Treatment with dihydroartemisinin-piperaquine does not improve pregnancy outcomes in women with malaria

1. Adverse pregnancy outcomes were less frequent among patients in the sulfadoxine-pyrimethamine group.

2. Differences in adverse pregnancy outcomes were mainly driven by an increased incidence of low birth weight and small for gestational age pregnancies.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Plasmodium falciparum malaria infection can have adverse maternal and fetal outcomes. Studies show that intermittent preventive treatment in pregnancy (IPTp) with dihydroartemisinin-piperaquine may be more effective at reducing malaria than sulfadoxine-pyrimethamine, although further research is needed. This randomized controlled trial aimed to assess the safety and efficacy of IPTp with dihydroartemisinin-piperaquine alone or with azithromycin on adverse pregnancy outcomes. The primary outcome was a composite of fetal loss, adverse newborn baby outcomes and neonatal death. According to the study results, patients in dihydroartemisinin-piperaquine (DP) and dihydroartemisinin-piperaquine plus azithromycin (DPA) groups reported greater adverse pregnancy outcomes than those in the sulfadoxine-pyrimethamine (SP) group, which was mainly driven by an increased incidence of low birth weight and small for gestational age pregnancies. This study was strengthened by a large sample size with patients from various countries, thus increasing its generalizability.

Click to read the study in The Lancet

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In-depth [randomized-controlled trial]: Between Mar 29, 2018, and Jul 5, 2019, 8065 women were screened for eligibility across 12 antenatal clinics in Kenya, Malawi, and Tanzania. Included were pregnant women with a singleton pregnancy between 16 to 28 weeks of gestation who were adherent to the follow-up schedule. Altogether, 4310 patients (1435 in SP, 1442 in DP, and 1433 in DPA) were included in the primary analysis. The primary outcome of adverse pregnancy outcomes was greatest in the DP group (27.9%, risk ratio [RR] 1.20, p=0.0040), followed by the DPA (27.6%, RR 1.16, p=0.017) and SG (23.3%) groups. Serious adverse outcomes among mothers and infants were greatest in the SP (17.7 and 49.2 per 100 person-years) group, followed by the DPA (16.9 and 47.8 per 100 person-years) and DP (14.8 and 42.4 per 100 person-years) groups respectively. Findings from this study suggest monthly DP with or without azithromycin did not improve pregnancy outcomes.

Image: PD

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