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Maternal combined antibiotic therapy reduces childhood stunting in Africa
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Administering monthly sulfadoxine-pyrimethamine and two doses of azithromycin to combat maternal infection during pregnancy in Malawi reduces stunting by 6 to 11 percentage points, with additional improvements made in developmental scores and overall child height and length.
“To date, most public health interventions to prevent growth failure have been based on the promotion of a healthy diet and effective infection control in early childhood,” Lotta Hallamaa, MSc, from the Center for Child Health Research and the faculty of Medicine of Life Sciences at the University of Tampere, Finland, and colleagues wrote. “This approach may, however, be insufficient because linear growth retardation often commences during the fetal period.”
“Maternal dietary supplementation with energy and/or nutrients during pregnancy has in some contexts resulted in modestly increased mean birth size, but gains in infant length have typically been lost within a year after birth,” the researchers continued.
To examine how previous plausible infection in pregnant women in rural, low-income locations affected sustained childhood growth, development and mortality, the researchers conducted a randomized trial that included 1,320 Malawian women. All were treated for various infections, including malaria, with two doses of sulfadoxine-pyrimethamine (SP; control), monthly SP or monthly SP in addition to two doses of azithromycin (AZI-SP).
Hallamaa and colleagues then assessed pediatric height or length and mortality at 1, 6, 12, 24, 36, 48 and 60 months. Additionally, the researchers reported development using Griffith’s Mental Development Scales at 60 months.
For children whose mothers were administered AZI-SP, the average child length was between 0.4 and 0.7 cm higher (P < .05 at 1 to 12 months) at follow-up than those in the control group. The prevalence of stunting was lower in this cohort, with rates 6 to 11 percentage points lower at 12 to 36 months (P < .05), and the cumulative incidence of stunting over 5 years was 13 percentage points lower than in the control group (hazard ratio: 0.70; 95% CI, 0.60-0.83).
Furthermore, children of mothers who received AZI-SP scored an average of 3.8 percentage points higher concerning developmental scores than those in the control group (95% CI, 1.1-6.4), and total mortality was lowest in the AZI-SP group (SP, 15.3%; monthly SP, 15.1%; AZI-SP, 13.1%). Mortality rates of postneonatal children were also lower in children of mothers who were administered AZI-SP (SP, 5.5%; monthly SP, 3.3%; AZI-SP, 1.9%; RR of AZI-SP vs. control: 0.34; 95% CI, 0.15-0.76).
“In our trial, the prevalence of maternal peripheral malaria at 32 weeks’ gestation and at delivery, as well as the postnatal prevalence of vaginal trichomoniasis, was significantly lower in the AZI-SP group than in the control group,” Hallamaa and colleagues wrote. “Although we have little data on other infections and no data on maternal inflammation, it seems likely that the AZI-SP intervention affected fetal growth and the duration of pregnancy through its impact on infection-mediated inflammation.”
“Besides malaria and trichomoniasis, azithromycin may have affected maternal bacterial vaginosis, oral infections and chorioamnionitis, all of which are common in Malawi and associated with reduced birth size,” the researchers continued. – by Katherine Bortz
Disclosure: Hallamaa reports a grant from the Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development, through the Food and Nutrition Assistance III Project, managed by FHI 360, during the conduct of the study. All other authors report no relevant financial disclosures.
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