Impact of prophylactic antimalarials in pregnant women living with Human Immunodeficiency Virus on birth outcomes in Botswana.
Infant, Newborn
Female
Pregnancy
Humans
Antimalarials
/ therapeutic use
Pregnant Women
Botswana
/ epidemiology
HIV Infections
/ complications
Pregnancy Complications, Infectious
/ drug therapy
Malaria
/ complications
Stillbirth
/ epidemiology
Chloroquine
/ therapeutic use
HIV
Premature Birth
/ epidemiology
Pregnancy Outcome
/ epidemiology
Botswana
HIV
antimalarial prophylaxis
birth outcomes
pregnancy
Journal
Tropical medicine & international health : TM & IH
ISSN: 1365-3156
Titre abrégé: Trop Med Int Health
Pays: England
ID NLM: 9610576
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
pubmed:
3
10
2022
medline:
16
11
2022
entrez:
2
10
2022
Statut:
ppublish
Résumé
Until late 2015, Botswana recommended preventive treatment for pregnant women in malarial regions with chloroquine and proguanil (CP). The guideline change provided an opportunity to evaluate CP and adverse birth outcomes. The Tsepamo Study performed birth outcomes surveillance at large delivery centres throughout Botswana. We evaluated adverse birth outcomes from 2015 to 2017 at three hospitals where 93% of CP use was recorded. Outcomes included neonatal death (NND), small for gestational age (SGA), very SGA, stillbirth (SB), preterm delivery (PTD) and very PTD. Logistic regression analysis (unadjusted and adjusted) was conducted for each adverse birth outcome. During the study period, 5883 (26%) of 23,033 deliveries were exposed to CP, with the majority (65%) in the most malaria-endemic region. At this site, there was a trend or an association between CP use and reduction of three adverse birth outcomes: PTD (aOR 0.85, 95% CI 0.76-0.96), vPTD (aOR 0.83, 95% CI 0.68-1.01) and NND (aOR 0.65, 95% CI 0.42-1.00). However, at the least malaria-endemic site, the association was in the opposite direction for SB (aOR 1.54, 95% CI 1.08-2.22), SGA (aOR 1.24, 95% CI 1.06-1.44) and vSGA (aOR 1.42, 95% CI 1.14-1.77). The association between CP and reduced PTD was present among women without HIV (aOR 0.77, 95% CI 0.67-0.89) but not among women with HIV (aOR 1.09, 95% CI 0.78-1.35). Antimalarial prophylaxis was associated with improved birth outcomes in the most malaria-endemic region of Botswana, but not elsewhere. This finding supports current WHO guidance to use prophylaxis strategies among pregnant women in highly malaria-endemic regions. Further studies of the risks and benefits of specific antimalarial regimens in pregnancy are warranted, particularly in areas with lower incidence of malaria.
Identifiants
pubmed: 36183175
doi: 10.1111/tmi.13823
pmc: PMC9855025
mid: NIHMS1840073
doi:
Substances chimiques
Antimalarials
0
Chloroquine
886U3H6UFF
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
990-998Subventions
Organisme : NICHD NIH HHS
ID : R01 HD080471
Pays : United States
Organisme : NIMHD NIH HHS
ID : U54 MD007605
Pays : United States
Organisme : NIH HHS
ID : R01 HD080471
Pays : United States
Organisme : NIH HHS
ID : 5U54MD007605-28
Pays : United States
Informations de copyright
© 2022 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Références
J Infect Dis. 2007 Dec 1;196(11):1585-94
pubmed: 18008241
Lancet Infect Dis. 2012 Dec;12(12):942-9
pubmed: 22995852
Proc Natl Acad Sci U S A. 2009 Jun 2;106(22):9027-32
pubmed: 19451638
Cochrane Database Syst Rev. 2014 Oct 10;(10):CD000169
pubmed: 25300703
PLoS One. 2014 May 15;9(5):e96017
pubmed: 24830749
Lancet. 2015 Dec 19;386(10012):2507-19
pubmed: 26429700
JAMA. 2013 Feb 13;309(6):594-604
pubmed: 23403684
Trans R Soc Trop Med Hyg. 2009 Aug;103(8):761-7
pubmed: 18707747
Lancet Infect Dis. 2018 Apr;18(4):e119-e132
pubmed: 29395997
JAMA Pediatr. 2017 Oct 2;171(10):e172222
pubmed: 28783807
BMC Pregnancy Childbirth. 2019 Jul 8;19(1):236
pubmed: 31286878
N Engl J Med. 2016 Mar 10;374(10):928-39
pubmed: 26962728
Cochrane Database Syst Rev. 2003;(1):CD000169
pubmed: 12535391
Lancet Infect Dis. 2006 Feb;6(2):100-11
pubmed: 16439330
Clin Infect Dis. 2011 Aug 1;53(3):215-23
pubmed: 21765069
J Infect Dis. 2012 Dec 1;206(11):1695-705
pubmed: 23066160
Am J Trop Med Hyg. 2003 Oct;69(4):447-9
pubmed: 14640507
PLoS Med. 2019 Oct 1;16(10):e1002914
pubmed: 31574087
Am J Trop Med Hyg. 2004 Aug;71(2 Suppl):41-54
pubmed: 15331818
AIDS. 2003 Nov 21;17(17):2539-41
pubmed: 14600529
Emerg Infect Dis. 2004 Apr;10(4):643-52
pubmed: 15200854
Trop Med Int Health. 2003 Jun;8(6):488-506
pubmed: 12791054
Lancet Infect Dis. 2011 Jul;11(7):541-56
pubmed: 21700241
Ann Trop Paediatr. 2009 Jun;29(2):71-83
pubmed: 19460261