Artemisinin-based combination therapy during pregnancy: Outcome of pregnancy and infant mortality: A cohort study

Michael Nambozi, Halidou Tinto, Victor Mwapasa, Harry Tagbor, Jean Bertin Bukasa Kabuya, Sebastian Hachizovu, Maminata Traoré, Innocent Valea, Marc Christian Tahita, Gifty Ampofo, Jozefien Buyze, Raffaella Ravinetto, Diana Arango, Kamala Thriemer, Modest Mulenga, Jean Pierre Van Geertruyden, Umberto D'Alessandro

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The World Health Organization (WHO) recommendation of treating uncomplicated malaria during the second and third trimester of pregnancy with an artemisinin-based combination therapy (ACT) has already been implemented by all sub-Saharan African countries. However, there is limited knowledge on the effect of ACT on pregnancy outcomes, and on newborn and infant's health. 

Methods: Pregnant women with malaria in four countries (Burkina Faso, Ghana, Malawi and Zambia) were treated with either artemether-lumefantrine (AL), amodiaquine-artesunate (ASAQ), mefloquine-artesunate (MQAS), or dihydroartemisinin-piperaquine (DHA-PQ); 3127 live new-borns (822 in the AL, 775 in the ASAQ, 765 in the MQAS and 765 in the DHAPQ arms) were followed-up until their first birthday. 

Results: Prevalence of placental malaria and low birth weight were 28.0% (738/2646) and 16.0% (480/2999), respectively, with no significant differences between treatment arms. No differences in congenital malformations (p = 0.35), perinatal mortality (p = 0.77), neonatal mortality (p = 0.21), and infant mortality (p = 0.96) were found. 

Conclusions: Outcome of pregnancy and infant survival were similar between treatment arms indicating that any of the four artemisinin-based combinations could be safely used during the second and third trimester of pregnancy without any adverse effect on the baby. Nevertheless, smaller safety differences between artemisinin-based combinations cannot be excluded; country-wide post-marketing surveillance would be very helpful to confirm such findings. 

Original languageEnglish
Article number105
Pages (from-to)1-8
Number of pages8
JournalMalaria Journal
Volume18
DOIs
Publication statusPublished - 28 Mar 2019

Fingerprint

Infant Mortality
Pregnancy Outcome
Cohort Studies
Malaria
Mefloquine
Pregnancy
dihydroartemisinin
Third Pregnancy Trimester
Second Pregnancy Trimester
Burkina Faso
Zambia
Malawi
Ghana
Perinatal Mortality
Low Birth Weight Infant
Therapeutics
Marketing
Pregnant Women
Safety
artemisinine

Cite this

Nambozi, M., Tinto, H., Mwapasa, V., Tagbor, H., Kabuya, J. B. B., Hachizovu, S., ... D'Alessandro, U. (2019). Artemisinin-based combination therapy during pregnancy: Outcome of pregnancy and infant mortality: A cohort study. Malaria Journal, 18, 1-8. [105]. https://doi.org/10.1186/s12936-019-2737-7
Nambozi, Michael ; Tinto, Halidou ; Mwapasa, Victor ; Tagbor, Harry ; Kabuya, Jean Bertin Bukasa ; Hachizovu, Sebastian ; Traoré, Maminata ; Valea, Innocent ; Tahita, Marc Christian ; Ampofo, Gifty ; Buyze, Jozefien ; Ravinetto, Raffaella ; Arango, Diana ; Thriemer, Kamala ; Mulenga, Modest ; Van Geertruyden, Jean Pierre ; D'Alessandro, Umberto. / Artemisinin-based combination therapy during pregnancy : Outcome of pregnancy and infant mortality: A cohort study. In: Malaria Journal. 2019 ; Vol. 18. pp. 1-8.
@article{07c7a0c80b194ce19f6fedf4bc6fa775,
title = "Artemisinin-based combination therapy during pregnancy: Outcome of pregnancy and infant mortality: A cohort study",
abstract = "Background: The World Health Organization (WHO) recommendation of treating uncomplicated malaria during the second and third trimester of pregnancy with an artemisinin-based combination therapy (ACT) has already been implemented by all sub-Saharan African countries. However, there is limited knowledge on the effect of ACT on pregnancy outcomes, and on newborn and infant's health. Methods: Pregnant women with malaria in four countries (Burkina Faso, Ghana, Malawi and Zambia) were treated with either artemether-lumefantrine (AL), amodiaquine-artesunate (ASAQ), mefloquine-artesunate (MQAS), or dihydroartemisinin-piperaquine (DHA-PQ); 3127 live new-borns (822 in the AL, 775 in the ASAQ, 765 in the MQAS and 765 in the DHAPQ arms) were followed-up until their first birthday. Results: Prevalence of placental malaria and low birth weight were 28.0{\%} (738/2646) and 16.0{\%} (480/2999), respectively, with no significant differences between treatment arms. No differences in congenital malformations (p = 0.35), perinatal mortality (p = 0.77), neonatal mortality (p = 0.21), and infant mortality (p = 0.96) were found. Conclusions: Outcome of pregnancy and infant survival were similar between treatment arms indicating that any of the four artemisinin-based combinations could be safely used during the second and third trimester of pregnancy without any adverse effect on the baby. Nevertheless, smaller safety differences between artemisinin-based combinations cannot be excluded; country-wide post-marketing surveillance would be very helpful to confirm such findings. ",
author = "Michael Nambozi and Halidou Tinto and Victor Mwapasa and Harry Tagbor and Kabuya, {Jean Bertin Bukasa} and Sebastian Hachizovu and Maminata Traor{\'e} and Innocent Valea and Tahita, {Marc Christian} and Gifty Ampofo and Jozefien Buyze and Raffaella Ravinetto and Diana Arango and Kamala Thriemer and Modest Mulenga and {Van Geertruyden}, {Jean Pierre} and Umberto D'Alessandro",
year = "2019",
month = "3",
day = "28",
doi = "10.1186/s12936-019-2737-7",
language = "English",
volume = "18",
pages = "1--8",
journal = "Malaria Journal",
issn = "1475-2875",
publisher = "BioMed Central",

