ABSTRACT.
malaria, parasitemia, infections
MALARIA, PARASITEMIA, INFECTIONS, FETAL GROWTH RESTRICTION
Financial support: This work was funded by grants from the Academy of Finland (79787 and 207010), the Foundation for Pediatric Research in Finland, and the Medical Research Fund of Tampere University Hospital.Disclosures: The azithromycin and its placebo used in the study were provided free of charge by Pfizer Inc (New York, NY), which had no role in study design, data collection and analysis, the decision to publish, or preparation of the manuscript.Authors’ addresses: Lotta Hallamaa, Mari Luntamo, Ulla Ashorn, Teija Kulmala, and Yue-Mei Fan, Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, E:mails: Maternal malaria and infections during pregnancy are risk factors for fetal growth restriction. We assessed the impact of preventive treatment in pregnancy on maternal malaria and fetal growth. Between 2003 and 2006, we enrolled 1,320 pregnant Malawian women, 14–26 gestation weeks, in a randomized trial and treated them with two doses of sulfadoxine-pyrimethamine (SP, control) at enrollment and between 28–34 gestation weeks; with monthly SP from enrollment until 37 gestation weeks; or with monthly SP and azithromycin twice, at enrollment and between 28 and 34 gestation weeks (AZI-SP). Participants were seen at 4-week intervals until 36 completed gestation weeks and weekly thereafter. At each visit, we collected dried blood spots for real-time polymerase chain reaction diagnosing of malaria parasitemia and, in a random subgroup of 341 women, we measured fetal biparietal diameter and femur length with ultrasound. For the monthly SP versus the control group, the odds ratios (OR) (95% CI) of malaria parasitemia during the second, third, and both trimesters combined were 0.79 (0.46–1.37), 0.58 (0.37–0.92), and 0.64 (0.42–0.98), respectively. The corresponding ORs for the AZI-SP versus control group were 0.47 (0.26–0.84), 0.51 (0.32–0.81), and 0.50 (0.32–0.76), respectively. Differences between the AZI-SP and the monthly SP groups were not statistically significant. The interventions did not affect fetal biparietal diameter and femur length growth velocity. The results suggest that preventive maternal treatment with monthly SP reduced malaria parasitemia during pregnancy in Malawi and that the addition of azithromycin did not provide much additional antimalarial effect.