Child growth and neurodevelopment after maternal antenatal antibiotic treatment

Karoliina Videman, Lotta Hallamaa, Otto Heimonen, Charles Mangani, Mari Luntamo, Kenneth Maleta, Per Ashorn, Ulla Ashorn, Karoliina Videman, Lotta Hallamaa, Otto Heimonen, Charles Mangani, Mari Luntamo, Kenneth Maleta, Per Ashorn, Ulla Ashorn

Abstract

Objective: To assess whether intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine (SP) and azithromycin (AZI) in a malaria-endemic area leads to sustained gains in linear growth and development in their offspring.

Design: Follow-up study of a randomised trial.

Setting: Mangochi District in rural southern Malawi.

Participants: 1320 pregnant women and their offspring.

Interventions: IPTp monthly with SP and twice with AZI (AZI-SP group), monthly with SP but no AZI (monthly SP), or twice with SP (control). No intervention was given to children.

Main outcome measures: Cognitive performance using Raven's Coloured Progressive Matrices (CPM) at 13 years of age; mean height and height-for-age Z-score (HAZ), cumulative incidence and prevalence of stunting (HAZ <-2); weight, body mass index, mid-upper-arm circumference and head circumference.

Results: At approximately 13 years of age, the mean CPM score was 14.3 (SD 3.8, range 6-29, maximum 36), with no differences between groups. Children in the AZI-SP group were on average 0.4 cm (95% CI -0.9 to 1.7, p=0.6) taller than those in the control group. For cumulative incidence of stunting, the HR in the AZI-SP group was 0.72 (95% CI 0.61 to 0.84, p<0.001) compared with the control and 0.76 (95% CI 0.65 to 0.90, p<0.001) compared with the monthly SP groups. There was no intergroup difference in stunting prevalence or anthropometric measurements.

Conclusions: In rural Malawi, maternal intensified infection control during pregnancy reduces offspring's cumulative incidence of ever being stunted by 13 years of age. In this study, there was no evidence of a positive impact on cognitive performance.

Trial registration number: NCT00131235.

Keywords: adolescent health; child development; growth; neurology.

Conflict of interest statement

Competing interests: KV: grant from the Foundation for Pediatric Research during the conduct of the study.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Follow-up of live-born children. Figure created by the authors. AZI-SP, intervention group with monthly SP and two doses of azithromycin; BMI, body mass index; SP, sulfadoxine-pyrimethamine.
Figure 2
Figure 2
Differences between means in the AZI-SP and control groups and 95% CI in height; measurement points from 1 month to approximately 13 years. Figure created by the authors. AZI-SP, intervention group with monthly sulfadoxine-pyrimethamine and two doses of azithromycin.
Figure 3
Figure 3
Cumulative incidence of stunting (HAZ

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