The Malaria in Pregnancy (MiP) Library is a regularly updated, comprehensive bibliographic database of published and unpublished literature relating to malaria in pregnancy, including a trial registry of planned and ongoing trials.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 2016
In September 2016, 119 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:
Results of two trials important for prevention of malaria in pregnancy were published. A multi-country trial partly sponsored by Pfizer compared intermittent preventive treatment (IPTp) with azithromycin-chloroquine (three courses, and one course over three days, IPTp-AZCQ) versus IPTp with sulfadoxine-pyrimethamine (3 courses). The trial was stopped prematurely because of futility after a planned interim analysis when 35% of participants had an observation for the primary endpoint: no significant differences were seen between arms for low birth weight and other outcomes (Kimani et al. 2016). In a trial in Malawi, scheduled intermittent screening with rapid diagnostic tests and treatment with dihydroartemisinin-piperaquine (ISTp-DP) was compared with IPTp-SP. Malaria at delivery and foetal loss were higher in the ISTp-DP arm, precluding its use as replacement strategy for IPTp-SP (Madanitsa et al. 2016).
Insecticide treated nets (ITNs) and IPTp are known to be very effective strategies to prevent malaria in pregnancy; less is known about indoor residual spraying (IRS) of insecticides. An observational study in Uganda documented the effect of IRS on birth outcome compared to birth outcomes among women whose residence was not exposed to IRS, and reports significantly lower incidence of low birth weight, preterm delivery and foetal and neonatal death among women in households exposed to IRS, even though only part of the pregnancy duration was protected by IRS (Muhindo et al. 2016).
Malaria in pregnancy has been acknowledged as a modifier of the development of immunity in the foetus and infant, and this was reviewed for the foetal T-cell immunity by Odorizzi et al. (2016,).
Cohort studies among pregnant women and their infants confirmed that malaria in pregnancy is associated with malaria and other diseases in their offspring during infancy; Sylvester et al. (2016) confirm this association in a cohort with 100% ITN use in Tanzania, where infants of women with placental malaria got clinical malaria earlier and more frequently than women without placental malaria.
It will be important to take breastfeeding into account in these types of studies in the future, given that Brazeau et al. (2016) report that exclusive breastfeeding in a cohort of infants in the first 6 months of life was associated with a reduced risk of clinical malaria compared to a control group without exclusive breastfeeding.
It is exciting to learn that two phase-I studies are currently underway for a malaria vaccine for pregnant women (NCT02647489, and NCT02658253). To facilitate laboratory studies into adhesion of infected erythrocytes to receptors in the placenta, Pehrson et al. (2016) developed an improved model of ex-vivo placental perfusion. McLean et al. (2016) followed postpartum women and a control group postpartum to assess antibody levels over time to P. falciparum and P. vivax, and noted that postpartum women had reduced antibody levels compared to controls at baseline, but they recovered over time, whereas antibody levels against VAR2CSA did not change.
Several studies involved the diagnosis of malaria in pregnancy, such as Kyabazinse et al. (2016) who compared RDTs, microscopy and PCR in Uganda and in Burkina Faso, and Liu et al. (2016), who explored the diagnosis of placental malaria using rapid diagnostic tests, PCR and placental histology in two studies. In Tanzania, a pilot study was conducted to explore the feasibility and utility of tracking the prevalence of malaria infection in pregnant women attending their first antenatal care (ANC) visit and infants presenting at 9–12 months of age for measles vaccination (Willilo et al. 2016). The authors concluded that screening of pregnant women at ANC could be used for routine surveillance and detection of hotspots.
In this update there is a study about malaria in pregnancy in Laos, a country with little information available on malaria in pregnancy; results were presented from community and clinic based surveys (Briand et al.2016); the overall prevalence of malaria was low (5.9%). For those who would appreciate an update on clinical and non-clinical safety of artemisinin derivatives in pregnancy, there is a review by Gomes et al. (2016).