly associated with significant acute drug-induced haemoglobin drop post SP-IPTp but a larger study is required to confirm consistency of findings.
Kintampo Health Research Centre, Ghana Health service, Kintampo, Ghana.
Ruth
R
Owusu
Kintampo Health Research Centre, Ghana Health service, Kintampo, Ghana.
Kwaku Poku
KP
Asante
Kintampo Health Research Centre, Ghana Health service, Kintampo, Ghana.
Emmanuel
E
Mahama
Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana.
Elizabeth
E
Awini
Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.
Thomas
T
Anyorigiya
Kintampo Health Research Centre, Ghana Health service, Kintampo, Ghana.
David
D
Dosoo
Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana.
Alberta
A
Amu
Kintampo Health Research Centre, Ghana Health service, Kintampo, Ghana.
Gabriel
G
Jakpa
Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana.
Emmanuel
E
Ofei
AngloGold Ashanti Malaria Control Program, Obuasi, Ghana.
Sylvester
S
Segbaya
Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.
Abraham Rexford
AR
Oduro
Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana.
Margaret
M
Gyapong
Research and Development Division, Ghana Health Service, Headquarters, Accra, Ghana.
Abraham
A
Hodgson
National Malaria Control Programme, Ghana Health Service, Korle-Bu, Accra, Ghana.
Constance
C
Bart-Plange
Kintampo Health Research Centre, Ghana Health service, Kintampo, Ghana.
Seth
S
Owusu-Agyei
D000328:Adult; D000962:Antimalarials / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D004338:Drug Combinations; D005260:Female; D005869:Ghana; D005954:Glucosephosphate Dehydrogenase / Q000378:metabolism; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000139:chemically induced* / Q000378:metabolism; D006402:Hematologic Diseases / Q000139:chemically induced* / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D011247:Pregnancy; D011739:Pyrimethamine / Q000009:adverse effects* / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000009:adverse effects* / Q000627:therapeutic use*
D000962:Antimalarials; D004338:Drug Combinations; D006454:Hemoglobins; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D005954:Glucosephosphate Dehydrogenase; D011739:Pyrimethamine