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[Antimalarials and pregnancy].

F Bricaire1, D Salmon, M Danis

  • 1Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, Paris.

Bulletin De La Societe De Pathologie Exotique (1990)
|January 1, 1991
PubMed
Summary
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Pregnant women in malaria-endemic areas require careful antimalarial drug selection due to potential risks. Quinine and chloroquine are options, but resistance and side effects necessitate individualized prophylaxis and treatment strategies.

Area of Science:

  • Medical Parasitology
  • Maternal Health
  • Pharmacology

Context:

  • Malaria poses significant risks to pregnant women, particularly in endemic regions.
  • Primiparous women and those in their second or third trimesters are especially vulnerable.
  • Increasing chloroquine resistance complicates treatment and prevention options.

Purpose:

  • To review the safety and efficacy of various antimalarial drugs during pregnancy.
  • To provide guidance on therapeutic and prophylactic antimalarial use in pregnant women.
  • To highlight the challenges posed by drug resistance and limited teratogenicity data.

Summary:

  • Quinine (Q) is effective but can cause maternal hypoglycemia; it's not teratogenic except at high doses. Chloroquine (CQ) is generally safe, despite some animal toxicity. Pyrimethamine-sulfadoxine (P-S) with folinic acid may be used, but proguanil is unrestricted. Mefloquine (MQ) and Halofantrine (HF) are contraindicated due to limited data and observed abnormalities in animal studies.

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  • Curative treatment options include quinine for severe cases. In chloroquine-sensitive areas, CQ is suitable for uncomplicated malaria. In resistant zones, quinine is preferred over Fansidar. Proguanil is the safest prophylactic agent.
  • Preventive measures include avoiding endemic areas. If unavoidable, chemoprophylaxis tailored to local resistance patterns is recommended (CQ in sensitive zones, proguanil + CQ in resistant zones). Mosquito bite prevention remains crucial.

    • Impact:

    • Informs clinical decision-making for managing malaria in pregnant populations.
    • Emphasizes the need for risk-benefit assessment for each antimalarial drug.
    • Highlights gaps in knowledge regarding the teratogenic effects of certain antimalarials.
    • Guides the development of safer and more effective malaria prevention and treatment strategies for pregnant women.