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Cahiers d'études et de recherches francophones / Santé

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Antimalarial medication and pregnancy Volume 1, issue 1, Avril 1991

Authors
département des maladies infectieuses, tropicales et de santé publique. INSERUM U. 313, groupe hospitalier Pitiè-Salpêtrière, 47, boulevard de l’Hôpital, 75651 Paris Cedex 13, France.
  • Page(s) : 39-46
  • Published in: 1991

Malaria often affects pregnant women in endemic zones, above all those who are primiparous or in their 2nd or 3rd terms. The onset of malarial attacks can be serious for both mother and child. Besides obviously imperative therapeutic action, prophylaxis is also a necessity. The use of antimalarial substances has been complicated during the last few years as a result of extension of chloroquin resistance. Our knowledge of teratogeneous or embryotoxic effects remains fragmentary. Among the principal antimalarial medications is quinine (Q), reported to be abortifacient, although in reality it is not. If is often poorly tolerated by the mother (hypoglycemia), but is not responsible for abnormalities in children, except after large doses. Chloroquine (CQ), considered to be without harmful effects, can be used, although toxic effects have been observed in animals. The pyrimethamin-sulfanilamide (PS) combination contains two substances which pose a potential risk. Nevertheless, experiments have not shown harmful effects in pregnant women, particularly when given jointly with folinic acid. Proguanil is without doubt the only molecule which can be used without restriction. Two new drugs, quinolein-methanol, mefloquine (MQ) and halofantrine (HF) are contra-indicated for a lack of experimentation and because of some abnormalities observed at high doses in animals. Artemisinin and amino-8-quinolein are contraindicated, and cyclins are strongly advised against. From the practical point of view, the present use of antimalarial medication in pregnancy should balance the risk, between malaria and treatment. Curatively, Q remains a good treatment in any form. In CQ-sensitive zones CQ is usable unreservedly in simple attacks. In CQ-resistant zones the use of Q seems preferable to that of Fansidar® proposed by some. MQ and HF, although contra-indicated, have been used without problems. For prevention, it is important to avoid all leisure stays in endemic zones. If travel is unavoidable, and for residents, chemoprophylaxis, judged according to the local risk of contamination, is desirable: CQ in sensitive zones and PG + CQ in resistant zones; PS is normally contra-indicated; MQ and JF are contra-indicated. Protection against nocturnal mosquito bites is still required (mosquito net, repellants, insecticides).