Intermittent preventive therapy for malaria during pregnancy using 2 vs 3 or more doses of sulfadoxine-pyrimethamine and risk of low birth weight in Africa: Systematic review and meta-analysis.

Background: Intermittent Preventive Therapy with sulfadoxine- pyrimethamine (IPTp-SP) for malaria in pregnancy is widely used in sub-Saharan Africa. Most countries use a 2-dose regimen given in the 2nd and 3rd trimester. While effective, the 2-dose regimen leaves many women unprotected during the last 4- 8 weeks of gestation, a pivotal period for fetal weight gain. We reviewed the evidence from randomized-controlled-trials comparing 3 or more doses (3+) vs. 2-dose IPTp-SP. Data Sources and Study Selection MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane CENTRAL, and the trial register and bibliographic database of the Malaria in Pregnancy Library were searched for relevant treatment studies regardless of language, published between 1966 and June 2011. Researchers in the field were contacted to identify unpublished data. Data Extraction Data were independently abstracted by two investigators using a standardized protocol. SP resistance was defined as the proportion of total treatment failures in symptomatic children by day 14 or 28 or by the frequency of SNPs in the parasite resistance genes DHPS and DHFR. Data Synthesis Seven trials compared 2-dose IPT-SP with 3 or more (3+) doses, six were completed and data from five studies were available to contribute to the preliminary analysis (N = 1839). Among HIV-negative women of all gravidae, 3+dose IPT-SP resulted in significantly less placental malaria, higher mean birth weights and less LBW. Similar effects were seen in four trials involving HIV-infected women. Conclusions: Adding a third dose of SP markedly reduces the risk of placental malaria and adverse birth outcomes compared with the standard two-dose regimen in areas with low to moderate levels of SP resistance.

• Population(s)
  • Women
• Co-infections
  • Malaria