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A new study suggests that treating pregnant women according to the results of malaria tests does not lower the risk of adverse pregnancy outcomes when compared to treating all women prophylactically.
In fact, the screen-and-treat approach, in which women received dihydroartemisinin-piperaquine (DP) only if they tested positive for malaria, was associated with higher fetal loss and more malaria at delivery than the prophylactic approach, in which women just received treatment with sulfadoxine-pyrimethamine (SP).
This is in spite of the fact that the study was conducted in an area of high SP resistance.
Feiko ter Kuile, MD, PhD, of the Liverpool School of Tropical Medicine in the UK, and his colleagues conducted this study and detailed the results in PLOS Medicine.
During pregnancy, undetected infection with malaria parasites can lead to maternal anemia, low birthweight, and fetal loss.
Therefore, in areas where malaria is endemic, the World Health Organization recommends treating pregnant women with SP. However, in some areas, more than 90% of Plasmodium parasites are resistant to SP.
In the current study, researchers compared this standard of care to a screening approach where pregnant women were tested for malaria using rapid diagnostic tests and treated with DP only if they tested positive for the parasite.
The study included 1873 HIV-negative pregnant women treated at 3 sites in Malawi, Africa. All of the women had 3 or 4 scheduled visits in the second and third trimester, 4 to 6 weeks apart.
The women were randomized to receive SP at each visit (n=921) or to be screened for malaria at every visit and treated with DP if they tested positive (n=923).
The prevalence of malaria at delivery was higher in the screening-DP group than in the SP group—48.7% and 40.8%, respectively (relative risk=1.19; P=0.007).
And fetal loss was higher in the screening-DP group than the SP group—2.6% and 1.3%, respectively (relative risk=2.06; P=0.046).
However, the risk of live adverse birth outcomes was similar between the screening-DP and SP groups—29.9% and 28.8%, respectively (relative risk=1.04, P=0.625).
The researchers said these results suggest that intermittent malaria screening and treatment with DP is not a viable strategy to replace intermittent preventive therapy with SP in malaria-endemic areas in sub-Saharan Africa, despite the high levels of resistance to SP. 
Photo by Nina Matthews
A new study suggests that treating pregnant women according to the results of malaria tests does not lower the risk of adverse pregnancy outcomes when compared to treating all women prophylactically.
In fact, the screen-and-treat approach, in which women received dihydroartemisinin-piperaquine (DP) only if they tested positive for malaria, was associated with higher fetal loss and more malaria at delivery than the prophylactic approach, in which women just received treatment with sulfadoxine-pyrimethamine (SP).
This is in spite of the fact that the study was conducted in an area of high SP resistance.
Feiko ter Kuile, MD, PhD, of the Liverpool School of Tropical Medicine in the UK, and his colleagues conducted this study and detailed the results in PLOS Medicine.
During pregnancy, undetected infection with malaria parasites can lead to maternal anemia, low birthweight, and fetal loss.
Therefore, in areas where malaria is endemic, the World Health Organization recommends treating pregnant women with SP. However, in some areas, more than 90% of Plasmodium parasites are resistant to SP.
In the current study, researchers compared this standard of care to a screening approach where pregnant women were tested for malaria using rapid diagnostic tests and treated with DP only if they tested positive for the parasite.
The study included 1873 HIV-negative pregnant women treated at 3 sites in Malawi, Africa. All of the women had 3 or 4 scheduled visits in the second and third trimester, 4 to 6 weeks apart.
The women were randomized to receive SP at each visit (n=921) or to be screened for malaria at every visit and treated with DP if they tested positive (n=923).
The prevalence of malaria at delivery was higher in the screening-DP group than in the SP group—48.7% and 40.8%, respectively (relative risk=1.19; P=0.007).
And fetal loss was higher in the screening-DP group than the SP group—2.6% and 1.3%, respectively (relative risk=2.06; P=0.046).
However, the risk of live adverse birth outcomes was similar between the screening-DP and SP groups—29.9% and 28.8%, respectively (relative risk=1.04, P=0.625).
The researchers said these results suggest that intermittent malaria screening and treatment with DP is not a viable strategy to replace intermittent preventive therapy with SP in malaria-endemic areas in sub-Saharan Africa, despite the high levels of resistance to SP.
Photo by Nina Matthews
A new study suggests that treating pregnant women according to the results of malaria tests does not lower the risk of adverse pregnancy outcomes when compared to treating all women prophylactically.
In fact, the screen-and-treat approach, in which women received dihydroartemisinin-piperaquine (DP) only if they tested positive for malaria, was associated with higher fetal loss and more malaria at delivery than the prophylactic approach, in which women just received treatment with sulfadoxine-pyrimethamine (SP).
This is in spite of the fact that the study was conducted in an area of high SP resistance.
Feiko ter Kuile, MD, PhD, of the Liverpool School of Tropical Medicine in the UK, and his colleagues conducted this study and detailed the results in PLOS Medicine.
During pregnancy, undetected infection with malaria parasites can lead to maternal anemia, low birthweight, and fetal loss.
Therefore, in areas where malaria is endemic, the World Health Organization recommends treating pregnant women with SP. However, in some areas, more than 90% of Plasmodium parasites are resistant to SP.
In the current study, researchers compared this standard of care to a screening approach where pregnant women were tested for malaria using rapid diagnostic tests and treated with DP only if they tested positive for the parasite.
The study included 1873 HIV-negative pregnant women treated at 3 sites in Malawi, Africa. All of the women had 3 or 4 scheduled visits in the second and third trimester, 4 to 6 weeks apart.
The women were randomized to receive SP at each visit (n=921) or to be screened for malaria at every visit and treated with DP if they tested positive (n=923).
The prevalence of malaria at delivery was higher in the screening-DP group than in the SP group—48.7% and 40.8%, respectively (relative risk=1.19; P=0.007).
And fetal loss was higher in the screening-DP group than the SP group—2.6% and 1.3%, respectively (relative risk=2.06; P=0.046).
However, the risk of live adverse birth outcomes was similar between the screening-DP and SP groups—29.9% and 28.8%, respectively (relative risk=1.04, P=0.625).
The researchers said these results suggest that intermittent malaria screening and treatment with DP is not a viable strategy to replace intermittent preventive therapy with SP in malaria-endemic areas in sub-Saharan Africa, despite the high levels of resistance to SP.