The dosage of antimalarial medication has an effect on birth weight in Africa
Per Ashorn, Professor of International Health at the University of Tampere (Photograph: Teemu Launis).An international research has just shown how the dosage of antimalarial medication affects the birth weight of babies in Africa. If the mother is treated for malaria during the pregnancy, the child’s birth weight increases and the risk of low birth weight becomes smaller. According to the research this effect is achieved by the dosage of the medication: the positive effects are achieved by three intermittent dosages instead of the two doses that are now commonly recommended.
The research was led by Professor Feiko ter Kuile from the Liverpool School of Tropical Medicine. Professor Per Ashorn and his research team from the University of Tampere participated in the research. Professor Ashorn’s team has conducted research into the effects of malaria on pregnant women and child health for a long time already.
About 20 million pregnant women are exposed to malaria every year and a large share of the exposed get malaria which is a health risk to both the mother and the child.
“Because it is often quite difficult to make a malaria diagnosis many countries have considered or are presently already giving a preventive drug to all pregnant mothers,” says Professor Per Ashorn.
Professor Ashorn thinks that it is likely that these results will change the World Health Organization guideline on the prevention of malaria during pregnancy in Africa.
“Our new research results will help to choose the proper frequency of doses of preventive antimalarial therapy during pregnancy,” Ashorn says.
The research results were published in the Journal of American Medical Association on 13 February 2013.
The doses must be taken more frequently
The researchers did a meta-analysis of previous research on 6,281 pregnancies. The analysis showed that the risk of having a baby with low birth weight was 20 per cent smaller in the women who got the preventive antimalarial medication three or more times.
The average birth weight of the babies was 60 grams higher in the group of mothers who received three or more doses of the medication. The researchers also reported that the mothers who got three or more doses of the drug had a lower risk of placental malaria.
Intermittent preventive therapy with sulfadoxine-pyrimethamine to control malaria during pregnancy is used in 37 countries in sub-Saharan Africa and the medication is given in intermittent doses. 31 countries recommend two doses. The researchers estimate that two doses are not necessarily enough to protect from malaria in the 4-10 last weeks of the pregnancy which is a pivotal time for foetal weight gain. Furthermore, increased sulfadoxine-pyrimethamine resistance has been observed in Africa which results in a progressive decrease of the duration of the preventive effect, which also speaks for more frequent dosing.
Infections and malnutrition cause concern
If an intermittent antimalarial therapy is recommended in a country, WHO advises that it should be administered during all visits to the ante-natal clinic in the second and third trimester of the pregnancy. The researchers are next going to analyse how the WHO recommendation would best be implemented and how the therapy should be administered during the visits to the ante-natal clinic. The researchers are also interested in the growing resistance to antimalarial therapy.
Per Ashorn’s research group is especially interested in the combined effect of malaria, other infections and malnutrition on the health of the mother, the foetus and the child.
“Our research group is engaged in several international research consortiums. In the near future, our aim is to start 1-2 therapy experiments testing the possibilities for reducing the mother’s and the child’s infections and to improve nutrition.”
For more information please contact
Professor Per Ashorn
per.ashorn@uta.fi