}

Nambozi, M, Tinto, H, Mwapasa, V, Tagbor, H, Kabuya, JBB, Hachizovu, S, Traoré, M, Valea, I, Tahita, MC, Ampofo, G, Buyze, J, Ravinetto, R, Arango, D, Thriemer, K, Mulenga, M, Van Geertruyden, JP & D'Alessandro, U 2019, 'Artemisinin-based combination therapy during pregnancy: Outcome of pregnancy and infant mortality: A cohort study' Malaria Journal, vol. 18, 105, pp. 1-8. https://doi.org/10.1186/s12936-019-2737-7

Artemisinin-based combination therapy during pregnancy : Outcome of pregnancy and infant mortality: A cohort study. / Nambozi, Michael; Tinto, Halidou; Mwapasa, Victor; Tagbor, Harry; Kabuya, Jean Bertin Bukasa; Hachizovu, Sebastian; Traoré, Maminata; Valea, Innocent; Tahita, Marc Christian; Ampofo, Gifty; Buyze, Jozefien; Ravinetto, Raffaella; Arango, Diana; Thriemer, Kamala; Mulenga, Modest; Van Geertruyden, Jean Pierre; D'Alessandro, Umberto.

In: Malaria Journal, Vol. 18, 105, 28.03.2019, p. 1-8.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Artemisinin-based combination therapy during pregnancy

T2 - Outcome of pregnancy and infant mortality: A cohort study

AU - Nambozi, Michael

AU - Tinto, Halidou

AU - Mwapasa, Victor

AU - Tagbor, Harry

AU - Kabuya, Jean Bertin Bukasa

AU - Hachizovu, Sebastian

AU - Traoré, Maminata

AU - Valea, Innocent

AU - Tahita, Marc Christian

AU - Ampofo, Gifty

AU - Buyze, Jozefien

AU - Ravinetto, Raffaella

AU - Arango, Diana

AU - Thriemer, Kamala

AU - Mulenga, Modest

AU - Van Geertruyden, Jean Pierre

AU - D'Alessandro, Umberto

PY - 2019/3/28

Y1 - 2019/3/28

N2 - Background: The World Health Organization (WHO) recommendation of treating uncomplicated malaria during the second and third trimester of pregnancy with an artemisinin-based combination therapy (ACT) has already been implemented by all sub-Saharan African countries. However, there is limited knowledge on the effect of ACT on pregnancy outcomes, and on newborn and infant's health. Methods: Pregnant women with malaria in four countries (Burkina Faso, Ghana, Malawi and Zambia) were treated with either artemether-lumefantrine (AL), amodiaquine-artesunate (ASAQ), mefloquine-artesunate (MQAS), or dihydroartemisinin-piperaquine (DHA-PQ); 3127 live new-borns (822 in the AL, 775 in the ASAQ, 765 in the MQAS and 765 in the DHAPQ arms) were followed-up until their first birthday. Results: Prevalence of placental malaria and low birth weight were 28.0% (738/2646) and 16.0% (480/2999), respectively, with no significant differences between treatment arms. No differences in congenital malformations (p = 0.35), perinatal mortality (p = 0.77), neonatal mortality (p = 0.21), and infant mortality (p = 0.96) were found. Conclusions: Outcome of pregnancy and infant survival were similar between treatment arms indicating that any of the four artemisinin-based combinations could be safely used during the second and third trimester of pregnancy without any adverse effect on the baby. Nevertheless, smaller safety differences between artemisinin-based combinations cannot be excluded; country-wide post-marketing surveillance would be very helpful to confirm such findings. 

AB - Background: The World Health Organization (WHO) recommendation of treating uncomplicated malaria during the second and third trimester of pregnancy with an artemisinin-based combination therapy (ACT) has already been implemented by all sub-Saharan African countries. However, there is limited knowledge on the effect of ACT on pregnancy outcomes, and on newborn and infant's health. Methods: Pregnant women with malaria in four countries (Burkina Faso, Ghana, Malawi and Zambia) were treated with either artemether-lumefantrine (AL), amodiaquine-artesunate (ASAQ), mefloquine-artesunate (MQAS), or dihydroartemisinin-piperaquine (DHA-PQ); 3127 live new-borns (822 in the AL, 775 in the ASAQ, 765 in the MQAS and 765 in the DHAPQ arms) were followed-up until their first birthday. Results: Prevalence of placental malaria and low birth weight were 28.0% (738/2646) and 16.0% (480/2999), respectively, with no significant differences between treatment arms. No differences in congenital malformations (p = 0.35), perinatal mortality (p = 0.77), neonatal mortality (p = 0.21), and infant mortality (p = 0.96) were found. Conclusions: Outcome of pregnancy and infant survival were similar between treatment arms indicating that any of the four artemisinin-based combinations could be safely used during the second and third trimester of pregnancy without any adverse effect on the baby. Nevertheless, smaller safety differences between artemisinin-based combinations cannot be excluded; country-wide post-marketing surveillance would be very helpful to confirm such findings. 

UR - http://www.scopus.com/inward/record.url?scp=85063721348&partnerID=8YFLogxK

U2 - 10.1186/s12936-019-2737-7

DO - 10.1186/s12936-019-2737-7

M3 - Article

VL - 18

SP - 1

EP - 8

JO - Malaria Journal

JF - Malaria Journal

SN - 1475-2875

M1 - 105

ER -