Imported malaria in pregnant women: A retrospective pooled analysis

Abstract

Summary Background Data on imported malaria in pregnant women are scarce. Method A retrospective, descriptive study of pooled data on imported malaria in pregnancy was done, using data from 1977 to 2014 from 8 different collaborators in Europe, the United States and Japan. Most cases were from the period 1991–2014. National malaria reference centresas well as specialists on this topic were asked to search their archives for cases of imported malaria in pregnancy. A total of 632 cases were collated, providing information on Plasmodium species, region of acquisition, nationality, country of residence, reason for travel, age, gestational age, prophylactic measures and treatment used, as well as on complications and outcomes in mother and child. Results Datasets from some sources were incomplete. The predominant Plasmodium species was P. falciparum in 72% of cases. Among the 543 cases where information on the use of chemoprophylaxis was known, 471 (74.5%) did not use chemoprophylaxis or used incorrect or incomplete chemoprophylaxis. The main reason for travelling was “visiting friends and relatives” VFR (48.6%) and overall, most cases of malaria were imported from West Africa (85.9%). Severe anaemia was the most frequent complication in the mother. Data on offspring outcome was limited, but spontaneous abortion was a frequently reported foetal outcome (n = 14). A total of 50 different variants of malaria treatment regimens were reported. Conclusion Imported cases of malaria in pregnancy are mainly P. falciparum acquired in sub-Saharan Africa. Malaria prevention and treatment in pregnant travellers is a challenge for travel medicine due to few data on medication safety and maternal and foetal outcomes. International, collaborative efforts are needed to capture standardized data on imported malaria cases in pregnant women.

The influence of pregnancy on the pharmacokinetic properties of artemisinin combination therapy (ACT): a systematic review

“…According to a systematic review to assess the burden of malaria in pregnancy, approximately 25 million pregnant women are at risk of Plasmodium falciparum infection every year [ 3 ]. One in four women have evidence of placental infection at the time of delivery; of which a small fraction is encountered as an imported condition in non-endemic countries in migrants and travellers [ 4 ]. Imported cases of malaria in pregnancy are mainly P. falciparum acquired in sub-Saharan Africa [ 4 ].…”

“…One in four women have evidence of placental infection at the time of delivery; of which a small fraction is encountered as an imported condition in non-endemic countries in migrants and travellers [ 4 ]. Imported cases of malaria in pregnancy are mainly P. falciparum acquired in sub-Saharan Africa [ 4 ]. Malaria in pregnancy is caused by all five species of Plasmodium infecting humans: P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi.…”

Recrudescence of Plasmodium falciparum in a Primigravida after Nearly 3 Years of Latency

“…Finally, Käser and others performed a retrospective analysis on 632 pregnant women, who presented with travel-associated malaria in eight non-endemic countries including the United States. 18 More than 70% of the cases were P. falciparum malaria. Of all the malaria cases, no maternal deaths were reported, but several fetal abortions occurred; no data were made available on the interval between travel and time of presentation.…”

Travel Characteristics and Pretravel Health Care Among Pregnant or Breastfeeding U.S. Women Preparing for International Travel

“…4,28 Moreover, malaria during pregnancy carries a high risk for morbidity and mortality for both the mother and fetus; hence, the prevention of malaria in pregnant women constitutes a priority, albeit problematic as a result of drug safety concerns, comorbidities (eg, neuropsychiatric disorders), or exposure to multidrug-resistant strains (Box 1). 3,4,29,30 …”