Malaria in pregnancy

In 2020 alone, an estimated 11.6 million pregnancies in sub-Saharan Africa were exposed to malaria, resulting in 819,000 babies with low birthweight.1  

Malaria in pregnancy is associated with outcomes such as maternal anaemia, miscarriage, low birthweight (and subsequent impact on development) as well as mortality.2 In malaria-endemic countries in Africa, the WHO recommends sulfadoxine-pyrimethamine (SP) as preventive medicine to all women in their first or second trimester of pregnancy as part of antenatal care.3 See the WHO Guidelines for more information on the prevention and treatment of malaria in pregnancy.

Low coverage of preventive medicine

Despite increased mobilization from the global malaria community in recent years, only 32% of pregnant women had access to the recommended three doses of SP in 2020.4 This is partly due to the low availability of quality medicine. Another contributing factor is due to the acceptability of the intervention. Almost 30 years ago, SP was a recommended treatment for acute uncomplicated malaria, but drug resistance undermined its curative efficacy in the 1990s. Hence, the hesitation of some healthcare providers to use the medicine for preventive treatment during pregnancy, despite continued evidence and normative recommendations for its beneficial use in chemoprevention. 

Increasing access and securing supply 

Currently, intermittent preventive treatment in pregnancy (IPTp) with SP is delivered primarily in healthcare facilities during antenatal care visits. However, because these visits happen in health centers, pregnant women from rural areas who do not have the means for transportation often skip them, missing the opportunity to receive the three doses of SP. TIPTOP (Transforming Intermittent Preventive Treatment for Optimal Pregnancy), a Unitaid-funded consortium led by Jhpiego which includes ISGlobal, WHO and MMV, aims to establish new delivery channels involving community health workers to increase coverage and protect as many pregnant women as possible.

In addition, MMV is working with partners, including local manufacturers, to address the supply gap and bring chemoprevention closer to home. We have established partnerships with Nigerian and Kenyan manufacturers to produce quality-assured SP in their own countries. For more information on this, visit the section on supporting African manufacturing.

Filling the data gap

There is growing interest amongst the research community in DHA-PQP as a possible alternative for intermittent preventive treatment in pregnancy (IPTp). MMV, via a collaboration with the London School of Hygiene and Tropical Medicine, is supporting a study to evaluate the cardiac safety of DHA-PQP in pregnant women compared to SP, the current standard of care for IPTp. This study also assesses the pharmacokinetics of DHA-PQP in pregnancy.

MMV is collaborating with the Liverpool School of Tropical Medicine (LSTM) to generate additional safety data for the use of DHA-PQP during the first trimester of pregnancy. This work is a dual-phase observational study in Indonesia carried out by the Timika Research Facility. The study involves retrospective and prospective analysis of DHA-PQP use during the first trimester of pregnancy.

→ Learn more about MMV’s work to raise the standard of care for pregnant women and their newborns affected by malaria