Background Intermittent preventive treatment in pregnancy (IPTp) with
sulfadoxine–pyrimethamine (SP) is widely implemented in sub-Saharan Africa for
the prevention of malaria in pregnancy and adverse birth outcomes. However, in
areas of intense SP resistance, the efficacy of IPTp may be compromised.
Methods A cross-sectional study among 915 delivering women (728 analysable
live singleton deliveries) was conducted in Fort Portal, western Uganda, to
assess associations of reported IPTp use, Plasmodium falciparum infection,
maternal anaemia, low birth weight, and preterm delivery, and to estimate the
degree of SP resistance as reflected by pfdhfr/pfdhps mutations. Results
Plasmodium falciparum infection was detected by PCR in 8.9 % and by microscopy
of placental blood samples in 4.0 %. Infection was significantly associated
with stillbirth, early neonatal death, anaemia, low birth weight, and pre-term
delivery. Eighty percent of the women had taken at least one dose of IPTp, and
more than half had taken two doses. As compared to women without
chemoprophylaxis against malaria, IPTp had no significant influence on the
presence of P. falciparum infection (13.8 vs. 9.6 %, P = 0.31). Nor was it
associated with reductions in anaemia, low birth weight or preterm delivery.
P. falciparum with intense SP resistance (pfdhfr/pfdhps quintuple or sextuple
mutations) were observed in 93 % (pfdhps 581G, 36 %), and the additional high
resistance allele pfhdr 164L in 36 %. Conclusions In Fort Portal, Uganda,
reported use of IPTp with SP does not provide an observable benefit. The
molecular markers of P. falciparum indicate high grade SP resistance reaching
the threshold set by WHO for the discontinuation of IPTp with SP. Alternative
approaches for the prevention of malaria in pregnancy are urgently needed