P-3604. Adverse Birth Outcomes Associated with Single Dose SP-IPTp in HIV Positive and Negative Zambian Women
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.
Amy Baranoski, MD1, Christopher Gill, MD, MS2, Davidson Hamer, MD3, R Chilengi4, V Mwanakasale5, William MacLeod, DSc3 and  A. S. Baranoski, None., (1)Boston University Medical Center, Boston, MA, (2)Boston University, Boston, MA, (3)Boston University School of Public Health, Boston, MA, (4)AMANET, (5)Tropical Diseases Research Centre

I graduated from Medical School (University of New South Wales, Sydney, Australia) in 1997 and completed internship at John Hunter Hospital (University of Newcastle ), NSW, Australia in 1998. I was a resident in Internal Medicine from 1999 -2000 at Westmead Hospital (University of Sydney). I then migrated to the USA and completed Internal Medicine Residency at New York University Downtown Hospital, New York from 2000-2003. I received my certification from the American Board of Internal Medicine that same year. I worked locums for the rest of that year until July 2004 when I started a combined 3-year clinical-investigator track Infectious Disease fellowship at Boston University Medical Center and a 2-year clinical research T32 training program (Boston Univeristy Clinical HIV/AIDS Research Training - BUCHART) culminating in a M.Sc degree in public Health. I am expecting to complete my master's thesis this summer and graduate from the Masters program.

Jacinto Blas V. Mantaring III, MD is a staff neonatologist in the Department of Pediatrics at the Philippines General Hospital in Manila, Philippines. He earned a B.S. in Zoology (cum laude) from the University of the Philippines and then his MD degree from the University of the Philippines College of Medicine. Dr. Mantaring completed a residency in Pediatrics at the University of the Philippines - Philippine General Hospital and then a Fellowship in Neonatology at Wayne State University in Detroit Michigan. He is currently a candidate for a MSc in Clinical Epidemiology at the University of the Philippines College of Medicine.

Jacinto Blas V. Mantaring III, MD is a staff neonatologist in the Department of Pediatrics at the Philippines General Hospital in Manila, Philippines. He earned a B.S. in Zoology (cum laude) from the University of the Philippines and then his MD degree from the University of the Philippines College of Medicine. Dr. Mantaring completed a residency in Pediatrics at the University of the Philippines - Philippine General Hospital and then a Fellowship in Neonatology at Wayne State University in Detroit Michigan. He is currently a candidate for a MSc in Clinical Epidemiology at the University of the Philippines College of Medicine.



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