Intermittent Preventive Treatment in Pregnancy with Sulphadoxine-Pyrimethamine Does Not Have Effect on Maternal Hemoglobin at Delivery and Birth Weight in Kisangani, Democratic Republic of Congo

Abstract

Background: The consequences of malaria during pregnancy are different regarding local conditions of malaria transmission. In stable malaria areas, the main complications are maternal anaemia and fetal growth restriction. This study aims to determine if pregnancy-associated malaria is associated with the risk of the above-mentioned complications and to determine if IPTp-sp reduces them in Kisangani. Methods: It is a cross-sectional analytical study conducted in parturients, in 6 medical facilities of Kisangani, from January 1st to September 30th, 2017. At delivery we measured their hemoglobin, we performed the thick blood smear of their peripheral blood and placental apposition; and we weighed their newborns at birth. Results: Risk of anaemia at delivery increased with malaria access during pregnancy (p = 0.0056; OR: 1.4221, 95% CI: 1.0851-1.8638) and peripheral parasitaemia at delivery (p = 0.0000; OR: 6.3855, 95% CI: 4.5552-8.9512). LBW increased with peripheral parasitaemia at delivery (p = 0.0000; OR: 3.5299, 95% CI: 2.4424-5.1015) and placental parasitaemia (p = 0.0000; OR: 18.3247, 95% CI: 12.5141-26.8332). IPTp-sp did not have effect on maternal hemoglobin at delivery (p = 0.1546; OR: 0.7553, IC à 95%: 0.4414-1.2923) and the birth weight (p = 0.1225; OR: 0.6638, IC à 95%: 0.3375-1.3056). Conclusion: In Kisangani, pregnancy-associated malaria is associated with maternal anaemia at delivery and LBW. IPTp-sp does not reduce the risk of these complications.

Efficacy and safety of malarial prophylaxis with mefloquine during pregnancy in Kisangani, Democratic Republic of Congo: A randomized clinical trial

“…[11][12][13][14][15][16][17][18] Indeed, Losimba et al 19 reported that high resistance to sulfadoxine-pyrimethamine could make intermittent preventive treatment during pregnancy using sulfadoxinepyrimethamine less effective in preventing low birth weight. This was confirmed by Labama et al 20 who found no benefits of intermittent preventive treatment during pregnancy using sulfadoxinepyrimethamine in preventing low birth weight in Kisangani where the current study was conducted.…”

“…19 Indeed, it has been previously reported that sulfadoxine-pyrimethamine has failed to prevent low birth weight in Kisangani. 20 The resistance to sulfadoxine-pyrimethamine raised serious concerns regarding its use for the intermittent preventive treatment during pregnancy. 21 Therefore, alternative options such as prophylaxis using mefloquine, sulfadoxine-pyrimethamine plus azithromycin or artesunate, chloroquine, sulfadoxine-pyrimethamine plus chloroquine have been proposed.…”