Trimethoprim–Sulfamethoxazole Fails to Prevent Adverse Birth Outcomes in Zimbabwean Trial
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on July 2nd, 2025
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Adverse birth outcomes, such as preterm birth and low birth weight, continue to pose a major public health challenge in many low-resource settings. Maternal inflammation and infections—including bacteriuria and syphilis—have been linked to higher risks of these outcomes. Based on this association, researchers conducted a study funded by the Wellcome Trust to evaluate whether prophylactic use of trimethoprim–sulfamethoxazole could reduce these risks during pregnancy.
The trial was carried out in Zimbabwe and enrolled 993 pregnant women with a median age of 24. At the time of enrollment, 70% were in their second trimester, with the remainder evenly split between the first and third trimesters. Thirteen percent of participants were HIV-positive, and over 95% of those individuals were receiving antiretroviral therapy, with a median CD4 count of approximately 550 cells/μL.
Participants were randomly assigned to receive daily treatment with either a placebo or a combination of trimethoprim (800 mg) and sulfamethoxazole (160 mg). This widely used broad spectrum antibiotic had been found to be able to modulate systemic and intestinal inflammation. After a median treatment duration of 21.7 weeks, the researchers observed no statistically significant difference in the rates of preterm birth or low birth weight between the two groups. The authors noted that these findings differ from a prior study in Zambia, which showed benefit among HIV-positive women with low CD4 counts. This suggests that patient population and immune status may influence treatment effectiveness.
The trial was carried out in Zimbabwe and enrolled 993 pregnant women with a median age of 24. At the time of enrollment, 70% were in their second trimester, with the remainder evenly split between the first and third trimesters. Thirteen percent of participants were HIV-positive, and over 95% of those individuals were receiving antiretroviral therapy, with a median CD4 count of approximately 550 cells/μL.
Participants were randomly assigned to receive daily treatment with either a placebo or a combination of trimethoprim (800 mg) and sulfamethoxazole (160 mg). This widely used broad spectrum antibiotic had been found to be able to modulate systemic and intestinal inflammation. After a median treatment duration of 21.7 weeks, the researchers observed no statistically significant difference in the rates of preterm birth or low birth weight between the two groups. The authors noted that these findings differ from a prior study in Zambia, which showed benefit among HIV-positive women with low CD4 counts. This suggests that patient population and immune status may influence treatment effectiveness.