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Artemisinin-based combination therapy during pregnancy: outcome of pregnancy and infant mortality: a cohort study

Article scientifique 2019 Anglais

Résumé

BACKGROUND: The World Health Organization (WHO) recommendation of treating uncomplicated malaria during the second and third trimester of pregnancy with an artemisinin-based combination therapy (ACT) has already been implemented by all sub-Saharan African countries. However, there is limited knowledge on the effect of ACT on pregnancy outcomes, and on newborn and infant's health. METHODS: Pregnant women with malaria in four countries (Burkina Faso, Ghana, Malawi and Zambia) were treated with either artemether-lumefantrine (AL), amodiaquine-artesunate (ASAQ), mefloquine-artesunate (MQAS), or dihydroartemisinin-piperaquine (DHA-PQ); 3127 live new-borns (822 in the AL, 775 in the ASAQ, 765 in the MQAS and 765 in the DHAPQ arms) were followed-up until their first birthday. RESULTS: Prevalence of placental malaria and low birth weight were 28.0% (738/2646) and 16.0% (480/2999), respectively, with no significant differences between treatment arms. No differences in congenital malformations (p = 0.35), perinatal mortality (p = 0.77), neonatal mortality (p = 0.21), and infant mortality (p = 0.96) were found. CONCLUSIONS: Outcome of pregnancy and infant survival were similar between treatment arms indicating that any of the four artemisinin-based combinations could be safely used during the second and third trimester of pregnancy without any adverse effect on the baby. Nevertheless, smaller safety differences between artemisinin-based combinations cannot be excluded; country-wide post-marketing surveillance would be very helpful to confirm such findings. Trial registration ClinicalTrials.gov, NCT00852423, Registered on 27 February 2009, https://clinicaltrials.gov/ct2/show/NCT00852423.

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Nambozi, M., Tinto, H., Mwapasa, V., Tagbor, H., Kabuya, J., Hachizovu, S., Traoré, M., Valéa, I., Tahita, M., Ampofo, G., Buyze, J., Ravinetto, R., Arango, D., Thriemer, K., Mulenga, M., Geertruyden, J., D’Alessandro, U. (2019). Artemisinin-based combination therapy during pregnancy: outcome of pregnancy and infant mortality: a cohort study. https://doi.org/10.1186/s12936-019-2737-7

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Auteur(s)

Michael Nambozi Halidou Tinto Victor Mwapasa Harry Tagbor Jean-Bertin Bukasa Kabuya Sebastian Hachizovu Maminata Traoré Innocent Valéa Marc Christian Tahita Gifty Dufie Ampofo Jozefien Buyze Raffaella Ravinetto Diana Arango Kamala Thriemer Modest Mulenga Jean‐Pierre Van Geertruyden Umberto D’Alessandro

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