Titre
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.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Saito, M.
Auteure/Auteur
Mansoor, R.
Auteure/Auteur
Kennon, K.
Auteure/Auteur
Anvikar, A.R.
Auteure/Auteur
Ashley, E.A.
Auteure/Auteur
Chandramohan, D.
Auteure/Auteur
Cohee, L.M.
Auteure/Auteur
D'Alessandro, U.
Auteure/Auteur
Genton, B.
Auteure/Auteur
Gilder, M.E.
Auteure/Auteur
Juma, E.
Auteure/Auteur
Kalilani-Phiri, L.
Auteure/Auteur
Kuepfer, I.
Auteure/Auteur
Laufer, M.K.
Auteure/Auteur
Lwin, K.M.
Auteure/Auteur
Meshnick, S.R.
Auteure/Auteur
Mosha, D.
Auteure/Auteur
Muehlenbachs, A.
Auteure/Auteur
Mwapasa, V.
Auteure/Auteur
Mwebaza, N.
Auteure/Auteur
Nambozi, M.
Auteure/Auteur
Ndiaye, J.A.
Auteure/Auteur
Nosten, F.
Auteure/Auteur
Nyunt, M.
Auteure/Auteur
Ogutu, B.
Auteure/Auteur
Parikh, S.
Auteure/Auteur
Paw, M.K.
Auteure/Auteur
Phyo, A.P.
Auteure/Auteur
Pimanpanarak, M.
Auteure/Auteur
Piola, P.
Auteure/Auteur
Rijken, M.J.
Auteure/Auteur
Sriprawat, K.
Auteure/Auteur
Tagbor, H.K.
Auteure/Auteur
Tarning, J.
Auteure/Auteur
Tinto, H.
Auteure/Auteur
Valéa, I.
Auteure/Auteur
Valecha, N.
Auteure/Auteur
White, N.J.
Auteure/Auteur
Wiladphaingern, J.
Auteure/Auteur
Stepniewska, K.
Auteure/Auteur
McGready, R.
Auteure/Auteur
Guérin, P.J.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1741-7015
Statut éditorial
Publié
Date de publication
2020-06-02
Volume
18
Numéro
1
Première page
138
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Résumé
Malaria in pregnancy, including asymptomatic infection, has a detrimental impact on foetal development. Individual patient data (IPD) meta-analysis was conducted to compare the association between antimalarial treatments and adverse pregnancy outcomes, including placental malaria, accompanied with the gestational age at diagnosis of uncomplicated falciparum malaria infection.
A systematic review and one-stage IPD meta-analysis of studies assessing the efficacy of artemisinin-based and quinine-based treatments for patent microscopic uncomplicated falciparum malaria infection (hereinafter uncomplicated falciparum malaria) in pregnancy was conducted. The risks of stillbirth (pregnancy loss at ≥ 28.0 weeks of gestation), moderate to late preterm birth (PTB, live birth between 32.0 and < 37.0 weeks), small for gestational age (SGA, birthweight of < 10th percentile), and placental malaria (defined as deposition of malaria pigment in the placenta with or without parasites) after different treatments of uncomplicated falciparum malaria were assessed by mixed-effects logistic regression, using artemether-lumefantrine, the most used antimalarial, as the reference standard. Registration PROSPERO: CRD42018104013.
Of the 22 eligible studies (n = 5015), IPD from16 studies were shared, representing 95.0% (n = 4765) of the women enrolled in literature. Malaria treatment in this pooled analysis mostly occurred in the second (68.4%, 3064/4501) or third trimester (31.6%, 1421/4501), with gestational age confirmed by ultrasound in 91.5% (4120/4503). Quinine (n = 184) and five commonly used artemisinin-based combination therapies (ACTs) were included: artemether-lumefantrine (n = 1087), artesunate-amodiaquine (n = 775), artesunate-mefloquine (n = 965), and dihydroartemisinin-piperaquine (n = 837). The overall pooled proportion of stillbirth was 1.1% (84/4361), PTB 10.0% (619/4131), SGA 32.3% (1007/3707), and placental malaria 80.1% (2543/3035), and there were no significant differences of considered outcomes by ACT. Higher parasitaemia before treatment was associated with a higher risk of SGA (adjusted odds ratio [aOR] 1.14 per 10-fold increase, 95% confidence interval [CI] 1.03 to 1.26, p = 0.009) and deposition of malaria pigment in the placenta (aOR 1.67 per 10-fold increase, 95% CI 1.42 to 1.96, p < 0.001).
The risks of stillbirth, PTB, SGA, and placental malaria were not different between the commonly used ACTs. The risk of SGA was high among pregnant women infected with falciparum malaria despite treatment with highly effective drugs. Reduction of malaria-associated adverse birth outcomes requires effective prevention in pregnant women.
A systematic review and one-stage IPD meta-analysis of studies assessing the efficacy of artemisinin-based and quinine-based treatments for patent microscopic uncomplicated falciparum malaria infection (hereinafter uncomplicated falciparum malaria) in pregnancy was conducted. The risks of stillbirth (pregnancy loss at ≥ 28.0 weeks of gestation), moderate to late preterm birth (PTB, live birth between 32.0 and < 37.0 weeks), small for gestational age (SGA, birthweight of < 10th percentile), and placental malaria (defined as deposition of malaria pigment in the placenta with or without parasites) after different treatments of uncomplicated falciparum malaria were assessed by mixed-effects logistic regression, using artemether-lumefantrine, the most used antimalarial, as the reference standard. Registration PROSPERO: CRD42018104013.
Of the 22 eligible studies (n = 5015), IPD from16 studies were shared, representing 95.0% (n = 4765) of the women enrolled in literature. Malaria treatment in this pooled analysis mostly occurred in the second (68.4%, 3064/4501) or third trimester (31.6%, 1421/4501), with gestational age confirmed by ultrasound in 91.5% (4120/4503). Quinine (n = 184) and five commonly used artemisinin-based combination therapies (ACTs) were included: artemether-lumefantrine (n = 1087), artesunate-amodiaquine (n = 775), artesunate-mefloquine (n = 965), and dihydroartemisinin-piperaquine (n = 837). The overall pooled proportion of stillbirth was 1.1% (84/4361), PTB 10.0% (619/4131), SGA 32.3% (1007/3707), and placental malaria 80.1% (2543/3035), and there were no significant differences of considered outcomes by ACT. Higher parasitaemia before treatment was associated with a higher risk of SGA (adjusted odds ratio [aOR] 1.14 per 10-fold increase, 95% confidence interval [CI] 1.03 to 1.26, p = 0.009) and deposition of malaria pigment in the placenta (aOR 1.67 per 10-fold increase, 95% CI 1.42 to 1.96, p < 0.001).
The risks of stillbirth, PTB, SGA, and placental malaria were not different between the commonly used ACTs. The risk of SGA was high among pregnant women infected with falciparum malaria despite treatment with highly effective drugs. Reduction of malaria-associated adverse birth outcomes requires effective prevention in pregnant women.
PID Serval
serval:BIB_525325789405
PMID
Open Access
Oui
Date de création
2020-06-10T19:10:46.505Z
Date de création dans IRIS
2025-05-20T13:44:12Z
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published
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PID Serval
serval:BIB_525325789405.P001
URN
urn:nbn:ch:serval-BIB_5253257894051
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(MD5):ee1c795bad49b7359a1361e2163cb0b5