20/10/06

Folic acid for pregnancy affects malaria treatment

Many African countries use high doses of folic acid because they are easy to obtain Copyright: NIH

By: Zablon Odhiambo

We encourage you to republish this article online and in print, it’s free under our creative commons attribution license, but please follow some simple guidelines:

You have to credit our authors.
You have to credit SciDev.Net — where possible include our logo with a link back to the original article.
You can simply run the first few lines of the article and then add: “Read the full article on SciDev.Net” containing a link back to the original article.
If you want to also take images published in this story you will need to confirm with the original source if you're licensed to use them.
The easiest way to get the article on your site is to embed the code below.

For more information view our media page and republishing guidelines.

The full article is available here as HTML.

Press Ctrl-C to copy

<div class="article-wrap">
<div id="article-introduction">
<h1>Folic acid for pregnancy affects malaria treatment</h1>
<h4>By: Zablon Odhiambo</h4>
</div>
<br />
<br />

<div id="article-body">
<p><P>Trials in pregnant women in Kenya show that combining the standard malaria drug for pregnant women with high doses of folic acid make the malaria treatment twice as likely to fail. </P><br />
<P>The findings, published in PLoS Clinical Trials yesterday (19 October), could mean that countries using Sulfadoxine pyrimethamine (SP) to treat malaria in pregnancy may need to reconsider their national guidelines for folic acid supplementation.</P><br />
<P>Health authorities worldwide recommend that pregnant women supplement their diet with 0.4 milligram (mg) of folic acid every day to protect against neural tube defects in the developing foetus, and possibly reduce the likelihood of anaemia in the mother. </P><br />
<P>But many African countries, including Kenya, use a higher dose of 5mg, as these tablets are more easily available.</P><br />
<P>The trials in western Kenya involved 415 pregnant women infected with the most common malaria parasite, <EM>Plasmodium falciparum</EM>. </P><br />
<P>They were given the standard dose of SP, together with a 14-day supply of either a high dose of folic acid at 5mg, a low dose of 0.4mg, or a placebo. </P><br />
<P>In the women receiving the higher dose of folic acid, the malaria treatment was approximately twice as likely to fail compared to women receiving a low dose or placebo. </P><br />
<P>The research team, led by Anna van Eijk of PATH (Program for Appropriate Technology in Health), urge countries using SP for malaria treatment or prevention in pregnancy to evaluate their antenatal policy on the timing or dose of folic supplementation. </P><br />
<P>The head of the Department of Malaria Control at Kenya’s Ministry of Health, Willis Akhwale, says his department will keenly study the trial’s findings to inform policy formulation. </P><br />
<P>Geoffrey Targett of the Department of Infectious and Tropical Diseases at the London School of Hygiene and Tropical Medicine, United Kingdom says the research deals with an important question, partly because there is uncertainty about best practice in malarial countries.</P><br />
<P>A complicating factor is that SP is becoming less effective in East Africa as people’s resistance to the drug grows. Targett cautions that this “will probably play a part in the interaction between folic acid and SP. It is only a matter of time before SP resistance becomes too high to make the drug sufficiently effective”.</P><br />
<P>He says a study in Gambia found that a low dose of folic acid plus iron proved beneficial and did not inhibit the anti-malarial action of SP in pregnant women, showing that “there are benefits from its use at a lower dose”.</P><br />
<P><a  href="http://dx.doi.org/10.1371/journal.pctr.0010028" target="_blank" onclick="pageTracker._trackPageview('/tracking/external/'+this.href);" rel="noopener noreferrer">Link to full paper in PLoS Clinical Trials</A><BR><BR>Reference: PLoS Clinical Trials doi: 10.1371/journal.pctr.0010028 (2006)<BR><BR></P></p>

</div>
<div class="quick-links-wrapper">
<h3>You might also like</h3>
[related-articles]
</div>
<p>This article was originally published on <a href="https://www.scidev.net" target="_blank">SciDev.Net</a>. Read the <a href="https://www.scidev.net/global/news/folic-acid-for-pregnancy-affects-malaria-treatment/" target="_blank">original article</a>.</p>
<script type="text/javascript">
(function(e,t,n,r,i,s,o){e["GoogleAnalyticsObject"]=i;e[i]=e[i]||function(){(e[i].q=e[i].q||[]).push(arguments)},e[i].l=1*new Date;s=t.createElement(n),o=t.getElementsByTagName(n)[0];s.async=1;s.src=r;o.parentNode.insertBefore(s,o)})(window,document,"script","//www.google-analytics.com/ga.js","ga");var _gaq=_gaq||[];var _gaq=_gaq||[];_gaq.push(["_setAccount","UA-3223906-8"],["_trackEvent","article interaction","republished","https://www.scidev.net/global/news/folic-acid-for-pregnancy-affects-malaria-treatment/",null,true])
</script>
</div>

Trials in pregnant women in Kenya show that combining the standard malaria drug for pregnant women with high doses of folic acid make the malaria treatment twice as likely to fail.

The findings, published in PLoS Clinical Trials yesterday (19 October), could mean that countries using Sulfadoxine pyrimethamine (SP) to treat malaria in pregnancy may need to reconsider their national guidelines for folic acid supplementation.

Health authorities worldwide recommend that pregnant women supplement their diet with 0.4 milligram (mg) of folic acid every day to protect against neural tube defects in the developing foetus, and possibly reduce the likelihood of anaemia in the mother.

But many African countries, including Kenya, use a higher dose of 5mg, as these tablets are more easily available.

The trials in western Kenya involved 415 pregnant women infected with the most common malaria parasite, Plasmodium falciparum.

They were given the standard dose of SP, together with a 14-day supply of either a high dose of folic acid at 5mg, a low dose of 0.4mg, or a placebo.

In the women receiving the higher dose of folic acid, the malaria treatment was approximately twice as likely to fail compared to women receiving a low dose or placebo.

The research team, led by Anna van Eijk of PATH (Program for Appropriate Technology in Health), urge countries using SP for malaria treatment or prevention in pregnancy to evaluate their antenatal policy on the timing or dose of folic supplementation.

The head of the Department of Malaria Control at Kenya’s Ministry of Health, Willis Akhwale, says his department will keenly study the trial’s findings to inform policy formulation.

Geoffrey Targett of the Department of Infectious and Tropical Diseases at the London School of Hygiene and Tropical Medicine, United Kingdom says the research deals with an important question, partly because there is uncertainty about best practice in malarial countries.

A complicating factor is that SP is becoming less effective in East Africa as people’s resistance to the drug grows. Targett cautions that this “will probably play a part in the interaction between folic acid and SP. It is only a matter of time before SP resistance becomes too high to make the drug sufficiently effective”.

He says a study in Gambia found that a low dose of folic acid plus iron proved beneficial and did not inhibit the anti-malarial action of SP in pregnant women, showing that “there are benefits from its use at a lower dose”.

Link to full paper in PLoS Clinical Trials

Reference: PLoS Clinical Trials doi: 10.1371/journal.pctr.0010028 (2006)