Session: Slide Session: Malaria
Monday, October 27, 2008: 12:00 AM
Room: Constitution E (Grand Hyatt)
Background: WHO guidelines recommend intermittent preventive treatment of malaria during pregnancy with sulfadoxine-pyrimethamine (SP-IPTp) to reduce adverse pregnancy outcomes, notably maternal anemia, and infant low birth weight (LBW). Recent data suggest that HIV positive women receiving single dose SP have worse outcomes; little is known about the adequacy of 1 dose SP among HIV negative women. Methods: In a nested case control study using data from a randomized, placebo-controlled trial of SP-IPTp in pregnant Zambian women, we calculated crude and adjusted risks for maternal and fetal outcomes in HIV positive and negative women based on whether they received 1 vs. 2 doses of SP (1 dose = 3 tablets of SP taken at once). Results: Of 97 HIV negative and 232 HIV positive women receiving SP-IPTp, HIV positive women were more likely to receive 2 doses (OR 2.58, 95% CI 1.44-4.62). When stratified by HIV status, mean birth weight was 247 g smaller for the HIV positive group who received 1 vs. 2 doses (p=0.008) and 63.3 g smaller for infants of HIV negative mothers who received 1 vs. 2 dose SP (p=0.537). The OR for LBW for 1 dose SP was 4.73 (95% CI 1.94-11.51) for HIV positives and 1.53 (95% CI 0.32-7.34) for HIV negatives. Mean delivery hemoglobin (Hgb) was 0.94 g lower for HIV positive mothers who received 1 vs. 2 dose SP (p=0.002), and 0.43 g higher for HIV negative women receiving 1 vs. 2 dose SP (p=0.562). The OR for anemia at delivery for 1 dose SP was 2.43 (95% CI 1.04-5.71) in HIV positives and 1.35 (95% CI 0.5-3.64) in HIV negatives. Conclusions: While the adverse effects of single dose SP-IPTp are felt most among HIV positive women, single dose SP appeared inferior to two dose SP even among HIV negative mothers. Efforts to optimize the delivery of IPTp, such as adopting a monthly dose schedule, are needed to ensure that mothers receive at least 2 doses of SP-IPTp.