Evaluating the Safety and Efficacy of Malaria Preventive Measures in Pregnant Women with a Focus on HIV Status: A Systematic Review and Network Meta-Analysis.

Malaria poses significant threats to pregnant women, particularly in endemic regions. Preventive measures against it include insecticide-treated bed nets, intermittent preventive treatment, and various supplements. We aimed to assess and compare the safety and effectiveness of malaria preventive measures in pregnant women, considering their HIV status. We conducted a systematic search of PubMed, the Cochrane Library, Scopus, Embase, and Web of Science through January 2024. A network meta-analysis was performed using R 4.3.3 software on 35 studies (50,103 participants). In HIV-positive pregnant women, Co-trimoxazole with dihydroartemisinin significantly reduced malaria incidence compared to Co-trimoxazole alone (RR = 0.45, 95% CI [0.30; 0.68]) and sulfadoxine-pyrimethamine (SP) (RR = 0.14, 95% CI [0.04; 0.48]). Mefloquine was also effective compared to controls and SP. In HIV-negative women, azithromycin-piperaquine significantly reduced infections compared to SP, bed nets, and controls (RR = 0.03, 95% CI [0.00; 0.83]; RR = 0.03, 95% CI [0.00; 0.86]; and RR = 0.03, 95% CI [0.00; 0.77], respectively). Different combinations of preventive measures show varying effectiveness based on HIV status. Co-trimoxazole with dihydroartemisinin and mefloquine are effective for HIV-infected pregnant women, while azithromycin-piperaquine and mefloquine work well for those without HIV. Customized prevention strategies considering HIV status are crucial for optimal protection.