Anna M van Eijk, Peter O Ouma, John Williamson, Feiko O Ter Kuile, Monica Parise, Kephas Otieno, Mary J Hamel, John G Ayisi, Simon Kariuki, Piet A Kager, Laurence Slutsker

Abstract

Sulfadoxine-pyrimethamine (SP) inhibits folate metabolism by the malaria parasite.We investigated the association between folate levels and SP failure in pregnant women. Data from a trial to assess the effect that folate supplementation has on SP failure in 467 pregnantwomenwere analyzed.Plasma folatelevelswere determined at enrollment and at day 7. High baseline folate levels, high parasite densities, and age<20 yearswere risk factors for SP failure. High-dose (5 mg daily) folate supplementation or high folate levels at day 7 were independent risk factors. Therefore, pregnant women receiving SP should receive low-/moderatedose folate supplementation