Christine Manyando; Kassoum Kayentao; Umberto D’Alessandro; Henrietta U Okafor; Elizabeth Juma; Kamal Hamed

“ It is vital that pregnant women with malaria receive prompt and effective treatment [11] . However, the frequent exclusion of pregnant women from pharmaceutical trials, including the original studies of artemisinins and different types of ACT, has limited the availability of data in this vulnerable population. Consequently, ACT safety and efficacy, including potential effects of changes in ACT pharmacokinetics during pregnancy, is an important area of malaria research with implications for national malaria control policies. ”

“ Piola and colleagues proposed that differences in the level of malaria immunity between the sites of the Ugandan and Thai trials could explain the different efficacies of AL in pregnant women, a plausible interpretation given the marked differences in the intensity of malaria transmission. The differences in cure rate could also be explained by the emergence of parasite resistance to artemisinins or lumefantrine at the Thai study site (Thai-Burmese border) . ”

“ ACT: Artemisinin-based combination therapy; AL: Artemether-lumefantrine; AS-AQ: Artesunate-amodiaquine; AS-MQ: Artesunate-mefloquine; AS + SP: Artesunate + sulphadoxine-pyrimethamine; AUC: Area under the curve; DHA: Dihydroartemisinin; DHA-PPQ: Dihydroartemisinin-piperaquine; IPTp: Intermittent preventive treatment in pregnancy; RDT: Rapid diagnostic test; SP: Sulphadoxine-pyrimethamine; WHO: World Health Organization.
Competing interests
CM, KK, HUO and EJ have no competing interests. UDA has received research funding from Sigma Tau and Sanofi-Aventis. ”

“ In one woman, P. falciparum infection reappeared during follow-up (Day 21) , but PCR genotyping confirmed this to be a new infection.
Table 4 "Pharmacokinetics of artemether–lumefantrine during pregnancy"AL artemether-lumefantrine; Q quinine;*90% range; †AUC60h∞. Two of the three efficacy studies of AL during pregnancy reported Day 7 lumefantrine plasma levels, a measure correlated with drug exposure estimates [31] . In particular, Day 7 lumefantrine plasma levels below 280 ng/ml have been related to the risk of therapeutic failure [ [37] . ”

“ Of these, the majority occurred in the African (30 million) , South East Asian and Western Pacific (44.2 million) regions. Within the African region, 29.6 million pregnancies occurred in areas of stable transmission and 0.4 million pregnancies occurred in areas of unstable transmission [3] . ”

“ Mutyaba, TS & Ndeezi, G (2008) , A randomized clinical trial comparing safety, clinical and parasitological response to artemether-lumefantrine and chlorproguanil-dapsone in treatment of uncomplicated malaria in pregnancy in Mulago hospital, Uganda, vol. 2, pp. 135–139, 10.3855/T2.2.13519738339 KayeDKNshemerirweRMutyabaTSNdeeziG, pmid:19738339, DOI 10.3855/T2.2.135 1 2 3 4 5 Adam, I; Elhassan, EM; Omer, EM; Abdulla, MA; Mahgoub, HM & Adam, GK (2009) , Safety of artemisinins during early pregnancy, assessed in 62 Sudanese women, vol. ”