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.