Pregnant women and their unborn children are particularly vulnerable to malaria: the women because they may develop lethal anemia, and the babies because infected red blood cells tend to clump in the placenta, robbing the fetus of nutrients.
In Africa, about 30 million women a year become pregnant in areas where falciparum malaria — the most dangerous kind — is common.
To protect them, health agencies use “intermittent preventive treatment,” or I.P.T., under which all pregnant women in such areas are given doses of anti-malarial drugs at regular intervals, whether or not they are tested for the disease.
But malaria fighters sharply disagree over how to do it, and a study recently published by The New England Journal of Medicine adds fuel to the debate.
To cure malaria, virtually everyone in the field uses two-drug cocktails containing artemisinin, a derivative of the sweet wormwood plant.
But for preventing malaria in pregnant women, the World Health Organization recommends only an older drug combination, sulfadoxine-pyrimethamine — also known as Fansidar — even though resistance to it is spreading in Africa.
The new study, led by scientists from Uganda and the University of California, San Francisco, found that women who received sulfadoxine-pyrimethamine for prevention were much more likely to develop malaria symptoms during pregnancy and to have parasites in the placenta when their babies were born.
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