Mortality, Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study

Abstract

BackgroundLittle is known about the effects of intermittent preventive treatment of malaria in pregnancy (IPTp) on the health of sub-Saharan African infants. We have evaluated the safety of IPTp with mefloquine (MQ) compared to sulfadoxine-pyrimethamine (SP) for important infant health and developmental outcomes.Methods and FindingsIn the context of a multicenter randomized controlled trial evaluating the safety and efficacy of IPTp with MQ compared to SP in pregnancy carried out in four sub-Saharan countries (Mozambique, Benin, Gabon, and Tanzania), 4,247 newborns, 2,815 born to women who received MQ and 1,432 born to women who received SP for IPTp, were followed up until 12 mo of age. Anthropometric parameters and psychomotor development were assessed at 1, 9, and 12 mo of age, and the incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were determined until 12 mo of age. No significant differences were found in the proportion of infants with stunting, underweight, wasting, and severe acute malnutrition at 1, 9, and 12 mo of age between infants born to women who were on IPTp with MQ versus SP. Except for three items evaluated at 9 mo of age, no significant differences were observed in the psychomotor development milestones assessed. Incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were similar between the two groups. Information on the outcomes at 12 mo of age was unavailable in 26% of the infants, 761 (27%) from the MQ group and 377 (26%) from the SP group. Reasons for not completing the study were death (4% of total study population), study withdrawal (6%), migration (8%), and loss to follow-up (9%).ConclusionsNo significant differences were found between IPTp with MQ and SP administered in pregnancy on infant mortality, morbidity, and nutritional outcomes. The poorer performance on certain psychomotor development milestones at 9 mo of age in children born to women in the MQ group compared to those in the SP group may deserve further studies.Trial registrationClinicalTrials.gov NCT00811421

Comparative study of mefloquine and sulphadoxine–pyrimethamine for malaria prevention among pregnant women with HIV in southwest Nigeria

“…In the present study, the incidence of a positive blood film for malaria parasites at delivery was lower among participants who received mefloquine than among those who received sulphadoxine–pyrimethamine, but this difference was not significant. This finding was similar to that of a multicenter study conducted by Ruperez et al., and comparable with the findings of González et al . The incidence of placenta parasitization was lower in the mefloquine group than in the sulphadoxine–pyrimethamine group, although again the difference was not significant.…”

Efficacy of two artemisinin-based combinations for the treatment of malaria in pregnancy in India: a randomized controlled trial

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Malaria in pregnancy shapes the development of foetal and infant immunity

“…However, the child's age at first malaria episode was assessed only through interview of the mother, and malaria blood smears were only performed at 1 week, 2 months and 9 months of age . Three more recent trials in Africa comparing IPTp‐SP with either, long‐lasting insecticide‐treated bed nets, mefloquine or intermittent screening and treatment with artemether‐lumefantrine also found that the incidence of malaria from birth to 12 months of age was similar in intervention and control groups of children. However, in each of these settings, the experimental group was not shown to significantly reduce the burden of PM in comparison with control …”