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Infection and Immunity, September 2004, p. 5027-5030, Vol. 72, No. 9
0019-9567/04/$08.00+0     DOI: 10.1128/IAI.72.9.5027-5030.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Intermittent Preventive Sulfadoxine-Pyrimethamine Treatment of Primigravidae Reduces Levels of Plasma Immunoglobulin G, Which Protects against Pregnancy-Associated Plasmodium falciparum Malaria

Trine Staalsoe,1 Caroline E Shulman,2,3 Edgar K. Dorman,3,4 Ken Kawuondo,3 Kevin Marsh,3 and Lars Hviid1*

Centre for Medical Parasitology, Department of Infectious Diseases, and Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet) and Institute for Medical Microbiology and Immunology, University of Copenhagen, Copenhagen, Denmark,1 London School of Hygiene and Tropical Medicine,2 Department of Obstetrics and Gynaecology, Homerton Hospital, London, United Kingdom,4 Centre for Geographical Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya3

Received 17 February 2004/ Returned for modification 21 March 2004/ Accepted 11 June 2004

Pregnancy-associated malaria (PAM) is an important cause of maternal and neonatal suffering. It is caused by Plasmodium falciparum capable of inhabiting the placenta through expression of particular variant surface antigens (VSA) with affinity for proteoglycans such as chondroitin sulfate A. Protective immunity to PAM develops following exposure to parasites inhabiting the placenta, and primigravidae are therefore particularly susceptible to PAM. The adverse consequences of PAM in primigravidae are preventable by intermittent preventive treatment (IPTp), where women are given antimalarials at specified intervals during pregnancy, but this may interfere with acquisition of protective PAM immunity. We found that Kenyan primigravidae receiving sulfadoxine-pyrimethamine IPTp had significantly lower levels of immunoglobulin G (IgG) with specificity for the type of parasite-encoded VSA—called VSAPAM—that specifically mediate protection against PAM than did women receiving a placebo. VSAPAM-specific IgG levels depended on the number of IPTp doses received and were sufficiently low to be of clinical concern among multidose recipients. Our data suggest that IPTp should be extended to women of all parities, in line with current World Health Organization recommendations.

* Corresponding author. Mailing address: Department of Infectious Diseases M7641, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. Phone:45 35 45 79 57. Fax:45 35 45 76 44. E-mail: lhcmp{at}rh.dk.

Editor: W. A. Petri, Jr.

Infection and Immunity, September 2004, p. 5027-5030, Vol. 72, No. 9
0019-9567/04/$08.00+0     DOI: 10.1128/IAI.72.9.5027-5030.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Rogerson, S. J., Mwapasa, V., Meshnick, S. R. (2007). Malaria in Pregnancy: Linking Immunity and Pathogenesis to Prevention. Am J Trop Med Hyg 77: 14-22 [Abstract] [Full Text]  


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