Sulfadoxine-Pyrimethamine Exhibits Dose-Response Protection Against Adverse Birth Outcomes Related to Malaria and Sexually Transmitted and Reproductive Tract Infections.
We conducted a prospective cohort study in Zambia among pregnant women who received intermittent preventive treatment using sulfadoxine-pyrimethamine (IPTp-SP).



We calculated the odds ratios (ORs) of adverse birth outcomes by IPTp-SP exposure, 0-1 dose (n = 126) vs ≥2 doses (n = 590) and ≥2 doses (n = 310) vs ≥3 doses (n = 280) in 7 categories of malaria infection and sexually transmitted and reproductive tract infections (STIs/RTIs).



We found no significant differences in baseline prevalence of infection across IPTp-SP exposure groups. However, among women given 2 doses compared to 0-1 dose, the odds of any adverse birth outcome were reduced 45% (OR, 0.55; 95% confidence interval [CI], 0.36, 0.86) and 13% further with ≥3 doses (OR, 0.43; 95% CI, 0.27, 0.68). Two or more doses compared to 0-1 dose reduced preterm delivery by 58% (OR, 0.42; 95% CI, 0.27, 0.67) and 21% further with ≥3 doses (OR, 0.21; 95% CI, 0.13, 0.35). Women with malaria at enrollment who received ≥2 doses vs 0-1 had 76% lower odds of any adverse birth outcome (OR, 0.24; 95% 0.09, 0.66), and Neisseria gonorrhoeae and/or Chlamydia trachomatis had 92% lower odds of any adverse birth outcome (OR, 0.08; 95% CI, 0.01, 0.64). Women with neither a malaria infection nor STIs/RTIs who received ≥2 doses had 73% fewer adverse birth outcomes (OR, 0.27; 95% CI, 0.11, 0.68).



IPTp-SP appears to protect against malaria, STIs/RTIs, and other unspecified causes of adverse birth outcome.
Department of Disease Control, London School of Hygiene & Tropical Medicine, United Kingdom.
R Matthew
RM
Chico
Department of Disease Control, London School of Hygiene & Tropical Medicine, United Kingdom.|Department of Biological Sciences, University of Zambia, Lusaka, Zambia.
Enesia Banda
EB
Chaponda
Department of Medical Statistics, London School of Hygiene & Tropical Medicine, United Kingdom.
Cono
C
Ariti
Department of Disease Control, London School of Hygiene & Tropical Medicine, United Kingdom.
Daniel
D
Chandramohan
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011739:Pyrimethamine / Q000627:therapeutic use*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D013413:Sulfadoxine / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult; D015024:Zambia
D000890:Anti-Infective Agents; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine
antenatal care; curable sexually transmitted infections; intermittent preventive treatment; malaria; sub-Saharan Africa.