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

• Published in: Malaria journal Vol. 23; no. 1; pp. 201 - 11
• Main Authors: Cellich, Philip, Unger, Holger W, Rogerson, Stephen J, Mola, Glen D L
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05-07-2024; BioMed Central; BMC
• Subjects: Adolescent; Adult; Anaemia; Antimalarials; Antimalarials - administration & dosage; Antimalarials - therapeutic use; Cohort Studies; Dosage and administration; Drug Combinations; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Intermittent preventive treatment; Low birth weight; Malaria; Malaria - prevention & control; Papua New Guinea - epidemiology; Patient outcomes; Pharmacology, Experimental; Physiological aspects; Plasmodium falciparum; Pregnancy; Pregnancy Complications, Parasitic - prevention & control; Pregnancy Outcome; Pyrimethamine; Pyrimethamine - administration & dosage; Pyrimethamine - therapeutic use; Retrospective Studies; Sulfadoxine - administration & dosage; Sulfadoxine - therapeutic use; Young Adult; Papua New Guinea; Plasmodium falciparum; Anaemia; Malaria; Pregnancy outcome; Low birth weight; Intermittent preventive treatment; Western Pacific
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-024-05010-0

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.