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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.

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".

Andrew Hyde | alfa
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