Antimalarial drugs for pregnant women
Preventive malaria treatment for pregnant women in Africa
MMV is devoting particular attention to the needs of pregnant and lactating mothers and their babies, for whom options are currently limited. In 2021, more than 13.3 million pregnant women in Africa contracted malaria, mainly in the World Health Organization (WHO) sub-regions of West and Central Africa.1
Consequences of malaria in pregnancy can be catastrophic. A mother’s immunity to the parasite is reduced by the biological and physiological changes of pregnancy, increasing her susceptibility to infection and her risk of severe illness and death.2 Furthermore, the accumulation of parasites in the placenta can lead to adverse outcomes for the child. Plasmodium falciparum malaria is associated with a shocking one in ten maternal deaths in malaria-endemic countries, as well as a three to fourfold increase in the risk of miscarriage.3 Malaria in pregnant women can also result in low birth weight and premature birth, which increase the risk of neonatal mortality and can have lasting developmental consequences for the growing child.
WHO recommends Intermittent Preventive Treatment in pregnancy (IPTp), a type of malaria chemoprevention, to prevent and reduce the impact of malaria on pregnant women and their children.
Malaria chemoprevention, whereby medicines are used to prevent malaria infection and its consequences, is a powerful way to reduce the toll of this disease. Malaria chemoprevention involves administering antimalarial medicines to populations at heightened risk if infected. An important example of a medicine used for malaria prevention is sulfadoxine pyrimethamine (SP.) SP is a well-tolerated, efficacious, and affordable medicine used alone or in combination with other drugs to prevent malaria in infants, children, and pregnant women.
Pregnant women living in areas of moderate to high malaria transmission in Africa should receive 3 or more doses of SP starting as early as possible in the 2nd trimester, to be administered at monthly intervals up to the time of delivery. Updated WHO guidance now recommends that all pregnant women living in malaria-endemic areas take IPTp-SP as of the second trimester regardless of the number of pregnancies (previously, it was recommended only during a woman’s first and second pregnancies). Always refer to the latest WHO guidelines.
Coverage of IPTp in 2021 remained low at 35%, well below the target of 80%.4 One of the reasons for this gap relates to supply-side issues around quality-assured SP. These can be bridged by strengthening local manufacturing capability to improve the quality and increase the quantity of regional supplies of this medicine.
About intermittent preventive treatment of malaria in pregnancy (IPTp)
Although millions of women in sub-Saharan Africa contract malaria in pregnancy, it is preventable. IPTp is strongly recommended by the World Health Organisation to combat malaria in pregnancy.
Transforming Intermittent Preventive Treatment for Optimal Pregnancy (TIPTOP)
This 5-year project was developed to fill an evidence gap on IPTp uptake due to the high malaria in pregnancy burden in sub-Saharan Africa
Partnerships to end malaria in pregnancy
One of MMV’s strategic priorities is ending malaria in pregnancy by developing medicines that are suitable for women of childbearing potential. This priority is implemented through its networks of partners.
An expectant mother with malaria: Dianah's story
Dianah Otiend (pictured left) – like millions of other women – lives with the real and constant fear of what malaria can do to her and her baby if she falls ill while pregnant. Dianah, who lives in Homa Bay on the south shore of Lake Victoria in Kenya, experienced an expectant mother’s worst nightmare: she became ill with malaria twice while pregnant with her baby girl. “When a mother is sick with malaria,” she observed, “it affects the entire family, because a pregnant woman is carrying a life beside her life.”
Dianah’s doctor recommended a caesarean section to save both her life and the life of her baby. Consequently, baby Elizabeth was born premature and significantly underweight, weighing around 1 kg (globally, newborns average between 2.5 and 4 kg at birth). Thanks to the care that they received, Dianah is optimistic about her family’s future: “I can say that today I have peace in my heart, I’ve come out of it. My baby is alive. I’m also alive. Elizabeth, I really wish a lot of great things in her life.”
It is difficult to know which medicines are suitable for pregnant and lactating women, as they are often excluded from clinical research for fear of causing harm, resulting in a lack of essential data. Including pregnant women in clinical trials will contribute to generating the robust evidence needed on the safety and efficacy of medicines that could save the lives of mothers at risk like Dianah whilst keeping their babies safe.
Meeting the needs of pregnant and lactating women: MMV's strategy
Every woman deserves to live their pregnancy without the fear of malaria. See how MMV is aiming to improve prevention and treatment options for pregnant and lactating women.
1. World Malaria Report, 2022
2. Schantz-Dunn J & Nour NM “Malaria and pregnancy : a global health perspective” Rev Obstet Gynecol. 2(3):186–92 (2009), PMCID: PMC2760896
3. Saito M et al. “Deleterious effects of malaria in pregnancy on the developing fetus: a review on prevention and treatment with antimalarial drugs” Lancet Child Adolescent Health. 4(10):761- 74 (2020), doi: 10.1016/ S2352-4642(20)30099-7
4. World Malaria Report, 2022