Bigger babies for women given extra prophylaxis against malariaBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f907 (Published 13 February 2013) Cite this as: BMJ 2013;346:f907
Updated guidelines from the World Health Organization recommend boosting malaria prophylaxis for pregnant women in sub-Saharan Africa. The new policy could help increase average birth weights and reduce the number of babies born weighing less than 2500 g, according to a meta-analysis of seven trials from the region.
In pooled analyses, women given three or more doses of sulfadoxine pyrimethamine in mid to late pregnancy had babies that were 56 g (95% CI 29 to 83) heavier at birth than women given the standard two doses. They also had significantly fewer low birthweight babies (134 v 167 per 1000; relative risk 0.8, 0.69 to 0.94; number needed to treat 31). Treatment with three or more doses was associated with a lower risk of both maternal malaria at delivery and placental malaria. Babies exposed to three or more doses had no more jaundice than those exposed to two.
About a quarter of the women in these trials used bed nets treated with insecticide. The authors were surprised that an extra dose of sulfadoxine pyrimethamine made such a difference to outcomes. Women with and without HIV seemed to benefit, as did regions with a higher and lower prevalence of molecular resistance to the drug.
These findings add weight to the new guidelines, which recommend that eligible women receive preventive treatment at every antenatal visit in the second and third trimester, say the authors.
Cite this as: BMJ 2013;346:f907