背景:使用磺胺多辛-乙胺嘧啶(IPTp-SP)的妊娠期间歇性预防性治疗可减少疟疾引起的不良妊娠结局,还可以通过独立于疟疾的机制预防低出生体重(<2,500g)。巴布亚新几内亚(PNG)的疟疾传播是高度异质性的。在疟疾传播很少或没有传播的环境中,IPTp-SP对不良出生结局的影响,比如PNG的首都莫尔兹比港,是未知的。
方法:对2022年7月18日至8月21日在莫尔兹比港综合医院分娩的单胎妊娠HIV阴性妇女进行了回顾性队列研究。使用logistic和线性回归模型评估IPTp-SP剂量对不良出生结局和贫血的影响。视情况而定。
结果:在1,228个连续出生的1,140名合格妇女中,1,110例活产,有记录的出生体重。共有156名妇女(13.7%)没有接受任何IPTp-SP,347名妇女(30.4%)获得了一项,333(29.2%)收到两个,304例(26.7%)接受了推荐的≥3剂量的IPTp-SP。在1,110例出生婴儿中,共有65例(5.9%)出生体重低,围产期死亡34例(3.0%)。在30.6%(243/793)的妇女中观察到贫血(血红蛋白<100g/L),14人(1.2%)在怀孕期间有临床疟疾。与接受0-1剂量IPTp-SP的女性相比,接受≥2次剂量的女性LBW的几率较低(调整后的比值比[aOR]0.50;95%置信区间[CI]0.26,0.96),早产(aOR0.58;95%CI0.32,1.04),围产期死亡(aOR0.49;95%CI0.18,1.38),LBW/围产期死亡(aOR0.55;95%CI0.27,1.12),贫血(OR0.50;95%CI0.36,0.69)。接受2剂与0-1剂相比,女性LBW的几率降低了45%(aOR0.55,95%CI0.27,1.10),且在≥3次剂量下进一步减少16%(总计61%)(aOR0.39,95%CI0.14,1.05)。与0-1相比,接受2次或≥3次剂量的女性的出生体重高81g(95%CI-3,166),和151克(58,246)高,分别。
结论:在PNG低疟疾传播环境中提供IPTp-SP似乎可以转化为实质性的健康益处,以剂量反应的方式,支持在PNG的所有传输设置中加强IPTp-SP摄取。
BACKGROUND: Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) reduces malaria-attributable adverse pregnancy outcomes and may also prevent low birth weight (< 2,500 g) through mechanisms independent of malaria. Malaria transmission in Papua New Guinea (PNG) is highly heterogeneous. The impact of IPTp-SP on adverse birth outcomes in settings with little or no malaria transmission, such as PNG\'s capital city Port Moresby, is unknown.
METHODS: A retrospective cohort study was conducted amongst HIV-negative women with a singleton pregnancy who delivered at Port Moresby General Hospital between 18 July and 21 August 2022. The impact of IPTp-SP doses on adverse birth outcomes and anaemia was assessed using logistic and linear regression models, as appropriate.
RESULTS: Of 1,140 eligible women amongst 1,228 consecutive births, 1,110 had a live birth with a documented birth weight. A total of 156 women (13.7%) did not receive any IPTp-SP, 347 women (30.4%) received one, 333 (29.2%) received two, and 304 (26.7%) received the recommended ≥ 3 doses of IPTp-SP. A total of 65 of 1,110 liveborn babies (5.9%) had low birth weight and there were 34 perinatal deaths (3.0%). Anaemia (haemoglobin < 100 g/L) was observed in 30.6% (243/793) of women, and 14 (1.2%) had clinical malaria in pregnancy. Compared to women receiving 0-1 dose of IPTp-SP, women receiving ≥ 2 doses had lower odds of LBW (adjusted odds ratio [aOR] 0.50; 95% confidence interval [CI] 0.26, 0.96), preterm birth (aOR 0.58; 95% CI 0.32, 1.04), perinatal death (aOR 0.49; 95% CI 0.18, 1.38), LBW/perinatal death (aOR 0.55; 95% CI 0.27, 1.12), and anaemia (OR 0.50; 95% CI 0.36, 0.69). Women who received 2 doses versus 0-1 had 45% lower odds of LBW (aOR 0.55, 95% CI 0.27, 1.10), and a 16% further (total 61%) reduction with ≥ 3 doses (aOR 0.39, 95% CI 0.14, 1.05). Birth weights for women who received 2 or ≥ 3 doses versus 0-1 were 81 g (95% CI -3, 166) higher, and 151 g (58, 246) higher, respectively.
CONCLUSIONS: Provision of IPTp-SP in a low malaria-transmission setting in PNG appears to translate into substantial health benefits, in a dose-response manner, supporting the strengthening IPTp-SP uptake across all transmission settings in PNG.