Al Khaja Khalid A J, Sequeira Reginald P
Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, P.O. Box 22979, Manama, Kingdom of Bahrain.
Malar J. 2021 Jan 23;20(1):62. doi: 10.1186/s12936-020-03565-2.
Malaria caused by Plasmodium falciparum in pregnancy can result in adverse maternal and fetal sequelae. This review evaluated the adherence of the national guidelines drawn from World Health Organization (WHO) regions, Africa, Eastern Mediterranean, Southeast Asia, and Western Pacific, to the WHO recommendations on drug treatment and prevention of chloroquine-resistant falciparum malaria in pregnant women.
Thirty-five updated national guidelines and the President's Malaria Initiative (PMI), available in English language, were reviewed. The primary outcome measures were the first-line anti-malarial treatment protocols adopted by national guidelines for uncomplicated and complicated falciparum malaria infections in early (first) and late (second and third) trimesters of pregnancy. The strategy of intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) was also addressed.
This review evaluated the treatment and prevention of falciparum malaria in pregnancy in 35 national guidelines/PMI-Malaria Operational Plans (MOP) reports out of 95 malaria-endemic countries. Of the 35 national guidelines, 10 (28.6%) recommend oral quinine plus clindamycin as first-line treatment for uncomplicated malaria in the first trimester. As the first-line option, artemether-lumefantrine, an artemisinin-based combination therapy, is adopted by 26 (74.3%) of the guidelines for treating uncomplicated or complicated malaria in the second and third trimesters. Intravenous artesunate is approved by 18 (51.4%) and 31 (88.6%) guidelines for treating complicated malaria during early and late pregnancy, respectively. Of the 23 national guidelines that recommend IPTp-SP strategy, 8 (34.8%) are not explicit about directly observed therapy requirements, and three-quarters, 17 (73.9%), do not specify contra-indication of SP in human immunodeficiency virus (HIV)-infected pregnant women receiving cotrimoxazole prophylaxis. Most of the guidelines (18/23; 78.3%) state the recommended folic acid dose.
Several national guidelines and PMI reports require update revisions to harmonize with international guidelines and emergent trends in managing falciparum malaria in pregnancy. National guidelines and those of donor agencies should comply with those of WHO guideline recommendations although local conditions and delayed guideline updates may call for deviations from WHO evidence-based guidelines.
妊娠期由恶性疟原虫引起的疟疾可导致不良的母婴后果。本综述评估了来自世界卫生组织（WHO）非洲、东地中海、东南亚和西太平洋区域的国家指南对WHO关于妊娠期耐氯喹恶性疟药物治疗和预防建议的遵循情况。
对35份更新后的英文国家指南和总统疟疾倡议（PMI）进行了审查。主要结局指标是国家指南针对妊娠早期（第一）和晚期（第二和第三）单纯性和复杂性恶性疟感染所采用的一线抗疟治疗方案。还探讨了使用磺胺多辛 - 乙胺嘧啶（SP）进行妊娠期疟疾间歇性预防治疗（IPTp）的策略。
本综述评估了95个疟疾流行国家中35份国家指南/PMI疟疾业务计划（MOP）报告中妊娠期恶性疟的治疗和预防情况。在35份国家指南中，10份（28.6%）推荐口服奎宁加克林霉素作为妊娠早期单纯性疟疾的一线治疗。作为一线选择，26份（74.3%）指南采用青蒿琥酯 - lumefantrine（一种青蒿素联合疗法）治疗妊娠中期和晚期的单纯性或复杂性疟疾。分别有18份（51.4%）和31份（88.6%）指南批准静脉注射青蒿琥酯用于治疗妊娠早期和晚期的复杂性疟疾。在23份推荐IPTp - SP策略的国家指南中，8份（34.8%）未明确直接观察治疗的要求，四分之三，即17份（73.9%）未明确在接受复方新诺明预防的感染人类免疫缺陷病毒（HIV）的孕妇中使用SP的禁忌症。大多数指南（18/23；78.3%）说明了推荐的叶酸剂量。
若干国家指南和PMI报告需要更新修订，以与国际指南以及妊娠期恶性疟管理的新趋势保持一致。国家指南和捐助机构的指南应遵循WHO指南建议，尽管当地情况和指南更新延迟可能需要偏离WHO基于证据的指南。
