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Safety of artemether-lumefantrine in pregnant women with malaria: results of a prospective cohort study in Zambia.

Manyando C, Mkandawire R, Puma L, Sinkala M, Mpabalwani E, Njunju E, Gomes M, Ribeiro I, Walter V, Virtanen M, Schlienger R, Cousin M, Chipimo M, Sullivan FM - Malar. J. (2010)

Bottom Line: Primary outcome was perinatal mortality (stillbirth or neonatal death within seven days after birth).These data suggest that exposure to AL in pregnancy, including first trimester, is not associated with particular safety risks in terms of perinatal mortality, malformations, or developmental impairment.However, more data are required on AL use during the first trimester.

View Article: PubMed Central - HTML - PubMed

Affiliation: Tropical Diseases Research Centre, Ndola, Zambia. cmanyando@yahoo.com

ABSTRACT

Background: Safety data regarding exposure to artemisinin-based combination therapy in pregnancy are limited. This prospective cohort study conducted in Zambia evaluated the safety of artemether-lumefantrine (AL) in pregnant women with malaria.

Methods: Pregnant women attending antenatal clinics were assigned to groups based on the drug used to treat their most recent malaria episode (AL vs. sulphadoxine-pyrimethamine, SP). Safety was assessed using standard and pregnancy-specific parameters. Post-delivery follow-up was six weeks for mothers and 12 months for live births. Primary outcome was perinatal mortality (stillbirth or neonatal death within seven days after birth).

Results: Data from 1,001 pregnant women (AL n = 495; SP n = 506) and 933 newborns (AL n = 466; SP n = 467) showed: perinatal mortality (AL 4.2%; SP 5.0%), comprised of early neonatal mortality (each group 2.3%), stillbirths (AL 1.9%; SP 2.7%); preterm deliveries (AL 14.1%; SP 17.4% of foetuses); and gestational age-adjusted low birth weight (AL 9.0%; SP 7.7%). Infant birth defect incidence was 1.8% AL and 1.6% SP, excluding umbilical hernia. Abortions prior to antenatal care could not be determined: abortion occurred in 4.5% of women treated with AL during their first trimester; none were reported in the 133 women exposed to SP and/or quinine during their first trimester. Overall development (including neurological assessment) was similar in both groups.

Conclusions: These data suggest that exposure to AL in pregnancy, including first trimester, is not associated with particular safety risks in terms of perinatal mortality, malformations, or developmental impairment. However, more data are required on AL use during the first trimester.

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Related in: MedlinePlus

Participant flowchart. AL exposure group 9 pairs of twins; SP exposure group 7 pairs of twins.
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Figure 1: Participant flowchart. AL exposure group 9 pairs of twins; SP exposure group 7 pairs of twins.

Mentions: A total of 1,001 pregnant women were enrolled, of whom 84.4% (845/1001) completed the study to six weeks after delivery (Figure 1). Demographic and clinical characteristics are shown in Table 1. Among the women enrolled, 98.9% had received at least some degree of schooling at the primary level and 52.2% had received some degree of secondary education.


Safety of artemether-lumefantrine in pregnant women with malaria: results of a prospective cohort study in Zambia.

Manyando C, Mkandawire R, Puma L, Sinkala M, Mpabalwani E, Njunju E, Gomes M, Ribeiro I, Walter V, Virtanen M, Schlienger R, Cousin M, Chipimo M, Sullivan FM - Malar. J. (2010)

Participant flowchart. AL exposure group 9 pairs of twins; SP exposure group 7 pairs of twins.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2944339&req=5

Figure 1: Participant flowchart. AL exposure group 9 pairs of twins; SP exposure group 7 pairs of twins.
Mentions: A total of 1,001 pregnant women were enrolled, of whom 84.4% (845/1001) completed the study to six weeks after delivery (Figure 1). Demographic and clinical characteristics are shown in Table 1. Among the women enrolled, 98.9% had received at least some degree of schooling at the primary level and 52.2% had received some degree of secondary education.

Bottom Line: Primary outcome was perinatal mortality (stillbirth or neonatal death within seven days after birth).These data suggest that exposure to AL in pregnancy, including first trimester, is not associated with particular safety risks in terms of perinatal mortality, malformations, or developmental impairment.However, more data are required on AL use during the first trimester.

View Article: PubMed Central - HTML - PubMed

Affiliation: Tropical Diseases Research Centre, Ndola, Zambia. cmanyando@yahoo.com

ABSTRACT

Background: Safety data regarding exposure to artemisinin-based combination therapy in pregnancy are limited. This prospective cohort study conducted in Zambia evaluated the safety of artemether-lumefantrine (AL) in pregnant women with malaria.

Methods: Pregnant women attending antenatal clinics were assigned to groups based on the drug used to treat their most recent malaria episode (AL vs. sulphadoxine-pyrimethamine, SP). Safety was assessed using standard and pregnancy-specific parameters. Post-delivery follow-up was six weeks for mothers and 12 months for live births. Primary outcome was perinatal mortality (stillbirth or neonatal death within seven days after birth).

Results: Data from 1,001 pregnant women (AL n = 495; SP n = 506) and 933 newborns (AL n = 466; SP n = 467) showed: perinatal mortality (AL 4.2%; SP 5.0%), comprised of early neonatal mortality (each group 2.3%), stillbirths (AL 1.9%; SP 2.7%); preterm deliveries (AL 14.1%; SP 17.4% of foetuses); and gestational age-adjusted low birth weight (AL 9.0%; SP 7.7%). Infant birth defect incidence was 1.8% AL and 1.6% SP, excluding umbilical hernia. Abortions prior to antenatal care could not be determined: abortion occurred in 4.5% of women treated with AL during their first trimester; none were reported in the 133 women exposed to SP and/or quinine during their first trimester. Overall development (including neurological assessment) was similar in both groups.

Conclusions: These data suggest that exposure to AL in pregnancy, including first trimester, is not associated with particular safety risks in terms of perinatal mortality, malformations, or developmental impairment. However, more data are required on AL use during the first trimester.

Show MeSH
Related in: MedlinePlus