The effect and control of malaria in pregnancy and lactating women in the Asia-Pacific region

Authors:

• Unger, Holger W
• Acharya, Sanjaya
• Arnold, Lachlan
• Wu, Connie
• van Eijk, Anna Maria
• Gore-Langton, Georgia R
• ter Kuile, Feiko O
• Lufele, Elvin
• Chico, R Matthew
• Price, Ric N
• Moore, Brioni R
• Thriemer, Kamala
• Rogerson, Stephen J

Details:

The Lancet Global Health, Volume 11, Issue 11, 2023-11-30

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Half of all pregnancies at risk of malaria worldwide occur in the Asia–Pacific region, where Plasmodium falciparum and Plasmodium vivax co-exist. Despite substantial reductions in transmission, malaria remains an important cause of adverse health outcomes for mothers and offspring, including pre-eclampsia. Malaria transmission is heterogeneous, and infections are commonly subpatent and asymptomatic. High-grade antimalarial resistance poses a formidable challenge to malaria control in pregnancy in the region. Intermittent preventive treatment in pregnancy reduces infection risk in meso-endemic New Guinea, whereas screen-and-treat strategies will require more sensitive point-of-care tests to control malaria in pregnancy. In the first trimester, artemether–lumefantrine is approved, and safety data are accumulating for other artemisinin-based combinations. Safety of novel antimalarials to treat artemisinin-resistant P falciparum during pregnancy, and of 8-aminoquinolines during lactation, needs to be established. A more systematic approach to the prevention of malaria in pregnancy in the Asia–Pacific is required.