• Davidson H Hamer, Victor Mwanakasale, William B Macleod, Victor Chalwe, Doreen Mukwamataba, Davies Champo, Lawrence Mwananyanda, Roma Chilengi, Lwambwa Mubikayi, Chikuli Kabika Mulele, Modest Mulenga, Donald M Thea, and Christopher J Gill.
• Center for International Health and Development, Boston University School of Public Health, Boston, MA 02118, USA. dhamer@bu.edu
• J. Infect. Dis. 2007 Dec 1; 196 (11): 1585-94.

BackgroundIntermittent preventive treatment of malaria during pregnancy (IPTp) reduces placental infection, maternal anemia, and low birth weight (LBW). However, the optimal dosing regimen in settings in which human immunodeficiency virus (HIV) is highly prevalent among pregnant women remains controversial.MethodsWe conducted a randomized, double-blind, placebo-controlled study of IPTp comparing the standard 2-dose sulfadoxine-pyrimethamine (SP) regimen with monthly IPTp among a cohort of HIV-positive pregnant Zambian women. Primary outcomes included placental malaria (by smear and histology) and maternal peripheral parasitemia at delivery.ResultsThere were no differences between monthly IPTp (n=224) and standard IPTp (n=232) in placental malaria by histopathology (26% vs. 29%; relative risk [RR], 0.90 [95% confidence interval {CI}, 0.64-1.26]) or placental parasitemia (2% vs. 4%; RR, 0.55 [95% CI, 0.17-1.79]). There also were no differences in maternal anemia, stillbirths, preterm delivery, LBW, or all-cause mortality of infants at 6 weeks.ConclusionsIn an area of mesoendemicity in Zambia, monthly SP IPTp was not more efficacious than the standard 2-dose regimen for the prevention of placental malaria or adverse birth outcomes. IPTp policy recommendations need to take into account local malaria transmission patterns and the prevalence of HIV.Trial RegistrationClinicalTrials.gov identifier: NCT00270530.

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