United Press International - October 14, 2006
Olga Pierce, UPI Health Business Correspondent

"Malaria in pregnancy poses a threat to both the mother and the fetus," said study author Brian Greenwood, an epidemiologist at the London School of Hygiene and Tropical Medicine. "Previous studies had already found amodiaquine alone or in combination with another drug known as SP to be an effective treatment of malaria in children in west Africa, but our research confirms that this is also true for pregnant women."

The parasite that causes malaria has begun to develop resistance to established treatments such as choloroquine and sulphadoxine-pyrimethamine. As a result, most countries in Africa are adopting artesunate-based combination therapy, known as ACT, as the preferred first line treatment but there is insufficient information as to its safety of ACT during pregnancy. There are concerns it may have a negative effect on the developing embryo, particularly when given during the first trimester of pregnancy.

Another treatment, amodiaquine, has been found effective in treating malaria in African children, but safety concerns prevented it from being used to treat pregnant women. The new study establishes that it is a viable treatment for malaria during pregnancy until ACT has been approved for pregnant women.

The researchers studied 900 pregnant women with malaria in Ghana and found that after 28 days, women who were treated with a combination of sulphadoxine-pyrimethamine and amodiaquine had 0 percent parasitological failure, meaning the malaria in their bodies was virtually eliminated.

The women treated with amodiaquine showed no serious side effects such as liver toxicity or white-blood-cell dyscrasias, although there was a higher incidence of minor side effects.

In areas where malaria is common, most people have developed some resistance to the disease by the time they reach adulthood. In pregnant women, however, this resistance is reduced, making them more susceptible to the disease, especially if the pregnancy is their first or second, or if they are HIV-positive.

Having malaria during pregnancy can cause severe anemia for the mother, and a variety of problems for the developing fetus including low birth weight, premature delivery, mental retardation and stillbirth.

In sub-Saharan Africa, where malaria is most acute, the disease causes an estimated 400,000 cases of severe maternal anemia per year, and between 75,000 and 200,000 infant deaths.

"Like a lot of infections, malaria goes after those most vulnerable -- pregnant women and young children," Nicole Bates, director of government relations at the Global Health Council, told United Press International. "If you want to make a difference, you have to target your interventions for those groups."

Effective anti-malarial treatments, like amodiaquine, are one-third of the strategy of treatment, mosquito nets and care management global health groups now recommend, she said. For pregnant women, such drugs can be dispensed at pre-natal checkups to ensure that malaria does not have negative effects. "It's like taking your vitamins," Bates said.

Women who have access to appropriate healthcare when they are pregnant will find this to be a good solution, Bates said, but more work needs to be done to help women who are not so lucky.

"If you want to make sure pregnant women are getting preventive care, they have to have basic health access." she said.

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