Pregnancy antimalarials

There is very limited evidence available on the effectiveness of the drugs in pregnant women. A possible increase in risk of stillbirth with the use of mefloquine in pregnancy has been reported. Standard adult dose of antimalarial drugs recommended for 2nd and 3rd trimester pregnancy did not cause harm or congenital abnormalities. Evidence on the safety of all recommended antimalarial drugs in the 1st trimester is still unclear. 

Nosten F et al Antimalarial drugs in pregnancy A review. Curr Drug Saf 2006 1 1. [PMID 18690910]... 

McGready R, Cho T, Keo NK, Thwai KL, Villegas L, Looareesuwan S, White NJ, Nosten F. Artemisinin antimalarials in pregnancy a prospective treatment study of 539 episodes of multidrug-resistant Plasmodium falciparum. Clin Infect Dis 2001 33(12) 2009-16. 

A review of the use of mefloquine in pregnancy (47) did not suggest that mefloquine has a worse effect in pregnancy than other antimalarial drugs, such as chloroquine and pyrimethamine + sulfadoxine. 

Phillips-Howard PA, Steffen R, Kerr L, Vanhauwere B, Schildknecht J, Fuchs E, Edwards R. Safety of mefloquine and other antimalarial agents in the first trimester of pregnancy. J Travel Med 1998 5(3) 121-6. 

Surgical sterilization is a widely used method of contraception for both men and women. The problem is that it is very difficult to reverse if a couple wants to have more children, as when a child dies. It may also be too expensive for very poor women in developing countries. A newer non-surgical approach sterilizes a woman by insertion of quinacrine (16.13) into the uterus by a trained paramedic.75 It produces scar tissue in the fallopian tubes that prevents pregnancy. This drug has been used over a long time period as an antimalarial. The cost of the treatment is estimated at less than 1.00 2.50 dollars compared with 12 dollars for laparoscopic sterilization (45 dollars if the cost of the whole team is included). Vasectomy for men is already inexpensive. 

A review of antimalarial drugs indicated that artemisinin-based compounds are not recommended for use during the first trimester of pregnancy, due to lack of safety data, but the compounds may be used during the second and third trimesters (Al Kadi 2007). An animal study published after that review indicated that an increase in postimplantation losses was observed in animals given relatively high amounts (35 or 70 mg/kg) of the compound artemisinin but not in animals given amounts comparable to the standard human dose (7 mg/kg) (Boareto et al. 2008). 

A review of antimalarial drugs indicated that, due to lack of safety data, artemisinin-based compounds are not recommended for use during the first trimester of pregnancy but the compounds may be used during the second and third trimesters (Al Kadi 2007). 

Phillips-Howard PA, Wood D. The safety of antimalarial drugs in pregnancy. Drug... 

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