Effects of metronidazole plus intermittent preventive treatment of malaria in pregnancy on birth outcomes: a randomised controlled trial in Zambia

Current interventions in sub-Saharan Africa to reduce the burden of malaria infection and curable sexually transmitted and reproductive tract infections (STIs/RTIs) in pregnancy are inadequate. To protect against adverse pregnancy outcomes in malaria-endemic areas, the World Health Organization (WHO) recommends the provision of intermittent preventive treatment of malaria (IPTp) in pregnancy using sulphadoxine-pyrimethamine (SP). However, the loss of parasite sensitivity to SP has compromised this intervention. The WHO recommends the syndromic management of curable STIs/RTIs in low- and middle-income countries. Bacterial vaginosis (BV) and Trichomonas vaginalis (TV) are included in these guidelines. However, syndromic management fails to detect the majority of infections in women. Metronidazole (MTZ), safe during the second and third trimester of pregnancy, is curative of TV and inhibits recurrence of BV. IPTp using dihydroartemisinin-piperaquine (DP) is the leading candidate to replace IPTp-SP. A trial in Kenya showed that IPTp-DP was superior to IPTp-SP in preventing malaria-related endpoints. However, IPTp-SP was superior to IPTp-DP in reducing the incidence of low birth weight, small-for-gestational age, and preterm birth. A potential explanation is that IPTp-SP also protects against non-malarial causes of adverse pregnancy outcomes.

Three-arm trial.

Europe PMC

Drug-based Strategies
Impact of Interventions
Vulnerable Populations

Nov 2018 — Oct 2022

$3.24M

Zambia

Intermittent preventive treatment in pregnancy (IPTp)