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Folic acid, the vitamin supplement prescribed for pregnant mothers for prevention
of spine and brain defects in the developing fetus, has been found to interact
with sulfadoxine-pyrimethamine (SP), a commonly used antimalaria drug. Annemieke van Eijk of the University of Amsterdam
working for PATH (Program for Appropriate Technology
in Health) and colleagues from the U.S. Centers for Disease Control and
Prevention and the Kenya Medical Research Institute carried out a randomized
trial comparing failure of anti-malarial treatment with sulfadoxine-pyrimethamine
in 415 pregnant Kenyan women. The women received either a low dose of folate, a high dose of folate or placebo tablets.
In the trial, women receiving the higher dose of folate were approximately twice
as likely to fail treatment with sulfadoxine-pyrimethamine than women receiving the low dose or
placebo. The results are published in PLoS Clinical Trials at
http://dx.doi.org/10.1371/journal.pctr.0010028. The authors
concluded that given the international recommendations, the relatively low prevalence of folate
deficiency in pregnancy, and the compromised efficacy of SP for malaria treatment
when folate 5mg is used, it is reasonable to recommend folate 0.4mg
daily for pregnant women in malarious areas in sub-Saharan Africa.
Pyrimethamine is a folate antagonist and high
doses of folic acid can interact with this drug and render it less effective, making the pregnant
mothers taking this drug to fail the treatment for malaria. Although a dose of 0.4mg of folic acid is prescribed for pregnancy, many take 5mg instead as this dose is easily available.
Many take it throughout pregnancy as it can also prevent folate deficiency anemia. Pregnant
women are particularly vulnerable to malaria as pregnancy reduces their immunity,
making them more susceptible to infection and increasing the risk of illness,
severe anaemia and death. For the unborn child maternal malaria is a leading
cause of mortality - it increases the
risk of abortion, stillbirth, premature delivery and low birth weight. Up to 200,000 newborns die each year as a result of
malaria in pregnancy. For these reasons, the World Health Organization recommends
malaria drugs to prevent and treat malaria in pregnant women.
Sources:
- http://dx.doi.org/10.1371/journal.pctr.0010028
- http://news.bbc.co.uk/1/hi/health/6067450.stm
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http://www.upi.com/ConsumerHealthDaily/view.php?StoryID=20061020-035858-9686r
- http://allafrica.com/stories/200610200741.html
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