TY - JOUR AU - Minja, Daniel T. R. AU - Schmiegelow, Christentze AU - Mmbando, Bruno AU - Boström, Stéphanie AU - Oesterholt, Mayke AU - Magistrado, Pamela AU - Pehrson, Caroline AU - John, Davis AU - Salanti, Ali AU - Luty, Adrian J.F. AU - Lemnge, Martha AU - Theander, Thor AU - Lusingu, John AU - Alifrangis, Michael T1 - Plasmodium falciparum Mutant Haplotype Infection during Pregnancy Associated with Reduced Birthweight, Tanzania T2 - Emerging Infectious Disease journal PY - 2013 VL - 19 IS - 9 SP - 1446 SN - 1080-6059 AB - Intermittent preventive treatment during pregnancy with sulfadoxine–pyrimethamine (IPTp-SP) is a key strategy in the control of pregnancy-associated malaria. However, this strategy is compromised by widespread drug resistance from single-nucleotide polymorphisms in the Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthetase genes. During September 2008–October 2010, we monitored a cohort of 924 pregnant women in an area of Tanzania with declining malaria transmission. P. falciparum parasites were genotyped, and the effect of infecting haplotypes on birthweight was assessed. Of the genotyped parasites, 9.3%, 46.3%, and 44.4% had quadruple or less, quintuple, and sextuple mutated haplotypes, respectively. Mutant haplotypes were unrelated to SP doses. Compared with infections with the less-mutated haplotypes, infections with the sextuple haplotype mutation were associated with lower (359 g) birthweights. Continued use of the suboptimal IPTp-SP regimen should be reevaluated, and alternative strategies (e.g., intermittent screening and treatment or intermittent treatment with safe and effective alternative drugs) should be evaluated. KW - Plasmodium falciparum KW - malaria KW - mutations KW - haplotype KW - pregnancy KW - drug resistance KW - polymorphisms KW - dihydrofolate reductase KW - dihydropteroate synthetase KW - Tanzania KW - intermittent preventive treatment KW - sulfadoxine-pyrimethamine KW - sextuple KW - low birth weight KW - parasites DO - 10.3201/eid1909.130133 UR - https://wwwnc.cdc.gov/eid/article/19/9/13-0133_article ER - End of Reference