Cellich, Philip

Unger, Holger

Rogerson, Stephen J

Mola, Glen D L

2024-07-05

Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) reduces malaria-attributable adverse pregnancy outcomes and may also prevent low birth weight (< 2,500 g) through mechanisms independent of malaria. Malaria transmission in Papua New Guinea (PNG) is highly heterogeneous. The impact of IPTp-SP on adverse birth outcomes in settings with little or no malaria transmission, such as PNG's capital city Port Moresby, is unknown.A retrospective cohort study was conducted amongst HIV-negative women with a singleton pregnancy who delivered at Port Moresby General Hospital between 18 July and 21 August 2022. The impact of IPTp-SP doses on adverse birth outcomes and anaemia was assessed using logistic and linear regression models, as appropriate.Of 1,140 eligible women amongst 1,228 consecutive births, 1,110 had a live birth with a documented birth weight. A total of 156 women (13.7%) did not receive any IPTp-SP, 347 women (30.4%) received one, 333 (29.2%) received two, and 304 (26.7%) received the recommended ≥ 3 doses of IPTp-SP. A total of 65 of 1,110 liveborn babies (5.9%) had low birth weight and there were 34 perinatal deaths (3.0%). Anaemia (haemoglobin < 100 g/L) was observed in 30.6% (243/793) of women, and 14 (1.2%) had clinical malaria in pregnancy. Compared to women receiving 0-1 dose of IPTp-SP, women receiving ≥ 2 doses had lower odds of LBW (adjusted odds ratio [aOR] 0.50; 95% confidence interval [CI] 0.26, 0.96), preterm birth (aOR 0.58; 95% CI 0.32, 1.04), perinatal death (aOR 0.49; 95% CI 0.18, 1.38), LBW/perinatal death (aOR 0.55; 95% CI 0.27, 1.12), and anaemia (OR 0.50; 95% CI 0.36, 0.69). Women who received 2 doses versus 0-1 had 45% lower odds of LBW (aOR 0.55, 95% CI 0.27, 1.10), and a 16% further (total 61%) reduction with ≥ 3 doses (aOR 0.39, 95% CI 0.14, 1.05). Birth weights for women who received 2 or ≥ 3 doses versus 0-1 were 81 g (95% CI -3, 166) higher, and 151 g (58, 246) higher, respectively.Provision of IPTp-SP in a low malaria-transmission setting in PNG appears to translate into substantial health benefits, in a dose-response manner, supporting the strengthening IPTp-SP uptake across all transmission settings in PNG.

Division of Obstetrics and Gynaecology, School of Medicine and Health Sciences, Port Moresby General Hospital, University of Papua New Guinea, Port Moresby, Papua New Guinea. philip.cellich@health.nsw.gov.au.

Department of Obstetrics and Gynaecology, Canterbury Hospital, 575 Canterbury Road, Campsie 2194, NSW, Australia. philip.cellich@health.nsw.gov.au.

Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina 0810, NT, Australia. holger.unger@menzies.edu.au.

Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia. holger.unger@menzies.edu.au.

Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. holger.unger@menzies.edu.au.

Department of Infectious Diseases, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia. holger.unger@menzies.edu.au.

Department of Infectious Diseases, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia.

Department of Medicine, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia.

Division of Obstetrics and Gynaecology, School of Medicine and Health Sciences, Port Moresby General Hospital, University of Papua New Guinea, Port Moresby, Papua New Guinea.

School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.

Malar J . 2024 Jul 5;23(1):201. doi: 10.1186/s12936-024-05010-0.

1475-2875

https://pubmed.ncbi.nlm.nih.gov/38970076/?otool=iaurydwlib

https://hdl.handle.net/10137/13450

Plasmodium falciparum

Anaemia

Intermittent preventive treatment

Low birth weight

Malaria

Pregnancy outcome

Western Pacific

Humans

Female

Pregnancy

Sulfadoxine

Pyrimethamine

Retrospective Studies

Papua New Guinea

Antimalarials

Drug Combinations

Adult

Pregnancy Outcome

Young Adult

Malaria

Pregnancy Complications, Parasitic

Infant, Low Birth Weight

Infant, Newborn

Adolescent

Cohort Studies

Impact on pregnancy outcomes of intermittent preventive treatment with sulfadoxine-pyrimethamine in urban and peri-urban Papua New Guinea: a retrospective cohort study.

Journal Article

Publication