Main Findings
To reduce child mortality, WHO reaffirmed reducing the incidence of LBW
as an important target of the UN Millennium Development
Goal25. With the
significant augment of malaria parasites at delivery26, The third edition
of Guidelines for the treatment of malaria had strengthened the
recommended strength, prompting the use of
DP27.
In this systematic review and meta-analysis of five randomized
controlled trials including 4660 HIV-seronegative pregnant women with
malaria, we found IPT-DP was a promising alternative option for MIP. All
included studies were conducted in high endemic
areas6. Women who were
given IPT-DP-4-6w showed a lower risk of placental malaria and infection
with
malaria
parasites at delivery, without increasing the risk of adverse birth
outcomes. DP had the better effectiveness and safety than SP.
Birth outcomes included prematurity, low birth weight, small for
gestational age and overall mortality (stillbirth and spontaneous
abortion). There was little difference in any interval and regimens of
DP and SP. The protection of IPT-SP against adverse birth outcomes has
been identified in the cross sectional
survey28 and the
prospective cohort
study29. However,
included five trials were conducted in Africa where has high malaria
transmission30. Women
were exposed to antenatal infections more frequently and acquired
immunity to prevent adverse outcomes malaria
earlier31. This may
result in the resistance and ineffectiveness of DP and
SP32.
Maternal outcomes such as anemia during pregnancy, placental malaria by
histology and infection with malaria parasites at delivery all were
direct indicators to reflect the efficacy of
antimalarials33. In
this meta-analysis, IPT-DP may be a better choice to take into account
when selecting of first and second line antimalarial. This was
consistent with recent
research34. Few studies
had reported the efficacy of IPT-DP-8w, this article suggested that more
frequent repetitive doses were needed to improve the efficacy of IPT-DP.
Safety and tolerance are important considerations when determining AEs
to malaria routine drugs during pregnancy. Only three studies reported
the adverse effects. Through the description of the adverse effects, the
IPT-DP-4-6w presented a better effect overall.