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The Malaria in Pregnancy (MiP) Library is a regularly updated, comprehensive bibliographic database of published and unpublished literature relating to malaria in pregnancy, including a trial registry of planned and ongoing trials.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 October 2014

Article highlights from the update in September 2014:

 

Results of two important trials are included in this update. One trial, reported by Gonzalez et al, evaluated the use of mefloquine given as one dose or a split dose as an alternative to sulfadoxine-pyrimethamine when used as intermittent preventive treatment under coverage of insecticide treated nets. The study component among HIV-negative women was conducted in Benin, Gabon, Mozambique, and Tanzania. The study component among HIV-positive women was conducted in Kenya, Mozambique and Tanzania, and women were using cotrimoxazole prophylaxis in addition to ITNs. Although the benefits of mefloquine in HIV negative women were similar to sulfadoxine-pyrimethamine, tolerability was lower and did not support a change in policy. A worrying finding in the trial of mefloquine among HIV positive women was the increased risk of vertical transmission of HIV despite reduced maternal parasitaemia. Interactions between antimalarials and antiretroviral treatments may be part of the problem and these interactions, or the interactions between antiretrovirals and malaria directly, have not been extensively studied. Further information is however available from a 2nd trial by Natureeba et al which examined whether type of antiretroviral treatment had an impact on malaria during pregnancy; again, all women received ITNs and cotrimoxazole prophylaxis. Participants were randomized to lopinavir/ritonavir based or efavirenz based ARTs. No differences were detected by treatment arm; effect on vertical transmission was not reported.

The Progress and Impact series of Roll Back Malaria released an issue on the contribution of malaria control to maternal and newborn health, which provides an overview of malaria in pregnancy and current status of prevention, mainly in Africa. A new estimate of the burden of malaria in pregnancy in Africa, which modelled placental malaria and low birth weight, is provided by Walker et al; however, this estimate does not take into account use of malaria prevention

Although case-management forms an important pillar of malaria in pregnancy, this has attracted generally less attention than prevention. Hill et al present a global review of women’s access and provider’s practices of case management and findings are of concern; there is a clear need to improve case management practices among health providers. A pharmacokinetic study of quinine by Kloprogge et al reported lower quinine concentrations in pregnant women compared to historical non-pregnant controls.

Lambert et al (2014) presents a new approach to determining the antigenic targets of opsonizing IgGs in phagocytosis assays. Saddisou et al (20140) show the possible involvement of sHLA-G in generating immune tolerance in the infant during pregnancy-associated malaria and Brickley et al provide data that suggest that pro-inflammatory cytokine levels at birth are inversely associated with the risk of severe malarial anaemia in infants.

Countries have several complementary strategies to increase ITN coverage, however mass campaigns may affect routine distribution of ITNs to pregnant women visiting antenatal clinics. These dilemmas are discussed in an article by Hill et al and Eze et al.

Finally, Rijken et al provide rich data from Thailand on the effect of malaria at the Thai-Burmese border on birth weight taking gestational age into account and show that the “true” effect of malaria will not be captured by measuring low birth weight alone. Also from Asia, a first report on malaria in pregnancy and Plasmodium knowlesi by Barber et al.

Please note that the MiP library also includes national policies with content on malaria in pregnancy. These can be selected using the key words “National policy”.