The Malaria in Pregnancy (MiP) Library is a regularly updated, comprehensive bibliographic database of published and unpublished literature relating to malaria in pregnancy, including a trial registry of planned and ongoing trials. The MiP library is a product of the Malaria in Pregnancy Consortium and is available free of charge.
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Article highlights from the update in September 2015:
In September 2015, over 150 new entries were added to the MiP library. New entries include peer reviewed journal articles, PhD and MSc theses, and reports. Here we highlight a few articles that may be of particular interest:
The results of a large trial comparing intermittent screening using rapid diagnostic malaria tests and treatment of women testing positive with artemether-lumefantrine (ISTp-AL) versus intermittent preventive treatment using sulfadoxine-pyrimethamine (IPTp-SP) in four West-African countries (The Gambia, Mali, Burkina Faso, and Ghana) was published (Tagbor et al. 2015). ISTp-AL was non-inferior to IPTp-SP in preventing low birth weight, anaemia, and placental malaria. However, significantly more women in the ISTp-AL arm than in the IPTp-SP group presented with malaria parasiteamia at scheduled antenatal clinic visits.
A double-blind trial in Nigeria compared artesunate-amodiaquine with artemether-lumefantrine for the treatment of uncomplicated malaria during pregnancy (Ukah et al. 2015). No differences were detected in day 3 parasite clearance or day 28 cure rate between the arms. However, participants using artesunate-amodiaquine were significantly more likely to experience adverse effects (body weakness and pruritis).
This update includes important information with regards to the debate on iron supplementation and malaria in pregnancy; observational studies have suggested that iron deficiency may be associated with reduced risk of malaria (e.g. Kabyemela et al. 2008; reviewed by Sangare et al. 2014). In a large double-blind trial in Dar es Salaam, Tanzania, among HIV-negative iron-replete paucigravidae with haemoglobin > 8.5 g/dl, participants were randomized to receive 60 mg iron or placebo, and followed-up every 4 weeks until delivery. Both arms received routine malaria prevention with IPTp-SP, screening for malaria if complaints compatible with malaria and treatment if malaria was detected, and vouchers for insecticide-treated nets (ITNs). Prenatal iron supplementation among participants was not associated with an increased risk of placental malaria or other adverse events in the context of malaria prevention. Participants receiving supplementation had improved heamatological and iron status at delivery compared with the placebo group (Etheredge et al. 2015).
A Kenyan double-blind trial among pregnant women with haemoglobin ≥9 g/dl randomized women to receive daily supervised supplementation with 60 mg iron or placebo; in parallel fortified flour was distributed to every participant. There was no difference in malaria risk between the groups, whereas the birth weight and maternal postpartum haemoglobin were significantly higher in the iron supplementation group (Mwangi et al. 2015).
The Cochrane review on iron supplementation in pregnancy has been updated (Pena-Rosas et al. 2015), but did not include the above studies yet. However, results were now stratified into “malarial setting” and “non-malarial setting”. Based on two other studies (Menendez et al. 1994, Fleming et al. 1985) they conclude that “there is no evidence that iron supplementation increases placental malaria”.
With regards to policy on folic acid supplementation in pregnancy, the Roll Back Malaria Partnership released a policy brief recommending “daily oral supplementation of 30–60 mg elemental iron and 400 μg (0.4 mg) folic acid should be provided as early as possible in pregnancy to meet iron and folic acid requirements.”
The effect of a country change in policy to a highly effective drug for the treatment of malaria in pregnancy in Indonesia is described by Poespoprodjo et al. (2015). The introduction of dihydroartemisinin-piperaquine for clinical malaria was associated with significant reductions in maternal and congenital malaria, and less low birthweight among women with a history of malaria in pregnancy.
Two articles examine the use of the prevalence of malaria among pregnant women as part of an evaluation of national malaria control programmes. Kamuliwo et al. (2015) tracked monthly reported district-level clinical cases of malaria in pregnancy using the Zambian District Health Information system and were able to detect malaria hotspots in the country. Van Eijk et al. (2015) detected a high correlation between malaria prevalence in children aged less than 5 years and pregnant women and suggested that data on prevalence in pregnant women could be an adjunct strategy to track trends in malaria transmission.
For a review on immunology and an update on vaccine development for malaria in pregnancy, a review was published by Tuikue-Ndam & Deloron (2015). A review of reviews (Lassi et al. 2015) on strategies to improve child survival found the use of prophylactic antimalarials during pregnancy was considered a promising strategy.
A study examining the pharmacokinetics of dihydroartemisinin-piperaquine in pregnant women in Papua New Guinea saw an effect of pregnancy on the piperaquine concentration, but not on the dihydroartemisinin concentration (Benjamin et al. 2015) which is in contrast with previous studies (Adam et al. 2012, Rijken et al 2011).
In this update we removed registered studies which have now published the primary study findings.