Unger, Holger W

Acharya, Sanjaya

Arnold, Lachlan

Wu, Connie

van Eijk, Anna Maria

Gore-Langton, Georgia R

Ter Kuile, Feiko O

Lufele, Elvin

Chico, R Matthew

Price, Ric N

Moore, Brioni R

Thriemer, Kamala

Rogerson, Stephen J

2023-11-01

Half of all pregnancies at risk of malaria worldwide occur in the Asia-Pacific region, where Plasmodium falciparum and Plasmodium vivax co-exist. Despite substantial reductions in transmission, malaria remains an important cause of adverse health outcomes for mothers and offspring, including pre-eclampsia. Malaria transmission is heterogeneous, and infections are commonly subpatent and asymptomatic. High-grade antimalarial resistance poses a formidable challenge to malaria control in pregnancy in the region. Intermittent preventive treatment in pregnancy reduces infection risk in meso-endemic New Guinea, whereas screen-and-treat strategies will require more sensitive point-of-care tests to control malaria in pregnancy. In the first trimester, artemether-lumefantrine is approved, and safety data are accumulating for other artemisinin-based combinations. Safety of novel antimalarials to treat artemisinin-resistant P falciparum during pregnancy, and of 8-aminoquinolines during lactation, needs to be established. A more systematic approach to the prevention of malaria in pregnancy in the Asia-Pacific is required.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Tiwi, NT, Australia; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Electronic address: hwunger@doctors.org.uk.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.

Royal Melbourne Hospital Clinical School, The University of Melbourne, Parkville, VIC, Australia.

Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.

Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Vector-Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

Curtin Medical School, Curtin University, Bentley, WA, Australia; Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia; Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia.

Department of Infectious Diseases, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia.

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Lancet Glob Health. 2023 Nov;11(11):e1805-e1818. doi: 10.1016/S2214-109X(23)00415-1.

https://pubmed.ncbi.nlm.nih.gov/37858590/?otool=iaurydwlib

https://hdl.handle.net/10137/12631

11

Pregnancy

Female

Humans

*Antimalarials/therapeutic use

*Malaria, Falciparum/drug therapy/epidemiology/prevention & control

Lactation

Artemether/therapeutic use

Artemether, Lumefantrine Drug Combination/therapeutic use

*Malaria/drug therapy/epidemiology/prevention & control

*Artemisinins/therapeutic use

Asia/epidemiology

The effect and control of malaria in pregnancy and lactating women in the Asia-Pacific region.

Journal Article

Research Support, Non-U.S. Gov't

Review

Publication