Table 2.
Studies of the treatment of severe malaria in pregnancy
| References | Country (study site) | Study design | Study population | Trimester | Antimalarials | Measure of outcome | Findings |
|---|---|---|---|---|---|---|---|
| Poespoprodjo et al. [52] | Indonesia | Prospective cohort | 1,806 pregnant women with malaria (559 treated with IV therapies) | 1, 2, 3 | QUI IV before 2006; after 2006 ART IV followed by PO DHA in 2nd or 3rd trimester or PO QUI in 1st | Stillbirth, early neonatal death | Stillbirth 3.3 % (1/30) for QUI, 4.4 % (2/45) for ART + DHP and 0 % (0/13) for ART alone; early neonatal death 3.3 % (1/30) for QUI, 0 % (0/45) for ART + DHP and 7.7 % (1/13) for ART alone; no miscarriages among 10 women exposed to ART IV in the first trimester |
| Elbadawi et al. [26] | Sudan | Cross-sectional | 150 pregnant women with P. falciparum malaria and 50 healthy controls | 1, 2, 3 | QUI IV | Plasma glucose levels | QUI was associated with rise in plasma insulin concentration and decrease plasma glucose. No pts experienced hyperglycemia |
| Adam et al. [25] | Sudan | Prospective cohort | 35 pregnant women with severe P. falciparum malaria | 2, 3 | QUI IV then PO for 7 days | Treatment response, pregnancy outcomes | All pts had negative blood films on day 7; 3 (6.1 %) had reoccurrences by day 20; 3 (6.1 %) delivered prematurely; no maternal or neonatal deaths, miscarriages, or stillbirths reported |
| Krishnan and Karnad [124] | India | Prospective cohort | 301 pts aged 12–90 admitted to ICU with P. falciparum malaria (23 pregnant women) | NR | QUI IV then PO for 7 days | Mortality | Mortality rate in pregnant women was 17.4 % but was not significantly higher than mortality in men or non-pregnant women |
| Looareesuwan et al. [125] | Thailand | Prospective cohort | 12 pregnant pts with severe malaria; and 8 women given quinine during labor | 3 | QUI IV then PO for 7 days | PK and toxicity in pregnancy | Hypoglycemia developed in 7 pts, 1 pt died; no increased uterine activity after administration of QUI; no stillbirths |
| Singh et al. [16] | India | Prospective cohort | 200 pregnant pts and 140 non-pregnant women; 22 pregnant pts with high parasite density infections due to P. falciparum and P. vivax malaria | NR | QUI/Chloroquine IV | Mortality | 16/20 (80 %) pregnant women treated with IV QUI died; 4/7 (36.4 %) treated with IV chloroquine died |
| Dondorp et al. [20] | Bangladesh, India, Indonesia, Myanmar | RCT | 1,461 pts with severe P. falciparum malaria (49 pregnant women) | NR | ART or QUI IV | Mortality | 9 % mortality for ART and 12 % mortality for QUI in pregnant women |
| McGready et al. [9] | Thailand | Retrospective cohort | 48,426 pregnant women who attended an antenatal clinic (24 severe malaria cases either P. vivax or P. falciparum) during the first trimester | 1 | ART or QUI IV | Miscarriage | 14/24 (58 %) women with severe malaria had a miscarriage; no difference in rates between ART and QUI |
| Kochar et al. [19]a | India | Prospective cohort | 441 adult pts with cerebral malaria age 14–74 years; 56 pregnant women | NR | PO or IV QUI | Mortality | 22 (39.3 %) pregnant and 53 (32.9 %) non-pregnant women died (p > 0.05) |
| Kochar et al. [14]a | India | Prospective cohort | 45 pregnant and 243 non-pregnant women with P. falciparum or mixed P. falciparum and P. vivax infection | NR | PO or IV QUI | Mortality, birth outcomes | 37.8 % of pregnant women and 14.8 % of non-pregnant women died (p < 0.05); normal pregnancy continued in only 16 (6.5 %) primiparous and 10 (34.5 %) multiparous pregnant women |
ART artesunate, DHA dihydroartemisinin, ICU intensive care unit, IV intravenous, NR not reported, PK pharmacokinetics, PO oral administration, pt(s) patient(s), QUI quinine, RCT randomized clinical trial
aStudies represent the same ongoing cohort of women