- CDC updated guidance now includes artemether-lumefantrine (AL, Coartem) as a treatment option for uncomplicated malaria in pregnant women during the second and third gestational periods.
- This provides a third option for uncomplicated malaria treatment during pregnancy when other options are unavailable or in regions where chloroquine-resistant Plasmodium falciparum exists.
Why this matters
- To guide informed management, clinicians should gain familiarity with current CDC and WHO malaria treatment guidelines for pregnant women.
- WHO has endorsed artemisinin-based combination therapy (ACT), including AL, for uncomplicated malaria in pregnant women.
- Global experience demonstrates cure rates >94.9% with ACT in the second, third trimesters vs non-ACT (pooled risk ratio random effects: 0.41; 95% CI, 0.16-1.06).
- Metadata demonstrate ACT safety in pregnant women with malaria and no differences in pregnancy outcomes vs sulfadoxine-pyrimethamine, nor association with congenital malformations or miscarriage.
- No differences observed in the first trimester safety/outcomes (miscarriages, stillbirth, pregnancy loss) vs quinine-based regimens.
- Pooled congenital anomalies in ACT, quinine-based regimens were similar (1.5%; 95% CI, 0.6-3.5 vs 1.2%; 95% CI, 0.6-2.4, respectively).
- Data demonstrate that compared with ACT-based treatment, quinine-based therapies are associated with higher rates of tinnitus, dizziness, and vomiting in pregnant women.