CDC adds new malaria treatment option for pregnancy

Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Key points

  • 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.