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pregnancy

NOT Open Access | Efficacy and safety of malarial prophylaxis with mefloquine during pregnancy in Kisangani, Democratic Republic of Congo: a randomized clinical trial

January 6, 2021 - 12:37 -- NOT Open Access
Author(s): 
Labama Otuli N, Marini Djang'eing'a R, Manga Okenge JP, et al.
Reference: 
Br J Clin Pharmacol. 2021 Jan 4

Kisangani is an area with intense malaria transmission and sulfadoxine‐pyrimethamine resistance. Alternative anti‐malaria prophylaxis medication and protocols are needed, particularly with pregnant individuals. In this study, we compare the tolerance and effectiveness of mefloquine regimen as a split dose with meal versus sulfadoxine‐pyrimethamine for the intermittent preventive treatment in pregnant individuals in Kisangani.

Changes in the frequencies of Plasmodium falciparum dhps and dhfr drug-resistant mutations in children from Western Kenya from 2005 to 2018: the rise of Pfdhps S436H

October 22, 2020 - 15:45 -- Open Access
Author(s): 
M. Andreína Pacheco, Kristan A. Schneider, Qiuying Cheng, Elly O. Munde, Caroline Ndege, Clinton Onyango, Evans Raballah, Samuel B. Anyona, Collins Ouma, Douglas J. Perkins and Ananias A. Escalante
Reference: 
Malaria Journal 2020 19:378, 22 October 2020

Sulfadoxine-pyrimethamine (SP) is the only anti-malarial drug formulation approved for intermittent preventive treatment in pregnancy (IPTp). However, mutations in the Plasmodium falciparum dhfr (Pfdhfr) and dhps (Pfdhps) genes confer resistance to pyrimethamine and sulfadoxine, respectively. Here, the frequencies of SP resistance-associated mutations from 2005 to 2018 were compared in samples from Kenyan children with malaria residing in a holoendemic transmission region.

Not Open Access | Teratogen update: Malaria in pregnancy and the use of antimalarial drugs in the first trimester

October 21, 2020 - 09:39 -- NOT Open Access
Author(s): 
Clark RL
Reference: 
Birth Defects Res. 2020 Oct 20

Malaria is a particular problem in pregnancy because of enhanced sensitivity, the possibility of placental malaria, and adverse effects on pregnancy outcome. Artemisinin-containing combination therapies (ACTs) are the most effective antimalarials known. WHO recommends 7-day quinine therapy for uncomplicated Plasmodium falciparum malaria in the first trimester despite the superior tolerability and efficacy of 3-day ACT regimens because artemisinins caused embryolethality and/or cardiovascular malformations at relatively low doses in rats, rabbits, and monkeys.

NOT Open Access | Associations between malaria preventive regimens and Plasmodium falciparum drug resistance mediating polymorphisms in Ugandan pregnant women

October 7, 2020 - 15:35 -- NOT Open Access
Author(s): 
Nayebare P, Asua V, Conrad MD, Kajubi R, Kakuru A, Nankabirwa JI, Muhanguzi D, Dorsey G, Kamya MR, Nsobya S, Rosenthal PJ
Reference: 
Antimicrob Agents Chemother. 2020 Oct 5:AAC.01047-20

Intermittent preventive treatment in pregnancy (IPTp) with monthly sulfadoxine-pyrimethamine (SP) is recommended for malaria-endemic parts of Africa, but efficacy is compromised by resistance and, in recent trials, dihydroartemisinin-piperaquine (DP) has shown better antimalarial protective efficacy. We utilized blood samples from a recent trial to evaluate selection by IPTp with DP or SP of Plasmodium falciparum genetic polymorphisms that alter susceptibility to these drugs.

Deleterious effects of malaria in pregnancy on the developing fetus: a review on prevention and treatment with antimalarial drugs

October 1, 2020 - 07:45 -- Open Access
Author(s): 
Saito M, Briand V, Min AM, McGready R
Reference: 
Lancet Child Adolesc Health. 2020 Oct;4(10):761-774

All malaria infections are harmful to both the pregnant mother and the developing fetus. One in ten maternal deaths in malaria endemic countries are estimated to result from Plasmodium falciparum infection. Malaria is associated with a 3-4 times increased risk of miscarriage and a substantially increased risk of stillbirth. Current treatment and prevention strategies reduce, but do not eliminate, malaria's damaging effects on pregnancy outcomes.

Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions

September 29, 2020 - 13:04 -- Open Access
Author(s): 
Matilda Aberese-Ako, Pascal Magnussen, Margaret Gyapong, Gifty D. Ampofo and Harry Tagbor
Reference: 
Malaria Journal 2020 19:347, 25 September 2020

Malaria in pregnancy (MiP) is an important public health problem across sub-Saharan Africa. The package of measures for its control in Ghana in the last 20 years include regular use of long-lasting insecticide-treated bed nets (LLINs), directly-observed administration (DOT) of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and prompt and effective case management of MiP. Unfortunately, Ghana like other sub-Saharan African countries did not achieve the reset Abuja targets of 100% of pregnant women having access to IPTp and 100% using LLINs by 2015.

Active case detection of malaria in pregnancy using loop-mediated amplification (LAMP): a pilot outcomes study in South West Ethiopia

September 1, 2020 - 09:45 -- Open Access
Author(s): 
Guluma Tadesse, Claire Kamaliddin, Cody Doolan, Ranmalee Amarasekara, Ruth Legese, Abu Naser Mohon, James Cheaveau, Delenasaw Yewhalaw and Dylan R. Pillai
Reference: 
Malaria Journal 2020 19:305, 27 August 2020

125 million women are pregnant each year in malaria endemic areas and are, therefore, at risk of Malaria in Pregnancy (MiP). MiP is the direct consequence of Plasmodium infection during pregnancy. The sequestration of Plasmodium falciparum parasites in the placenta adversely affects fetal development and impacts newborn birth weight. Importantly, women presenting with MiP commonly develop anaemia. In Ethiopia, the Ministry of Health recommends screening symptomatic women only at antenatal care visits with no formal intermittent preventive therapy. Since MiP can display low-level parasitaemia, current tests which include microscopy and RDT are challenged to detect these cases. Loop mediated isothermal Amplification (LAMP) technology is a highly sensitive technique for DNA detection and is field compatible. This study aims to evaluate the impact of active malaria case detection during pregnancy using LAMP technology in terms of birth outcomes.

Impact of Health Systems on the Implementation of Intermittent Preventive Treatment for Malaria in Pregnancy in Sub-Saharan Africa: A Narrative Synthesis

August 27, 2020 - 08:07 -- Open Access
Author(s): 
Olaleye AO, Walker O
Reference: 
Trop Med Infect Dis. 2020 Aug 22;5(3):E134

Malaria in pregnancy is a public health challenge with serious negative maternal and newborn consequences. Intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine is recommended for the control of malaria during pregnancy within endemic areas, but coverage for the recommended ≥3 doses IPTp regimen has remained suboptimal. We searched PubMed, Cochrane library, and HINARI database from 1 January 2010 to 23 May 2020, for studies investigating the effect of the health system on IPTp implementation.

Malaria in pregnancy regulates P-glycoprotein (P-gp/Abcb1a) and ABCA1 efflux transporters in the Mouse Visceral Yolk Sac

August 13, 2020 - 11:34 -- Open Access
Author(s): 
Martinelli LM, Fontes KN, Reginatto MW, Andrade CBV, Monteiro VRS, Gomes HR, Silva-Filho JL, Pinheiro AAS, Vago AR, Almeida FRCL, Bloise FF, Matthews SG, Ortiga-Carvalho TM, Bloise E
Reference: 
J Cell Mol Med. 2020 Aug 11

Malaria in pregnancy (MiP) induces intrauterine growth restriction (IUGR) and preterm labour (PTL). However, its effects on yolk sac morphology and function are largely unexplored. We hypothesized that MiP modifies yolk sac morphology and efflux transport potential by modulating ABC efflux transporters. C57BL/6 mice injected with Plasmodium berghei ANKA (5 × 105 infected erythrocytes) at gestational day (GD) 13.5 were subjected to yolk sac membrane harvesting at GD 18.5 for histology, qPCR and immunohistochemistry.

Safety of Artemisinin Derivatives in the First Trimester of Pregnancy: A Controversial Story

August 5, 2020 - 16:21 -- Open Access
Author(s): 
D'Alessandro S, Menegola E, Parapini S, Taramelli D, Basilico N
Reference: 
Molecules. 2020 Jul 31;25(15):E3505

Artemisinin combination therapy (ACT) is recommended by the World Health Organization (WHO) as first line treatment for uncomplicated malaria both in adults and children. During pregnancy, ACT is considered safe only in the second and third trimester, since animal studies have demonstrated that artemisinin derivatives can cause foetal death and congenital malformation within a narrow time window in early embryogenesis.

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