First-Trimester Malaria: Treatment and Outcomes - Infectious Diseases

First-Trimester Malaria: Treatment and Outcomes - Infectious Diseases
Malaria during pregnancy has adverse effects, including maternal mortality, miscarriage, and low birthweight. During early pregnancy, treatment options are limited, especially in regions with drug resistance. In a retrospective study covering a 25-year period (1986–2010), investigators compared outcomes between women with a single episode of malaria during the first trimester and women without malaria during pregnancy. The women came from a camp for displaced persons in a remote rural area near the Thai–Burmese border.

Among 17,613 pregnant women, 945 (5%) had a single episode of malaria during the first trimester. Risk for miscarriage was increased by 2.7-fold in women with asymptomatic malaria — and by nearly 4-fold in those with symptomatic malaria — compared with uninfected women. Risk was similar between vivax and falciparum infections and was higher in women with hyperparasitemic or severe malaria. Other risk factors for miscarriage included smoking, maternal age 26, previous miscarriage, and nonmalarial febrile illness. Miscarriage risk was similar whether the woman was treated with chloroquine, quinine, or artesunate. No excess or specific fetal abnormalities were associated with artesunate-containing therapies, but the numbers available for this group were small (44 deliveries to artesunate recipients).

Comment: These findings are reassuring with regard to the safety of artemisinin derivatives during the first trimester of pregnancy, despite animal studies suggesting potential embryo toxicity. Prospective studies in women are warranted. The present results clearly demonstrate the adverse consequences of malaria — whether asymptomatic or symptomatic — so testing and treatment during all stages of pregnancy should be part of malaria programs. Although both malarial and nonmalarial febrile illnesses are associated with increased risk for miscarriage during the first trimester, the pathological process underlying the increased miscarriage risk with asymptomatic malaria is unclear and likely malaria specific. As emphasized by editorialists, the risk from malaria clearly outweighs the theoretical risk from artemisinin treatment during early pregnancy.

— Mary E. Wilson, MD

Published in Journal Watch Infectious Diseases December 14, 2011

CITATION(S):

McGready R et al. Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: A population-based study. Lancet Infect Dis 2011 Dec 13; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1473-3099(11)70339-5)

Desai M and Dellicour S. Effects of malaria and its treatment in early pregnancy. Lancet Infect Dis 2011 Dec 13; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1473-3099(11)70345-0)