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
C2 - 30922317
AN - SCOPUS:85063721348
SN - 1475-2875
VL - 18
SP - 1
EP - 8
JO - Malaria Journal
JF - Malaria Journal
M1 - 105
ER -
