• To assess whether intermittent treatment with sulfadoxine-pyrimethamine provides any additional benefit to the protection afforded by ITNs on the:
• Maternal anaemia at and after delivery
• Parasite prevalence at and after delivery
• Placental malaria infection
• Infant mortality and morbidity
• Gestational age of the newborn
• Child parasitaemia and anaemia 12 months after delivery
• To identify the operational and socio-cultural issues involved in the delivery to and use of ITNs by pregnant women
• To evaluate the cost-effectiveness of the interventions
• To determine the duration of the efficacy of long-lasting insecticide-treated nets against Anopheles mosquitoes
• To assess the immunological protection against malaria in children during the first year of life regarding malaria preventive interventions in their mothers during pregnancy
• To asses the effect of IPT with SP in HIV positive pregnant women on the prevention of mother-to-child HIV transmission and on the viral load reduction in the mother

• · To assess whether intermittent treatment with sulfadoxine-pyrimethamine provides any additional benefit to the protection afforded by ITNs on the:
• i) Maternal anaemia at and after delivery
• ii) Parasite prevalence at and after delivery
• iii) Placental malaria infection
• iv) Proportion of low birth weight babies
• v) Gestational age of the newborn
• vi) Child parasitaemia and anaemia 12 months after delivery
• · To identify the operational and socio-cultural issues involved in the delivery to and use of ITNs by pregnant women
• · To evaluate the cost-effectiveness of the interventions
• · To determine the duration of the efficacy of long-lasting insecticide-treated nets against Anopheles mosquitoes
• · To assess the immunological protection against malaria in children during the first year of life regarding malaria preventive interventions in their mothers during pregnancy
• · To asses the effect of IPT with SP in HIV positive pregnant women on the prevention of mother-to-child HIV transmission and on the viral load reduction in the mother

We aim to evaluate whether IPT in pregnancy provides any additional benefit to the protection afforded by ITNs.

Pregnant women are at an increased risk for malaria infection and disease. Maternal anaemia, low birth weight and prematurity are the most frequent adverse effects of the infection. The current WHO recommendation consists on the provision of insecticide treated nets (ITN's) and intermittent preventive treatment (IPT). Results from a recentn trial of ITN's have shown a significant reduction in maternal anaemia, parasitaemia and low birth weight prevalence in women sleeping under impregnated nets. However, scarce information exists on the relative efficacy of IPT and ITNs to reduce the deleterious effects of malaria infection during pregnancy when given at the same time. This information is of relevance to guide national malaria control programmes.

This study consists on the administration of two double blind doses of IPT with Sulfadoxine-Pyrimethamine or placebo at predefined intervals, after the beginning of the second trimester. All women receive an ITN.

• Drug: Sulfadoxine-Pyrimethamine (Fansidar)
• Device: ITNs

• Menéndez C, Bardají A, Sigauque B, Sanz S, Aponte JJ, Mabunda S, Alonso PL. Malaria prevention with IPTp during pregnancy reduces neonatal mortality. PLoS One. 2010 Feb 26;5(2):e9438.
• Serra-Casas E, Menéndez C, Bardají A, Quintó L, Dobaño C, Sigauque B, Jiménez A, Mandomando I, Chauhan VS, Chitnis CE, Alonso PL, Mayor A. The effect of intermittent preventive treatment during pregnancy on malarial antibodies depends on HIV status and is not associated with poor delivery outcomes. J Infect Dis. 2010 Jan 1;201(1):123-31.
• Naniche D, Lahuerta M, Bardaji A, Sigauque B, Romagosa C, Berenguera A, Mandomando I, David C, Sanz S, Aponte J, Ordi J, Alonso P, Menendez C. Mother-to-child transmission of HIV-1: association with malaria prevention, anaemia and placental malaria. HIV Med. 2008 Oct;9(9):757-64. Epub 2008 Jul 19.
• Menéndez C, Bardají A, Sigauque B, Romagosa C, Sanz S, Serra-Casas E, Macete E, Berenguera A, David C, Dobaño C, Naniche D, Mayor A, Ordi J, Mandomando I, Aponte JJ, Mabunda S, Alonso PL. A randomized placebo-controlled trial of intermittent preventive treatment in pregnant women in the context of insecticide treated nets delivered through the antenatal clinic. PLoS ONE. 2008 Apr 9;3(4):e1934.

Inclusion Criteria:

• Less than 28 weeks of pregnancy

Exclusion Criteria:

• Previous allergic reactions to sulphonamides