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Background  Single nucleotide polymorphisms occurring in the  Plasmodium falciparum  multidrug resistant gene 1 ( pfmdr1)  are known to be associated with aminoquinoline resistance and, therefore, represent key  P. falciparum  markers for monitoring resistance both in susceptible groups (children under 5 years old and pregnant women) and in the general population. This study aimed to determine prevalence and factors associated with the carriage of  pfmdr1  N86Y, Y184F and D1246Y polymorphisms among pregnant women in a setting of high malaria transmission in Burkina Faso.    Methods   Plasmodium falciparum  isolates were collected at the first antenatal care visit (ANC-1) as well as at delivery from pregnant women participating in the COSMIC trial (NTC01941264), which assessed malaria preventive interventions during pregnancy in the Nanoro Health District. Here, pregnant women received intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and malaria infections and/or diseases were treated using artemether-lumefantrine (AL) during the trial. Parasite DNA was extracted from dried blood spots and the presence of  pfmdr1  mutations at positions 86, 184 and 1246 was determined using nested PCR, followed by restriction fragment length polymorphism (RFLP) analysis.    Results  A prevalence of 13.2% (20/151) and 12.1% (14/116) of the  pfmdr1  86Y mutant allele was found at ANC-1 and at delivery, respectively, while no mutant allele was observed for Y184F and D1246Y codons at both ANC-1 and at delivery. There were no significant factors associated with  pfmdr1  86Y mutant allele carriage at ANC-1. However, malaria infections at delivery with a parasite density above the median (2237.2 (IQR: 613.5–11,425.7) parasites/µl) was associated with an increase risk of  pfmdr1  86Y mutant allele carriage (AOR = 5.5 (95% CI  1.07–28.0);  P  = 0.04). In contrast, both three or more IPTp-SP doses (AOR = 0.25 (95% CI 0.07–0.92);  P  = 0.04) and one or more AL treatment (AOR = 0.25 (95% CI 0.07–0.89);  P  = 0.03) during pregnancy were associated with a significant reduce risk of  pfmdr1  86Y mutant allele carriage at delivery.    Conclusion  These findings suggest that both high coverage of IPTp-SP and the use of AL for the treatment of malaria infection/disease during pregnancy select for  pfmdr1  N86 wild-type allele at delivery.

malaria journal

Prevalence and factors associated with carriage of Pfmdr1 polymorphisms among pregnant women receiving intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and artemether-lumefantrine for malaria treatment in Burkina Faso