Moya-Alvarez V., Ouedraogo S., Accrombessi M., Cot Michel. (2018). High folate levels are not associated with increased malaria risk but with reduced anaemia rates in the context of high-dosed folate supplements and intermittent preventive treatment against malaria in pregnancy with sulphadoxine-pyrimethamine in Benin. Tropical Medicine and International Health, 23 (6), p. 582-588. ISSN 1360-2276.
Auteurs
Moya-Alvarez V., Ouedraogo S., Accrombessi M., Cot Michel
Source
Tropical Medicine and International Health, 2018,
23 (6), p. 582-588 ISSN 1360-2276
ObjectivesTo investigate whether high-dosed folate supplements might diminish the efficacy of malaria intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) in a cohort of pregnant women in Benin, where malaria is holoendemic. MethodsWe followed 318 women during the entire pregnancy and analysed haematological and Plasmodium falciparum indicators in the context of an intermittent preventive treatment trial in Benin. During the follow-up, women received two-dose IPTp (1500/75 mg of SP per dose) at the maternity clinic and 600 mg of albendazole, 200 mg ferrous sulphate and 5 mg folic acid per day for home treatment. ResultsHigh folate levels were not associated with increased malaria risk (adjusted OR (aOR) = 0.51 (95% CI: 0.17; 1.56, P-value = 0.24)), nor with increased P. falciparum density (beta coefficient = -0.26 (95% CI: -0.53; 0.02), P-value = 0.07) in a randomised trial of IPTp in Benin. On the contrary, higher iron levels were statistically associated with increased odds of a positive blood smear (aOR = 1.7 95% CI (1.2; 2.3), P-value < 0.001) and P. falciparum parasite density (beta coefficient = 0.2 95% CI (0.1; 0.3), P-value < 0.001). High folate levels were statistically associated with decreased odds of anaemia (aOR = -0.30 95% CI (0.10; 0.88), P-value = 0.03). ConclusionsHigh folate levels are not associated with increased malarial risk in a prospective longitudinal cohort in the context of both iron and high-dosed folate supplements and IPTp. They are associated with reduced risk of anaemia, which is particularly important because iron, also given to treat anaemia, might be associated with increased malaria risk. Abstract ObjectifsExaminer si des supplements de folates a forte dose pourraient diminuer l'efficacite du traitement preventif intermittent du paludisme pendant la grossesse (TPIg) par la sulfadoxine- pyrimethamine (SP) dans une cohorte de femmes enceintes au Benin, oU le paludisme est holoendemique. MethodesNous avons suivi 318 femmes pendant toute la grossesse et analyse les indicateurs hematologiques et de P. falciparum dans le cadre d'un essai de traitement preventif intermittent au Benin. Durant le suivi, les femmes ont recu deux doses de TPIg (1500/75 mg de SP par dose) a la clinique de maternite et 600 mg d'albendazole, 200 mg de sulfate ferreux et 5 mg d'acide folique par jour pour le traitement a domicile. ResultatsDes taux eleves de folates n'etaient pas associes a un risque accru de paludisme (OR ajuste (ORa) = 0,51; IC95%: 0,17; 1,56; p = 0,24), ni a une augmentation de la densite de P. falciparum (coefficient beta = -0,26; IC95%: -0,53; 0,02; p = 0,07) dans un essai randomise de TPIg au Benin. Par contre, des niveaux de fer plus eleves etaient statistiquement associes a une augmentation de la probabilite d'un frottis sanguin positif (ORa = 1,7; IC95%: 1,2- 2,3; p <0,001) et de la densite parasitaire de P. falciparum (coefficient beta = 0,2; IC95%: 0,1-0,3; p <0,001). Les taux eleves de folates etaient statistiquement associes a une diminution de la probabilite d'anemie (ORa = -0,30; IC95%: 0,10; 0,88; p = 0,03). ConclusionsLes niveaux eleves de folates ne sont pas associes a une augmentation du risque de paludisme dans une cohorte longitudinale prospective dans le contexte de supplements de fer et de folates a forte dose et du TPIg. Ils sont associes a un risque reduit d'anemie, ce qui est particulierement important puisque le fer, egalement administre pour traiter l'anemie, pourrait etre associe a un risque accru de paludisme.
