Impact of prophylactic antimalarials in pregnant women living with Human Immunodeficiency Virus on birth outcomes in Botswana
© 2022 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd..
OBJECTIVES: Until late 2015, Botswana recommended preventive treatment for pregnant women in malarial regions with chloroquine and proguanil (CP). The guideline change provided an opportunity to evaluate CP and adverse birth outcomes.
METHODS: The Tsepamo Study performed birth outcomes surveillance at large delivery centres throughout Botswana. We evaluated adverse birth outcomes from 2015 to 2017 at three hospitals where 93% of CP use was recorded. Outcomes included neonatal death (NND), small for gestational age (SGA), very SGA, stillbirth (SB), preterm delivery (PTD) and very PTD. Logistic regression analysis (unadjusted and adjusted) was conducted for each adverse birth outcome.
RESULTS: During the study period, 5883 (26%) of 23,033 deliveries were exposed to CP, with the majority (65%) in the most malaria-endemic region. At this site, there was a trend or an association between CP use and reduction of three adverse birth outcomes: PTD (aOR 0.85, 95% CI 0.76-0.96), vPTD (aOR 0.83, 95% CI 0.68-1.01) and NND (aOR 0.65, 95% CI 0.42-1.00). However, at the least malaria-endemic site, the association was in the opposite direction for SB (aOR 1.54, 95% CI 1.08-2.22), SGA (aOR 1.24, 95% CI 1.06-1.44) and vSGA (aOR 1.42, 95% CI 1.14-1.77). The association between CP and reduced PTD was present among women without HIV (aOR 0.77, 95% CI 0.67-0.89) but not among women with HIV (aOR 1.09, 95% CI 0.78-1.35).
CONCLUSIONS: Antimalarial prophylaxis was associated with improved birth outcomes in the most malaria-endemic region of Botswana, but not elsewhere. This finding supports current WHO guidance to use prophylaxis strategies among pregnant women in highly malaria-endemic regions. Further studies of the risks and benefits of specific antimalarial regimens in pregnancy are warranted, particularly in areas with lower incidence of malaria.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:27 |
|---|---|
| Enthalten in: |
Tropical medicine & international health : TM & IH - 27(2022), 11 vom: 25. Nov., Seite 990-998 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Olaleye, Omonike Arike [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
886U3H6UFF |
|---|
| Anmerkungen: |
Date Completed 15.11.2022 Date Revised 01.03.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/tmi.13823 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM34698677X |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM34698677X | ||
| 003 | DE-627 | ||
| 005 | 20240301231914.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/tmi.13823 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1313.xml |
| 035 | |a (DE-627)NLM34698677X | ||
| 035 | |a (NLM)36183175 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Olaleye, Omonike Arike |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impact of prophylactic antimalarials in pregnant women living with Human Immunodeficiency Virus on birth outcomes in Botswana |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 15.11.2022 | ||
| 500 | |a Date Revised 01.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd. | ||
| 520 | |a OBJECTIVES: Until late 2015, Botswana recommended preventive treatment for pregnant women in malarial regions with chloroquine and proguanil (CP). The guideline change provided an opportunity to evaluate CP and adverse birth outcomes | ||
| 520 | |a METHODS: The Tsepamo Study performed birth outcomes surveillance at large delivery centres throughout Botswana. We evaluated adverse birth outcomes from 2015 to 2017 at three hospitals where 93% of CP use was recorded. Outcomes included neonatal death (NND), small for gestational age (SGA), very SGA, stillbirth (SB), preterm delivery (PTD) and very PTD. Logistic regression analysis (unadjusted and adjusted) was conducted for each adverse birth outcome | ||
| 520 | |a RESULTS: During the study period, 5883 (26%) of 23,033 deliveries were exposed to CP, with the majority (65%) in the most malaria-endemic region. At this site, there was a trend or an association between CP use and reduction of three adverse birth outcomes: PTD (aOR 0.85, 95% CI 0.76-0.96), vPTD (aOR 0.83, 95% CI 0.68-1.01) and NND (aOR 0.65, 95% CI 0.42-1.00). However, at the least malaria-endemic site, the association was in the opposite direction for SB (aOR 1.54, 95% CI 1.08-2.22), SGA (aOR 1.24, 95% CI 1.06-1.44) and vSGA (aOR 1.42, 95% CI 1.14-1.77). The association between CP and reduced PTD was present among women without HIV (aOR 0.77, 95% CI 0.67-0.89) but not among women with HIV (aOR 1.09, 95% CI 0.78-1.35) | ||
| 520 | |a CONCLUSIONS: Antimalarial prophylaxis was associated with improved birth outcomes in the most malaria-endemic region of Botswana, but not elsewhere. This finding supports current WHO guidance to use prophylaxis strategies among pregnant women in highly malaria-endemic regions. Further studies of the risks and benefits of specific antimalarial regimens in pregnancy are warranted, particularly in areas with lower incidence of malaria | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Botswana | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a antimalarial prophylaxis | |
| 650 | 4 | |a birth outcomes | |
| 650 | 4 | |a pregnancy | |
| 650 | 7 | |a Antimalarials |2 NLM | |
| 650 | 7 | |a Chloroquine |2 NLM | |
| 650 | 7 | |a 886U3H6UFF |2 NLM | |
| 700 | 1 | |a Zash, Rebecca |e verfasserin |4 aut | |
| 700 | 1 | |a Diseko, Modiegi |e verfasserin |4 aut | |
| 700 | 1 | |a Mayondi, Gloria |e verfasserin |4 aut | |
| 700 | 1 | |a Mabuta, Judith |e verfasserin |4 aut | |
| 700 | 1 | |a Lockman, Shahin |e verfasserin |4 aut | |
| 700 | 1 | |a Melton, M Lendsey |e verfasserin |4 aut | |
| 700 | 1 | |a Mmalane, Mompati |e verfasserin |4 aut | |
| 700 | 1 | |a Makhema, Joseph |e verfasserin |4 aut | |
| 700 | 1 | |a Shapiro, Roger L |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Tropical medicine & international health : TM & IH |d 1997 |g 27(2022), 11 vom: 25. Nov., Seite 990-998 |w (DE-627)NLM086387235 |x 1365-3156 |7 nnns |
| 773 | 1 | 8 | |g volume:27 |g year:2022 |g number:11 |g day:25 |g month:11 |g pages:990-998 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/tmi.13823 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 27 |j 2022 |e 11 |b 25 |c 11 |h 990-998 | ||