Child Health Outcomes After Presumptive Infection Treatment in Pregnant Women: A Randomized Trial

BACKGROUND AND OBJECTIVES: We showed earlier that presumptive infection treatment in pregnancy reduced the prevalence of neonatal stunting in a rural low-income setting. In this article, we assess how these gains were sustained and reflected in childhood growth, development, and mortality. METHODS: We enrolled 1320 pregnant Malawian women in a randomized trial and treated them for malaria and other infections with either 2 doses of sulfadoxine-pyrimethamine (SP) (control), monthly SP, or monthly sulfadoxine-pyrimethamine and 2 doses of azithromycin (AZI-SP). Child height or length and mortality were recorded at 1, 6, 12, 24, 36, 48, and 60 months and development at 60 months by using Griffith’s Mental Development Scales. RESULTS: Throughout follow-up, the mean child length was 0.4 to 0.7 cm higher ( P P P P = .005). Total mortality during pregnancy and childhood was 15.3%, 15.1%, and 13.1% ( P = .60) in the control, monthly SP, and AZI-SP groups, respectively. Postneonatal mortality (secondary outcome) was 5.5%, 3.3%, and 1.9%, respectively (risk ratio of AZI-SP versus control: 0.34, 95% CI: 0.15 to 0.76, P = .008). CONCLUSIONS: Provision of AZI-SP rather than 2 doses of SP during pregnancy reduced the incidence of stunting in childhood. AZI-SP during pregnancy also had a positive effect on child development and may have reduced postneonatal mortality.