Child Health Outcomes After Presumptive Infection Treatment in Pregnant Women: A Randomized Trial

Hallammaa, Lotta, Cheung, Yin Bun, Maleta, K, Luntamo, Mari, Ashorn, Ulla, Gladstone, MJ ORCID: 0000-0002-2579-9301, Kulmala, Teija, Mangani, Charles and Ashorn, Per (2018) Child Health Outcomes After Presumptive Infection Treatment in Pregnant Women: A Randomized Trial. Pediatrics, 141 (3). e20172459-.

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Abstract

BACKGROUND AND OBJECTIVES: We showed earlier that presumptive infection treatment in pregnancy reduced the prevalence of neonatal stunting in a rural low-income setting. In this article, we assess how these gains were sustained and reflected in childhood growth, development, and mortality. METHODS: We enrolled 1320 pregnant Malawian women in a randomized trial and treated them for malaria and other infections with either 2 doses of sulfadoxine-pyrimethamine (SP) (control), monthly SP, or monthly sulfadoxine-pyrimethamine and 2 doses of azithromycin (AZI-SP). Child height or length and mortality were recorded at 1, 6, 12, 24, 36, 48, and 60 months and development at 60 months by using Griffith’s Mental Development Scales. RESULTS: Throughout follow-up, the mean child length was 0.4 to 0.7 cm higher (P < .05 at 1–12 months), the prevalence of stunting was 6 to 11 percentage points lower (P < .05 at 12–36 months), and the 5-year cumulative incidence of stunting was 13 percentage points lower (hazard ratio: 0.70, 95% confidence interval [CI]: 0.60 to 0.83, P < .001) in the AZI-SP group than in the control group. The mean developmental score was 3.8 points higher in the AZI-SP group than in the control group (95% CI: 1.1 to 6.4, P = .005). Total mortality during pregnancy and childhood was 15.3%, 15.1%, and 13.1% (P = .60) in the control, monthly SP, and AZI-SP groups, respectively. Postneonatal mortality (secondary outcome) was 5.5%, 3.3%, and 1.9%, respectively (risk ratio of AZI-SP versus control: 0.34, 95% CI: 0.15 to 0.76, P = .008). CONCLUSIONS: Provision of AZI-SP rather than 2 doses of SP during pregnancy reduced the incidence of stunting in childhood. AZI-SP during pregnancy also had a positive effect on child development and may have reduced postneonatal mortality.

Item Type:	Article
Uncontrolled Keywords:	Humans, Pregnancy Complications, Infectious, Pregnancy Complications, Parasitic, Malaria, Fetal Death, Growth Disorders, Sulfadoxine, Azithromycin, Pyrimethamine, Drug Combinations, Anti-Bacterial Agents, Antimalarials, Incidence, Prevalence, Child Mortality, Follow-Up Studies, Child Development, Pregnancy, Adult, Child, Preschool, Infant, Rural Population, Malawi, Female, Child Health
Depositing User:	Symplectic Admin
Date Deposited:	04 Jan 2018 07:45
Last Modified:	19 Jan 2023 06:46
DOI:	10.1542/peds.2017-2459
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3015370