Volume 74, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Folic acid is frequently given to pregnant women at the same time as intermittent preventive treatment (IPTp) with sulfadoxine/pyrimethamine (SP), but it is not known if it interferes with the anti-malarial activity of SP. To investigate this concern, 1,035 Gambian primigravidae were randomized to receive either folic acid (500–1,500 μg/day) together with oral iron (522) or oral iron alone (513) for 14 days at the same time as they received IPTp with SP. On presentation, 261 women (25%) had asexual parasitemia. Prevalences of parasitemia on day 14 after treatment were similar in both groups: 5.7% (26 of 458) in the iron plus folic acid group and 4.9% (22 of 446) in the iron alone group (risk difference = 0.74%, 95% confidence interval [CI] = −2.2% to 3.7%). Parasitologic cure was observed in 116 (91%) of 128 of women who were parasitemic on presentation and who received iron and folic acid and in 122 (92%) of 133 women who received iron alone (difference = 1.1%, 95% CI = −5.6% to 8.0%). Women who received folic acid and iron had a slightly higher mean hemoglobin concentration at day 14 than women who had received iron alone (difference = 0.14 g/dL, 95% CI = 0.01–0.27 g/dL). The results of this study suggest that in an area of low SP resistance, administration of folic acid to pregnant women in a dose of 500–1,500 μg/day will not interfere with the protective effect of SP when used for IPTp.


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  1. Brabin BJ, 1991. The risk and severity of malaria in pregnant women. Applied Field Research in Malaria Reports 1. Geneva: World Health Organization.
  2. Menendez C, 1995. Malaria during pregnancy: a priority area of malaria research and control. Parasitol Today 2 : 178–183. [Google Scholar]
  3. Guyatt HL, Snow RW, 2001. Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa. Trans R Soc Trop Med Hyg 95 : 569–576. [Google Scholar]
  4. ter Kuile FO, Terlouw DJ, Phillips-Howard PA, Hawley WA, Friedman JF, Kariuki SK, Shi YP, Kolczak MS, Lal AA, Vulule JM, Nahlen BL, 2003. Reduction of malaria during pregnancy by permethrintreated bed nets in an area of intense perennial malaria transmission in Western Kenya. Am J Trop Med Hyg 68 (Suppl 4): 50–60. [Google Scholar]
  5. Schultz LJ, Steketee RW, Macheso A, Kazembe P, Chitsulo I, Wirima JJ, 1994. The efficacy of antimalarial regimens containing sulfadoxine-pyrimethamine and/or chloroquine in preventing peripheral and placental Plasmodium falciparum infection amongst pregnant women in Malawi. Am J Trop Med Hyg 51 : 515–522. [Google Scholar]
  6. Parise ME, Ayisi JG, Nahlen BL, Schultz LJ, Roberts JM, Misore A, Muga R, Oloo AJ, Steketee RW, 1998. Efficacy of sulfa-doxine pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection. Am J Trop Med Hyg 59 : 813–822. [Google Scholar]
  7. Shulman CE, Dorman EK, Cutts F, Kawuondo K, Bulmer JN, Peshu N, Marsh K, 1998. Intermittent sulphadoxine-pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial. Lancet 353 : 632–636. [Google Scholar]
  8. Rogerson SJ, Chaluluka E, Kanjala M, Mkundika P, Mhango C, Molyneux ME, 2000. Intermittent sulfadoxine-pyrimethamine in pregnancy: effectiveness against malaria morbidity in Blantyre, Malawi, in 1997–1999. Trans R Soc Trop Med Hyg 94 : 549–553. [Google Scholar]
  9. Greenwood BM, Bradley AK, Greenwood AM, Byass P, Jammeh K, Marsh K, Tulloch S, Oldfield FSJ, Hayes R, 1987. Mortality and morbidity from malaria among children in a rural area of the Gambia, West Africa. Trans R Soc Trop Med Hyg 81 : 478–486. [Google Scholar]
  10. Nacher M, McGready R, Stepniewska K, Cho T, Looareesuwan S, White NJ, Nosten F, 2003. Haematinic treatment of anaemia increases the risk of Plasmodium vivax malaria in pregnancy. Trans R Soc Trop Med Hyg 97 : 273–276. [Google Scholar]
  11. Boele van Hensbroek M, Morris-Jones S, Meisner S, Jaffar SB, Dackour R, Phillips C, Greenwood BM, 1995. Iron, but not folic acid, combined with effective antimalarial therapy promotes haematological recovery in African children with acute falciparum malaria. Trans R Soc Trop Med Hyg 89 : 672–676. [Google Scholar]
  12. Carter JY, Loolpapit MP, Lema OE, Tome JL, Nagelkerke NJD, Watkins WM, 2005. Folic acid supplementation reduces the efficacy of antifolate antimalarial therapy. Am J Trop Med Hyg 73 : 166–170. [Google Scholar]
  13. Hyde JE, 2005. Exploring the folate pathway in Plasmodium falciparum. Acta Trop 94 : 191–206. [Google Scholar]
  14. Fleming AF, 1989. Tropical obstetrics and gynaecology. 1. Anaemia in pregnancy in tropical Africa. Trans R Soc Trop Med Hyg 83 : 441–448. [Google Scholar]
  15. Shulman CE, Graham WJ, Jilo H, Lowe BS, New L, Obiero J, Snow RW, Marsh K, 1996. Malaria is an important cause of anaemia in primigravidae: evidence from a district hospital in Kenya. Trans R Soc Trop Med Hyg 90 : 535–539. [Google Scholar]
  16. Hamilton PJS, Gebbie DAM, Wilks NE, Lothe F, 1972. The role of malaria, folic acid deficiency and haemoglobin AS in pregnancy at Mulago Hospital. Trans R Soc Trop Med Hyg 66 : 594–602. [Google Scholar]
  17. Fleming AF, Ghatoura GBS, Harrison KA, Briggs ND, Dunn DT, 1986. The prevention of anaemia in pregnancy in primigravidae in the guineas savanna of Nigeria. Ann Trop Med Parasitol 80 : 211–233. [Google Scholar]

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  • Received : 19 Aug 2005
  • Accepted : 23 Feb 2006

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