Safety of antimalarial drugs exposure during early pregnancy
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Date
2014-06-19
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Publisher
DovePress
Abstract
Inadequately controlled malaria infection in pregnancy is associated with poor
maternal and fetal outcomes. However, there are important questions about drug safety for
mothers with malaria and their fetuses as, currently, there is limited safety data on many of the
medications used. The objective of this review is to determine from published evidence the
safety of antimalarial drugs exposure during early pregnancy, focusing on abortions, stillbirths,
and congenital abnormalities.
Methods: We searched PubMed, Embase, Cochrane Library, and Malaria in Pregnancy databases
from their inception to June 2013, inclusive, for reports published in English only. Data were
extracted on exposure to antimalarial drugs during early pregnancy and adverse pregnancy
outcomes including congenital abnormalities, stillbirth, and miscarriage.
Results: Twenty-two publications including one abstract with a total of 6,333 early pregnancy
exposures to antimalarial agents used for treatment and/or prevention of malaria in pregnancy
met the inclusion criteria. More than 40% of the pregnancies were exposed to mefloquine, about
10% to artemisinin based regimens and, 15.2% and 14.7% were exposed to chloroquine and
quinine, respectively. A total of 1,199 adverse outcomes including abortions, stillbirths, and
congenital abnormalities were reported. The reported absolute risks of adverse outcomes were
similar for all the antimalarial exposures, but, in two publications, increased risk of stillbirths
was linked to mefloquine exposure. Extensive heterogeneity and variability in the way in which
authors assessed, recorded, and reported safety data precluded formal meta-analysis.
Conclusion: The absolute estimates of risks obtained in the included studies are difficult to
interpret and the clinical significance of any association of adverse outcomes reported with antimalarial exposure in early pregnancy is uncertain. Well planned, executed, and analyzed studies
are needed to confirm whether there is increased risk for adverse fetal outcomes attributable to
exposure of first trimester pregnancies to antimalarials compared to relevant controls.
Description
Published in Research and Reports in Tropical Medicine
Keywords
malaria in pregnancy, first trimester, antimalarials, adverse outcomes
Citation
Tagbor, Harry, Gifty Antwi, and Joslin Dogbe. "Safety of antimalarial drugs exposure during early pregnancy." Research and Reports in Tropical Medicine 5 (2014): 23-33.