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Safety of artemisinins in first trimester of prospectively followed pregnancies: an observational study.

Moore KA, Simpson JA, Paw MK, Pimanpanarak M, Wiladphaingern J, Rijken MJ, Jittamala P, White NJ, Fowkes FJ, Nosten F, McGready R - Lancet Infect Dis (2016)

Bottom Line: Artemisinins, the most effective antimalarials available, are not recommended for falciparum malaria during the first trimester of pregnancy because of safety concerns.Therefore, quinine is used despite its poor effectiveness.We noted no evidence of an increased risk of miscarriage or of major congenital malformations associated with first-line treatment with an artemisinin derivative compared with quinine.

View Article: PubMed Central - PubMed

Affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Australia. Electronic address: kerrynmoore.kam@burnet.edu.au.

No MeSH data available.


Related in: MedlinePlus

Frequency of first-line quinine and artemisinin treatments in first trimester and rates of falciparum malaria during pregnancy and miscarriage over timeThe increase in the rate of falciparum malaria in 1998 was due to the establishment of Shoklo Malaria Research Unit antenatal clinics in migrant communities.
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fig2: Frequency of first-line quinine and artemisinin treatments in first trimester and rates of falciparum malaria during pregnancy and miscarriage over timeThe increase in the rate of falciparum malaria in 1998 was due to the establishment of Shoklo Malaria Research Unit antenatal clinics in migrant communities.

Mentions: Of the 2558 women with first-trimester malaria, 1207 (47%) had falciparum malaria, 1532 (60%) had vivax malaria, and 181 (7%) had both vivax and falciparum (either separate or mixed infections). Recurrent first-trimester falciparum malaria occurred in 162 (13%) of 1207 women, and recurrent first-trimester vivax malaria in 139 (9%) of 1532. Most (971 [80%] of 1207) women with first-trimester falciparum malaria were treated initially with quinine and 183 (15%) of 1207 were treated initially with artemisinin (ie, first-line artemisinin treatment; table 1). Of the 971 women who received first-line quinine treatment, 129 (13%) were rescued with artemisinin (usually artesunate monotherapy or artesunate plus clindamycin) following recurrence. Of the 183 first-line artemisinin treatments, 37 (20%) were for hyperparasitaemia (administered orally) or severe disease (administered parenterally). First-line treatment of first-trimester falciparum malaria occurred at a median of 8·2 gestation weeks (IQR 5·3–11·1). Loss to follow-up was similar between antimalarial treatment groups, except women receiving mefloquine–artesunate were less likely to be lost (p=0·0417; appendix p 6). Rates of falciparum malaria during pregnancy and miscarriage and the frequency of first-line quinine and artemisinin treatments in first trimester over time are shown in figure 2.


Safety of artemisinins in first trimester of prospectively followed pregnancies: an observational study.

Moore KA, Simpson JA, Paw MK, Pimanpanarak M, Wiladphaingern J, Rijken MJ, Jittamala P, White NJ, Fowkes FJ, Nosten F, McGready R - Lancet Infect Dis (2016)

Frequency of first-line quinine and artemisinin treatments in first trimester and rates of falciparum malaria during pregnancy and miscarriage over timeThe increase in the rate of falciparum malaria in 1998 was due to the establishment of Shoklo Malaria Research Unit antenatal clinics in migrant communities.
© Copyright Policy - CC BY
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835584&req=5

fig2: Frequency of first-line quinine and artemisinin treatments in first trimester and rates of falciparum malaria during pregnancy and miscarriage over timeThe increase in the rate of falciparum malaria in 1998 was due to the establishment of Shoklo Malaria Research Unit antenatal clinics in migrant communities.
Mentions: Of the 2558 women with first-trimester malaria, 1207 (47%) had falciparum malaria, 1532 (60%) had vivax malaria, and 181 (7%) had both vivax and falciparum (either separate or mixed infections). Recurrent first-trimester falciparum malaria occurred in 162 (13%) of 1207 women, and recurrent first-trimester vivax malaria in 139 (9%) of 1532. Most (971 [80%] of 1207) women with first-trimester falciparum malaria were treated initially with quinine and 183 (15%) of 1207 were treated initially with artemisinin (ie, first-line artemisinin treatment; table 1). Of the 971 women who received first-line quinine treatment, 129 (13%) were rescued with artemisinin (usually artesunate monotherapy or artesunate plus clindamycin) following recurrence. Of the 183 first-line artemisinin treatments, 37 (20%) were for hyperparasitaemia (administered orally) or severe disease (administered parenterally). First-line treatment of first-trimester falciparum malaria occurred at a median of 8·2 gestation weeks (IQR 5·3–11·1). Loss to follow-up was similar between antimalarial treatment groups, except women receiving mefloquine–artesunate were less likely to be lost (p=0·0417; appendix p 6). Rates of falciparum malaria during pregnancy and miscarriage and the frequency of first-line quinine and artemisinin treatments in first trimester over time are shown in figure 2.

Bottom Line: Artemisinins, the most effective antimalarials available, are not recommended for falciparum malaria during the first trimester of pregnancy because of safety concerns.Therefore, quinine is used despite its poor effectiveness.We noted no evidence of an increased risk of miscarriage or of major congenital malformations associated with first-line treatment with an artemisinin derivative compared with quinine.

View Article: PubMed Central - PubMed

Affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Australia. Electronic address: kerrynmoore.kam@burnet.edu.au.

No MeSH data available.


Related in: MedlinePlus