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Review
. 2014 Jun 19:5:23-33.
doi: 10.2147/RRTM.S34683. eCollection 2014.

Safety of antimalarial drugs exposure during early pregnancy

Harry Tagbor  1 , Gifty Antwi  1 , Joslin Dogbe  2
Affiliations
Review

Safety of antimalarial drugs exposure during early pregnancy

Harry Tagbor et al. Res Rep Trop Med. .

Abstract

Introduction: 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.

Keywords: adverse outcomes; antimalarials; congenital abnormalities; first trimester; malaria in pregnancy; mefloquine.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

References

    1. Koren G, Pastuszak A, Ito S. Drugs in pregnancy. N Engl J Med. 1998; 338(16):1128–1137. - PubMed
    1. Briggs GG, Freeman RK, Yaffe SJ. Drugs In Pregnancy And Lactation: A Reference Guide to Fetal and Neonatal Risk. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2008.
    1. Rijken MJ, de Wit MC, Mulder EJ, et al. Effect of malaria in pregnancy on foetal cortical brain development: a longitudinal observational study. Malar J. 2012;11:222. - PMC - PubMed
    1. Rijken MJ, Papageorghiou AT, Thiptharakun S, et al. Ultrasound evidence of early fetal growth restriction after maternal malaria infection. PloS One. 2012;7(2):e31411. - PMC - PubMed
    1. Umbers AJ, Aitken EH, Rogerson SJ. Malaria in pregnancy: small babies, big problem. Trends Parasitol. 2011;27(4):168–175. - PubMed