The effect and control of malaria in pregnancy and lactating women in the Asia-Pacific region

Holger W. Unger, Sanjaya Acharya, Lachlan Arnold, Connie Wu, Anna Maria van Eijk, Georgia R. Gore-Langton, Feiko O. ter Kuile, Elvin Lufele, R. Matthew Chico, Ric N. Price, Brioni R. Moore, Kamala Thriemer, Stephen J. Rogerson

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Abstract

Half of all pregnancies at risk of malaria worldwide occur in the Asia–Pacific region, where Plasmodium falciparum and Plasmodium vivax co-exist. Despite substantial reductions in transmission, malaria remains an important cause of adverse health outcomes for mothers and offspring, including pre-eclampsia. Malaria transmission is heterogeneous, and infections are commonly subpatent and asymptomatic. High-grade antimalarial resistance poses a formidable challenge to malaria control in pregnancy in the region. Intermittent preventive treatment in pregnancy reduces infection risk in meso-endemic New Guinea, whereas screen-and-treat strategies will require more sensitive point-of-care tests to control malaria in pregnancy. In the first trimester, artemether–lumefantrine is approved, and safety data are accumulating for other artemisinin-based combinations. Safety of novel antimalarials to treat artemisinin-resistant P falciparum during pregnancy, and of 8-aminoquinolines during lactation, needs to be established. A more systematic approach to the prevention of malaria in pregnancy in the Asia–Pacific is required.

Original languageEnglish
Pages (from-to)e1805-e1818
Number of pages14
JournalThe Lancet Global Health
Volume11
Issue number11
DOIs
Publication statusPublished - Nov 2023

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