Safety of artemisinins in first trimester of prospectively followed pregnancies: an observational study

This study was designed to yield the safety and efficacy of the most rapid-acting antiparasitic drug class, artemisinin derivatives, during the first trimester of human pregnancies.  Previously, it administered as a preventative intervention only during the second and third trimesters successfully. However, when these same drugs were tested on animals during their first trimester, their pregnancies either ended in a miscarriage or serious congenital malformations.   It is to be noted that the drug quinine, an antiparasitic, had been given to women in their first three months of pregnancy up to this point. This research would hopefully find out if artemisinins can safely and effectively be given to mother in the first trimester.  It is also of interest to see if it is more successful in preventing the spread of Malaria from mother to child–and ultimately miscarriages–than quinine.

This study was conducted near the border of Thailand and Myanmar between January 1994 and December 2013. They documented 55,636 pregnancies, but only 25,485 were further analyzed for Malaria and miscarriages. After ruling out many of the pregnancy cases, 183 were given the artemisinin treatment. They noticed no significant decrease or increase in the miscarriage rate as compared to treatment with quinine. They also could not draw firm conclusions on artemisinin’s effect on malformations, as the number of actual participants in the treatment ended up being too small.

Overall, they were able to determine that artemisinin derivatives are not as harmful to humans as they were in the animal trials. First-line artemisinin treatment is not deemed more effective after this research, but the miscarriage rate when receiving first-line artemisinin is lower than receiving quinine first and artemisinins secondarily. Artemisinin safety in the first trimester is still to be determined, but this sheds light to the severity of Malaria during pregnancies and how hard it can be to treat it successfully.

 

Moore KA, Simpson JA, Paw MK, et al. Safety of artemisinins in first trimester of prospectively followed pregnancies: an observational study. Lancet Infect Dis. 2016.