New treatment regimen reduces the severity of drug-resistant malaria in pregnancy ;
a preventive treatment of two drugs greatly reduces the severity of malaria during pregnancy, according to a study funded by the National Institutes of Health. The treatment offers an alternative for many parts of Africa where the parasite that causes malaria Plasmodium falciparum has become resistant to standard treatment.
Pregnancy reduces the body’s defenses against parasites that cause malaria. Malaria during pregnancy increases the risk of maternal and infant death. However, even in areas where mothers have a high level of immunity, malaria parasites can infect the placenta, depriving the fetus of nutrients and increase the chances of LBW , premature birth and infection .
The two-drug regimen, dihydroartemisinin-piperaquine, seemed to provide a reliable alternative to the standard treatment, sulfadoxine-pyrimethamine, by study participants. The authors note that in sub-Saharan Africa, malaria during pregnancy is responsible for up to 20 percent of births of low birth weight and more than 100,000 infant deaths each year.
The study appears in the New England Journal of Medicine . It was made by Abel Kakuru, MD, collaboration Infectious Diseases Research in Uganda, Grant Dorsey, MD, Ph.D., of the University of California, San Francisco, and colleagues at Makerere University College of Health Sciences in Kampala, Uganda.
“On average, pregnant women living in the study area support an estimated 310 bites from mosquitoes carrying malaria each year,” said Rohan Hazra, MD, chief of the Division of maternal and pediatric Infectious diseases at NIH Institute Eunice Kennedy Shriver National child Health and human Development (NICHD), which funded the study. “This drug combination seems to offer a welcome addition to our defenses against this debilitating and potentially fatal disease.”
In the study 300 pregnant women Tororo, Uganda participated from June to October 2014. All were over 16 years, ranging from 12 to 20 weeks pregnant. The women were randomly assigned to one of three groups for preventive treatment. The first dihydroartemisinin-piperaquine received at three intervals: 20, 28 and 30 weeks of pregnancy. The second group received the same combination of drugs, but once every month. The comparison group was given sulfadoxine-pyrimethamine, the standard treatment, at 20, 28 and 30 weeks of pregnancy. Participants had monthly exams in the study clinic, where they received regular blood tests for malaria.
Researchers evaluated the women for malaria infection in the placenta, diagnosed by finding parasites in the placenta at birth or by observing the presence of pigment deposits parasites tissue digested after blood cells. The researchers confirmed placental malaria in 50 percent of women in the group of sulfadoxine-pyrimethamine. Among the group that received three doses of dihydroartemisinin-piperaquine, 34.1 percent had placental malaria compared with 27.1 percent in the monthly treatment group.
Many of the women who have no symptoms of malaria during pregnancy , however, had malaria pigment in the placenta. However, heavy deposits of pigment malaria were more likely to occur in the group of sulfadoxine-pyrimethamine and less likely to occur in the dihydroartemisinin-piperaquine monthly group.
The researchers also women and children in the study of adverse birth outcome composed of spontaneous abortion, stillbirth, low birth weight, premature birth or birth defects. Risk of any adverse outcome at birth was lower in the dihydroartemisinin-piperaquine (9.2 percent) monthly group than in the group of three doses (21.3 percent) or sulfadoxine-pyrimethamine group (18.6 percent ).
The researchers concluded that the monthly dose of dihydroartemisinin-piperaquine provides the best protection malaria and called for additional studies to determine whether the drug combination would provide an effective alternative treatment in other parts of Uganda and other places Africa.
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