A groundbreaking clinical trial in Zimbabwe has found that a safe, inexpensive, and widely available antibiotic may help reduce the risk of preterm births—especially among women living with HIV. Conducted by an international team of researchers, the Cotrimoxazole for Mothers to Improve Birthweight in Infants (COMBI) trial tested whether daily use of trimethoprim–sulfamethoxazole, a broad-spectrum antimicrobial with anti-inflammatory properties, could improve pregnancy outcomes.
Globally, one in four babies is born preterm (before 37 weeks), underweight, or small for gestational age. Prematurity is now the leading cause of death among children under five, particularly in low-resource settings. Maternal infections and inflammation—especially in mothers with HIV—are strongly linked to these adverse birth outcomes.
Led by Professor Andrew Prendergast of Queen Mary University of London and Bernard Chasekwa of the Zvitambo Institute for Maternal and Child Health Research in Zimbabwe, the study enrolled 993 pregnant women from rural antenatal clinics in Shurugwi, central Zimbabwe. Participants received either a daily dose of 960 mg of trimethoprim–sulfamethoxazole or a placebo, alongside routine antenatal care. Researchers then monitored birth outcomes including weight and gestational age.
Although the trial’s primary goal—improving birthweight—was not achieved, the reduction in preterm births was significant. Among all participants, just 6.9% of women receiving the antibiotic gave birth prematurely, compared to 11.5% in the placebo group—a 40% decrease. Notably, no women in the antibiotic group had babies born before 28 weeks.
The benefit was even more striking among the 131 women with HIV. Only 2% of those receiving trimethoprim–sulfamethoxazole delivered preterm, compared with 14% in the placebo group. Babies in the antibiotic group also had an average increase in birth weight of 177 grams, though this result did not meet statistical significance for the overall cohort.
“This trial, conducted in routine rural antenatal care settings, didn’t show improvement in birthweight, but the potential to prevent preterm births is compelling,” said Bernard Chasekwa, first author of the study. “We now need to replicate this trial in different global settings to confirm its impact.”
Professor Prendergast added: “Infections are common during pregnancy in sub-Saharan Africa, especially among women with HIV. Our findings suggest that a low-cost, daily antibiotic might reduce the risk of preterm births—offering a potential new strategy to help newborns survive and thrive.”
Sophie Hawksworth, Senior Manager of Clinical Discovery Research at Wellcome, which funded the study, emphasized its significance: “Reducing child mortality globally requires urgent solutions for preterm birth, especially in areas without access to neonatal care. While the primary outcome of birthweight was unaffected, this promising evidence of reduced preterm births calls for further investigation.”
If confirmed in larger, diverse trials, the use of trimethoprim–sulfamethoxazole during pregnancy could become a simple, scalable intervention in global efforts to combat newborn mortality.
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Source: News Medical
