Effect of prenatal and perinatal antibiotics on maternal health in Malawi, Tanzania, and Zambia

Received 15 April 2009; received in revised form 30 June 2009; accepted 22 July 2009. published online 01 September 2009.

Abstract

Objective

We assessed the effect of prenatal and peripartum antibiotics on maternal morbidity and mortality among HIV-infected and uninfected women.

Methods

A multicenter trial was conducted at clinical sites in 4 Sub-Saharan African cities: Blantyre and Lilongwe, Malawi; Dar es Salaam, Tanzania; and Lusaka, Zambia. A total of 1558 HIV-infected and 271 uninfected pregnant women who were eligible to receive both the prenatal and peripartum antibiotic/placebo regimens were enrolled. Pregnant women were interviewed at 20–24weeks of gestation and a physical examination was performed. Women were randomized to receive either antibiotics or placebo. At the 26–30week visit, participants were given antibiotics or placebo to be taken every 4 hours beginning at the onset of labor and continuing after delivery 3 times a day until a 1-week course was completed. Logistic regression and Cox proportional hazards models were used.

Results

There were no significant differences between the antibiotic and placebo groups for medical conditions, obstetric complications, physical examination findings, puerperal sepsis, and death in either the HIV-infected or the uninfected cohort.

Conclusion

Administration of study antibiotics during pregnancy had no effect on maternal morbidity and mortality among HIV-infected and uninfected pregnant women.

Keywords: Antibiotics, HIV, Maternal morbidity, Maternal mortality, Pregnancy

a Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

b Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

c Pediatric, Adolescent, and Maternal AIDS Branch, NICHD, NIH, DHHS, Bethesda, MD, USA

d Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA

e Prevention Sciences Program, NIAID, NIH, Bethesda, MD, USA

f UNC Project, Lilongwe, Malawi

g Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

h Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA

i Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

Corresponding author. Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania. Tel.: +255 22 2150302x276; fax: +255 22 2153114.

PII: S0020-7292(09)00408-1

doi:10.1016/j.ijgo.2009.07.037

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