Antimalarial drugs for treating and preventing malaria in pregnant and lactating women

Abstract

Introduction: Malaria in pregnancy and postpartum cause maternal mortality and adverse fetal outcomes. Efficacious and safe antimalarials are needed to treat and prevent such serious consequences. However, because of the lack of evidence on fetal safety, quinine, an old and less efficacious drug has long been recommended for pregnant women. Uncertainty about safety in relation to breastfeeding leads to withholding of efficacious treatments postpartum or cessation of breastfeeding. Areas covered: A search identified literature on humans in three databases (MEDLINE, Embase and Global health) using pregnancy or lactation, and the names of antimalarial drugs as search terms. Adverse reactions to the mother, fetus or breastfed infant were summarized together with efficacies. Expert opinion: Artemisinins are more efficacious and well-tolerated than quinine in pregnancy. Furthermore, the risks of miscarriage, stillbirth or congenital abnormality were not higher in pregnancies exposed to artemisinin derivatives for treatment of malaria than in pregnancies exposed to quinine or in the comparable background population unexposed to any antimalarials, and this was true for treatment in any trimester. Assessment of safety and efficacy of antimalarials including dose optimization for pregnant women is incomplete. Resistance to sulfadoxine-pyrimethamine in Plasmodium falciparum and long unprotected intervals between intermittent treatment doses begs reconsideration of current preventative recommendations in pregnancy. Data remain limited on antimalarials during breastfeeding; while most first-line drugs appear safe, further research is needed.

Pregnancy outcomes and risk of placental malaria after artemisinin-based and quinine-based treatment for uncomplicated falciparum malaria in pregnancy: a WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis

“…Many studies have been conducted to assess the relationship between placental malaria and adverse pregnancy outcomes and have confirmed the association [18][19][20]. Placental malaria is a direct consequence of malaria infection and is therefore an efficacy outcome measure after treatment or intermittent preventive treatment in pregnancy (IPTp) [21,22].…”

Malaria congénita por Plasmodium falciparum

“…La Organización Mundial de la Salud (OMS) recomienda quinina y clindamicina para tratamiento de malaria no complicada por P. falciparum en el primer trimestre del embarazo y terapia combinada basada en artemisina en trimestres posteriores 7 . En el caso 1 la gestante recibió quinina a las 22 semanas de gestación, la cual ha mostrado menor eficacia que los derivados de la artemisina 16 y aunque cruza la placenta no es terapéutico para el feto 17 .…”

In vitro and in vivo antimalarial activity of Nigella sativa L. extracts

“…The four day suppressive test mostly assesses the antimalarial activity of candidates on early periods of infection (Verma et al, 2011). The best antimalarial drug should be safe without adverse effects (Saito et al, 2018). As a result, cytotoxicity and toxicity studies were appropriate to identify potential application of N. sativa in malaria management.…”