Impact of folate supplementation on the efficacy of sulfadoxine/pyrimethamine in preventing malaria in pregnancy: the potential of 5-methyl-tetrahydrofolate.
Citation:
Nzila A, Okombo J, Molloy AM, Impact of folate supplementation on the efficacy of sulfadoxine/pyrimethamine in preventing malaria in pregnancy: the potential of 5-methyl-tetrahydrofolate., Journal of Antimicrobial Chemotherapy, 69, 2, 2014, 323 - 330Download Item:
Abstract:
Malaria remains the leading cause of mortality and morbidity in children under the age of 5 years and pregnant
women. To counterbalance the malaria burden in pregnancy, an intermittent preventive treatment strategy has
been developed. This is based on the use of the antifolatesulfadoxine/pyrimethamine, taken at specified intervals
duringpregnancy,andreportsshowthatthisapproachreducesthemalariaburdeninpregnancy.Pregnancyisalso
associated with the risk of neural tube defects (NTDs), especially in women with low folate status, and folic acid
supplementation is recommended in pregnancy to lower the risk of NTDs. Thus, in malaria-endemic areas, preg-
nant women have to take both antifolate medication to prevent malaria and folic acid to lower the risk of NTDs.
However,theconcomitantuseoffolateandantifolateisassociatedwithadecreaseinantifolateefficacy,exposing
pregnant women to malaria. Thus, there is genuine concern that this strategy may not be appropriate. We have
reviewedworkcarriedoutonmalariafolatemetabolismandantifolateefficacyinthecontextoffolatesupplemen-
tation. This review shows that: (i) the folate supplementation effect on antifolate efficacy is dose-dependent, and
folic acid doses required to protect pregnant women from NTDs will not decrease antifolate activity; and (ii) 5-
methyl-tetrahydrofolate, the predominant form of folate in the blood circulation, could be administered (even
at high dose) concomitantly with antifolate without affecting antifolate efficacy. Thus, strategies exist to
protect pregnant women from malaria while maintaining adequate folate levels in the body to reduce the
occurrence of NTDs.
Author's Homepage:
http://people.tcd.ie/amolloyDescription:
PUBLISHED
Author: MOLLOY, ANNE
Type of material:
Journal ArticleCollections
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Journal of Antimicrobial Chemotherapy69
2
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folateSubject (TCD):
International DevelopmentDOI:
http://dx.doi.org/10.1093/jac/dkt394Metadata
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