CAN MALARIA CHEMOPROPHYLAXIS BE RESTRICTED TO FIRST PREGNANCIES

The harmful effects of malaria are most pronounced during first pregna ncies and chemoprophylaxis is most effective when given at this time. However, restriction of chemoprophylaxis to first pregnancies might le ad to enhanced susceptibility to malaria during second pregnancies. We have investigated this possibility by studying the outcome of second pregnancies in 165 Gambian women who had received either malaria chemo prophylaxis with Maloprim(R) or placebo during their first pregnancy. Many of these primigravidae did not present until the third trimester of pregnancy so that some are likely to have experienced a malaria inf ection before they started medication. The prevalence of malaria infec tion of the blood and of the placenta during second pregnancies was si milar in women who had received chemoprophylaxis during their first pr egnancy and in those who had not, and the mean birth weights of babies born to women in each group were almost identical. Thus, in areas whe re the epidemiology of malaria is similar to that of The Gambia and wh ere most women present relatively late in pregnancy, it may be possibl e to restrict malaria chemoprophylaxis to first pregnancies with conse quent savings in cost and a reduction in drug pressure on Plasmodium f alciparum.