@article {Videmanarchdischild-2021-322043, author = {Karoliina Videman and Lotta Hallamaa and Otto Heimonen and Charles Mangani and Mari Luntamo and Kenneth Maleta and Per Ashorn and Ulla Ashorn}, title = {Child growth and neurodevelopment after maternal antenatal antibiotic treatment}, elocation-id = {archdischild-2021-322043}, year = {2021}, doi = {10.1136/archdischild-2021-322043}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objective To assess whether intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine (SP) and azithromycin (AZI) in a malaria-endemic area leads to sustained gains in linear growth and development in their offspring.Design Follow-up study of a randomised trial.Setting Mangochi District in rural southern Malawi.Participants 1320 pregnant women and their offspring.Interventions IPTp monthly with SP and twice with AZI (AZI-SP group), monthly with SP but no AZI (monthly SP), or twice with SP (control). No intervention was given to children.Main outcome measures Cognitive performance using Raven{\textquoteright}s Coloured Progressive Matrices (CPM) at 13 years of age; mean height and height-for-age Z-score (HAZ), cumulative incidence and prevalence of stunting (HAZ \<-2); weight, body mass index, mid-upper-arm circumference and head circumference.Results At approximately 13 years of age, the mean CPM score was 14.3 (SD 3.8, range 6{\textendash}29, maximum 36), with no differences between groups. Children in the AZI-SP group were on average 0.4 cm (95\% CI -0.9 to 1.7, p=0.6) taller than those in the control group. For cumulative incidence of stunting, the HR in the AZI-SP group was 0.72 (95\% CI 0.61 to 0.84, p\<0.001) compared with the control and 0.76 (95\% CI 0.65 to 0.90, p\<0.001) compared with the monthly SP groups. There was no intergroup difference in stunting prevalence or anthropometric measurements.Conclusions In rural Malawi, maternal intensified infection control during pregnancy reduces offspring{\textquoteright}s cumulative incidence of ever being stunted by 13 years of age. In this study, there was no evidence of a positive impact on cognitive performance.Trial registration number NCT00131235.Data are available upon reasonable request.}, issn = {0003-9888}, URL = {https://adc.bmj.com/content/early/2021/09/03/archdischild-2021-322043}, eprint = {https://adc.bmj.com/content/early/2021/09/03/archdischild-2021-322043.full.pdf}, journal = {Archives of Disease in Childhood} }