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Background  The impact of sulfadoxine–pyrimethamine (SP) used as intermittent preventive treatment during pregnancy (IPTp-SP) on mutant parasite selection has been poorly documented in Burkina Faso. This study sought first to explore the relationship between IPTp-SP and the presence of mutant parasites. Second, to assess the relationship between the mutant parasites and adverse pregnancy outcomes.    Methods   From September to December 2010, dried blood spots (DBS) were collected during antenatal care visits and at delivery from 109 pregnant women with microscopically confirmed  falciparum  malaria infection. DBS were analysed by PCR–restriction fragment length polymorphism (PCR–RFLP) for the polymorphisms at codons 51, 59, 108, and 164 of the  Pfdhfr  gene and codons 437 and 540 in the  Pfdhps  gene.    Results  Both the  Pfdhfr  and  Pfdhps  genes were successfully genotyped in 92.7% (101/109) of the samples. The prevalence of  Pfdhfr  mutations N51I, C59R and S108N was 71.3, 42.6 and 64.4%, respectively. Overall, 80.2% (81/101) of samples carried the  Pfdhps  A437G mutation. None of the samples had the  Pfdhfr  I164L and the  Pfdhps  K540E mutations. The prevalence of the triple mutation N51I + C59R + S108N was 25.7% (26/101). The use of IPTp-SP was associated with a threefold increased odds of  Pfdhfr  C59R mutation [crude OR 3.29; 95% CI (1.44–7.50)]. Pregnant women with  recent  uptake of IPTp-SP were at higher odds of both the  Pfdhfr  C59R mutation [adjusted OR 4.26; 95% CI (1.64–11.07)] and the  Pfdhfr  intermediate-to-high resistance, i.e., ≥ 2  Pfdhfr  mutations [adjusted OR 3.45; 95% CI (1.18–10.07)]. There was no statistically significant association between the presence of the  Pfdhfr  intermediate-to-high resistance and parasite densities or both maternal haemoglobin level and anaemia.    Conclusion  The data indicate that despite the possibility that IPTp-SP contributes to the selection of resistant parasites, it did not potentiate pregnancy-associated malaria morbidity, suggesting the continuation of SP use as IPTp in Burkina Faso.    Electronic supplementary material  The online version of this article (doi:10.1186/s12936-017-1695-1) contains supplementary material, which is available to authorized users.

malaria journal

Recent uptake of intermittent preventive treatment during pregnancy with sulfadoxine–pyrimethamine is associated with increased prevalence of Pfdhfr mutations in Bobo-Dioulasso, Burkina Faso