Antimalarial therapy needed in early pregnancy

One episode of malaria significantly increased the risk for miscarriage during early pregnancy, but antimalarial therapy was relatively safe and associated with a reduced risk for miscarriage, according to new findings published in The Lancet.

“We have been able to quantify the risk of malaria: Symptomatic malaria increases the risk for malaria from one in five to one in two, and even when malaria is asymptomatic, the risk is increased to one in three,” Rose McGready, MBBS, PhD, of the Shoklo Malaria Research Unit in Thailand, told Infectious Disease News.

“There was no significant difference in the risk for miscarriage when we compared Plasmodium falciparum and P. vivax malaria or treatments.”

For the population-based study, McGready and colleagues pooled antenatal records of women in their first trimester at Shoklo Malaria Research Unit from 1986 to 2010.

The researchers assessed the outcome of malaria-exposed and malaria-unexposed first-trimester pregnancies, and they compared the effects of different antimalarial drugs, including chloroquine-based, quinine-based and artemisinin-based treatments.

Of 17,613 women, 5% had a single episode of malaria in the first trimester.

The likelihood of miscarriage increased in women with both asymptomatic malaria (OR=2.70; 95% CI, 2.04-3.59) and symptomatic malaria (OR=3.99; 95% CI, 3.10-5.13). In addition, the researchers found that the risk for miscarriage was similar among women treated with chloroquine (26% of 354), quinine (27% of 355) and artesunate (31% of 64); no adverse events were observed.

“Early pregnancy is a vulnerable period in malaria endemic areas, and malaria control measures have not adequately addressed what needs to be done, as preventive treatment starts at the beginning of the second trimester,” McGready said. “We need a randomized controlled trial to confirm the safety of artemisinin derivatives in the first trimester.”

In an accompanying editorial, Meghna Desai, MD, and Stephanie Dellicour, BSc, MSc, both of the Kenya Medical Research Institute and CDC’s Research and Public Health Collaboration, wrote: “The evidence presented by McGready and colleagues highlights the importance of malaria prevention early in pregnancy, possibly as early as before conception.” – by Ashley DeNyse

For more information:

• Desai M. Lancet. 2011;doi:10.1016/S1473-3099(11)70345-0.
• McGready R. Lancet. 2011;doi:10.1016/S1473-3099(11)70339-5.

Disclosure: This research was funded by the Wellcome Trust and Bill & Melinda Gates Foundation.

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