Folate supplement interacts with malaria treatment in pregnant women

Most health authorities worldwide have recommendations that pregnant women supplement their diet with folate, a B-vitamin, in order to protect against neural tube defects in the baby and possibly reduce the likelihood of anemia in mothers. However until now it has not been clear whether folate supplementation might interact with certain antimalarial drugs which are commonly used to treat and / or prevent malaria infection. In some African countries, folate is commonly given at a higher dose than generally recommended because this dose is more easily available. Annemieke van Eijk, from the University of Amsterdam, and her colleagues from the Centers for Disease Control and the Kenya Medical Research Institute, therefore carried out a randomized trial, comparing failure of antimalarial treatment with a drug called sulfadoxine-pyrimethamine, in 415 pregnant Kenyan women. The women then received either a low dose of folate, a high dose of folate (currently recommended in Kenya for pregnant women), or placebo tablets. In the trial, women receiving the higher dose of folate were approximately twice as likely to fail treatment with sulfadoxine-pyrimethamine than women receiving the low dose, or placebo.

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Author comment:

This is important information for countries using sulfadoxine-pyrimethamine for the treatment or prevention of malaria in pregnancy. Because of the increased treatment failure of sulfadoxine pyrimethamine for malaria when it is given with high daily doses of folate (such as 5 mg), this kind of dosage should be avoided in the antenatal clinics of these countries. National malaria programs and programs for reproductive health should evaluate the need to change their national policies for folate supplementation during pregnancy. This information needs to be widely and freely available; for this reason we chose PLoS Clinical Trials for publication.

The results are published in PLoS Clinical Trials, an open-access journal that aims to increase the reporting of clinical trials. José Belizan, from the Institute for Clinical Effectiveness, Argentina, an editorial board member for PLoS Clinical Trials, comments: "As a result of trials conducted in the last three to four decades, many aspects of maternal care are now evidence-based. However, others in use still lack rigorous evaluation, and we need innovative, proven practices to improve outcomes for mothers and children. PLoS Clinical Trials represents a unique forum where new and challenging trials will be published, including those from developing countries".

Citation: Ouma P, Parise ME, Hamel MJ, ter Kuile FO, Otieno K, et al. (2006) A randomized controlled trial of folate supplementation when treating malaria in pregnancy with sulfadoxine-pyrimethamine. PLoS Clin Trials 1(6): e28.

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pctr.0010028

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plct-01-06-van_eijk.pdf

Related image for press use: http://www.plos.org/press/plct-01-06-van_eijk.jpg

Caption: Anopheles gambiae mosquito feeding – (Photo: James Gathany)

CONTACT:

Annamieke van Eijk
University of Amsterdam
Department of Infectious Diseases, Tropical Medicine and AIDS
172 Herbert Chitepo
Harare
Zimbabwe
+263-4-302971
+263-4-796032 (fax)
vaneijka@zimcdc.co.zw

About PLoS Clinical Trials

PLoS Clinical Trials is an open access, freely available international medical journal. The journal's goal is to broaden the scope of clinical trials reporting by peer-reviewing and publishing the results of all randomized trials that are ethically and scientifically sound, irrespective of the trial's outcome. PLoS Clinical Trials aims to increase the accuracy and completeness of the evidence base for clinical decision-making. For more information see http://www.plosclinicaltrials.org.

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org


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