Table 2.

Observational studies on the use of artemisinin derivatives in the first trimester of pregnancy.

Author, Publication Year [ref]	ACT	Country	Period	N. of Women Involved	Period of Exposure	Conclusions
Augusto 2020 [60]	AL	Mozambique, Burkina Faso and Kenya	2011–13	92	2–13 weeks	No evidence of an increased risk of LBW, SGA or prematurity among pregnancies with ACT exposure during the first trimester of pregnancy
Rouamba 2020 [61]	ASAQ	Burkina Faso	2010–12	13	10 in the third month; 2 in the second; 1 in the first	12 women delivered live newborns (including one with twins) with no congenital malformations. One woman had experienced a spontaneous abortion that was judged not to be related to ASAQ
Moore 2016 [62]	ACTs	Thai–Myanmar border	1994–2013	183	5–11 weeks	No evidence that first-line treatment with an artemisinin derivative was associated with an increased risk of miscarriage or congenital malformations
Manyando 2015 [63]	AL	Zambia	2004–2008	156	<14 weeks	No evidence of higher risk of perinatal or neonatal mortality, premature delivery or low birth weight in women exposed AL compared with SP exposure
Dellicour S 2015 [64]	ACTs	Kenya	2011–13	77	6–13 weeks	Artemisinin exposure during the potential embryo-sensitive period was not associated with increased risk of miscarriage.
Poespoprodjo 2014 [65]	AS-DHA/PQ	Indonesia	2004–09	22		The risk of abortion was over 60% in women receiving an ACT compared to 1% in women treated with quinine. None of the 10 women who received IV artesunate miscarried
Mosha D 2014 [66]	AL	Tanzania	2012–13	172	<20 weeks	Exposure to AL in the first trimester was common. Quinine, but not AL exposure was associated with adverse pregnancy outcome
Dellicour 2013 [67]	ACTs	Senegal	2004–08	7	3 of 7 4–10 weeks	Exposure to ACTs resulted in normal live births.
McGready R 2012 [42]	Artesunate or ACT	Thailand	1986–2010	44	6–12 weeks	Risk of miscarriage was similar for women treated with CQ, Q or Artesunate
Rulisa S 2012 [68]	AL	Rwanda	2007–2009	96		Increased frequency of obstetric adverse outcomes but no significant increase in congenital defects after AL treatment in all trimesters of pregnancy
Adam 2009 [69]	Artemether-AS/SP-AL	Sudan	2006–2008	62	<12 weeks	Women delivered apparently healthy babies at full term. No congenital malformations, no preterm labour, no maternal deaths; none of the babies died during their first year of life.
Adam 2004 [70]	Artemether	Sudan	1997–2001	1	10 weeks	No abortion, stillbirth or congenital abnormalities in the newborn baby.
McGready 2001 [71]	Artesunate	Thailand	1992–2000	44	3–12.9 weeks	The rates of abortion, congenital abnormality, and stillbirth were all within the normal range of their communities
Deen 2001 [72]	Artesunate-PSD	Gambia	1999	77		No evidence of a teratogenic effect, no evidence of increased foetal loss or infant death
McGready 1998 [73]	Artesunate	Thailand	1992–96	13	3–12 weeks	No congenital abnormality in any of the newborn children, no adverse effect was found in women or neonates.