Gutman Julie R, Hall Clinton, Khodr Zeina G, Bukowinski Anna T, Gumbs Gia R, Conlin Ava Marie S, Wells Natalie Y, Tan Kathrine R
Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA; Leidos Inc, San Diego, CA, USA.
Travel Med Infect Dis. 2019 Nov-Dec;32:101519. doi: 10.1016/j.tmaid.2019.101519. Epub 2019 Nov 17.
Malaria in pregnancy can cause severe maternal and fetal complications. Chloroquine (CQ) and mefloquine (MQ) are recommended for chemoprophylaxis in pregnancy, but are not always suitable. Atovaquone-proguanil (AP) might be a viable option for malaria prevention in pregnancy, but more safety data are needed.
Data for pregnancies and live births among active duty military women, 2003-2014, from the Department of Defense Birth and Infant Health Research program were linked with pharmacy data to determine antimalarial exposure. Multivariable Cox and logistic regression models were used to assess the relationship of antimalarial exposure with fetal and infant outcomes, respectively.
Among 198,164 pregnancies, 50 were exposed to AP, 156 to MQ, and 131 to CQ. Overall, 17.6% of unexposed pregnancies and 28.0%, 16.0%, and 6.1% of pregnancies exposed to AP, MQ, and CQ, respectively, ended in fetal loss (spontaneous abortion or stillbirth) (adjusted hazard ratios [aHR] = 1.46, 95% confidence interval [CI] 0.87-2.46; aHR = 1.06, 95% CI 0.72-1.57; and aHR = 0.47, 95% CI 0.24-0.94, respectively).
The small number of AP exposed pregnancies highlights the difficulty in assessing safety. While definitive conclusions are not possible, these data suggest further research of AP exposure in pregnancy and fetal loss is warranted.
More research on fetal loss following atovaquone-proguanil exposure in pregnancy is warranted.
妊娠期疟疾可导致严重的母婴并发症。氯喹（CQ）和甲氟喹（MQ）被推荐用于妊娠期化学预防，但并非总是适用。阿托伐醌-氯胍（AP）可能是预防妊娠期疟疾的一个可行选择，但需要更多的安全性数据。
将2003 - 2014年国防部出生与婴儿健康研究项目中现役军人女性的妊娠和活产数据与药房数据相链接，以确定抗疟药物暴露情况。分别使用多变量Cox模型和逻辑回归模型评估抗疟药物暴露与胎儿及婴儿结局之间的关系。
在198,164例妊娠中，50例暴露于AP，156例暴露于MQ，131例暴露于CQ。总体而言，未暴露妊娠中有17.6%、暴露于AP、MQ和CQ的妊娠中分别有28.0%、16.0%和6.1%以胎儿丢失（自然流产或死产）告终（校正风险比[aHR]分别为1.46，95%置信区间[CI] 0.87 - 2.46；aHR = 1.06，95% CI 0.72 - 1.57；aHR = 0.47，95% CI 0.24 - 0.94）。
暴露于AP的妊娠数量较少凸显了评估安全性的困难。虽然无法得出确定性结论，但这些数据表明有必要进一步研究妊娠期暴露于AP与胎儿丢失之间的关系。
有必要对妊娠期暴露于阿托伐醌-氯胍后的胎儿丢失情况进行更多研究。
