@article{fdi:010072674,
  title = {{P}revention of malaria in pregnancy},
  author = {{D}esai, {M}. and {H}ill, {J}. and {F}ernandes, {S}. and {W}alker, {P}. and {P}ell, {C}. and {G}utman, {J}. and {K}ayentao, {K}. and {G}onzalez, {R}. and {W}ebster, {J}. and {G}reenwood, {B}. and {C}ot, {M}ichel and ter {K}uile, {F}. {O}.},
  editor = {},
  language = {{ENG}},
  abstract = {{M}alaria remains one of the most preventable causes of adverse birth outcomes. {I}ntermittent preventive treatment in pregnancy ({IPT}p) with sulfadoxine-pyrimethamine is used to prevent malaria, but resistance to this drug combination has decreased its efficacy and new alternatives are needed. {I}n {A}frica, a meta-analysis showed three-course or monthly {IPT}p with sulfadoxine-pyrimethamine to be safe and more effective than the original two-course sulfadoxine-pyrimethamine strategy, prompting {WHO} to update its policy in 2012. {A}lthough resistance to sulfadoxine-pyrimethamine reduces the parasitological efficacy of {IPT}p, this drug combination remains associated with reduced incidence of low birthweight in areas where prevalence of parasites with quintuple {P}lasmodium falciparum dihydrofolate reductase ({P}fdhfr) and dihydropteroate synthetase ({P}fdhps) mutations is greater than 90%. {N}evertheless, its effectiveness is compromised in women infected with sextuple mutant parasites. {S}ix trials of {IPT}p showed that neither amodiaquine, mefloquine, nor chloroquine-azithromycin are suitable replacements for sulfadoxine-pyrimethamine because of poor tolerability. {F}urthermore, four trials showed that intermittent screening and treatment with the current generation of malaria rapid diagnostic tests was not a suitable alternative strategy to {IPT}p with sulfadoxine-pyrimethamine, even in areas with high prevalence of quintuple mutations. {T}wo trials showed that {IPT}p with dihydroartemisinin-piperaquine was well tolerated, effective, and acceptable for {IPT}p, with monthly regimens being the most effective. {C}overage of {IPT}p and insecticide-treated nets continues to lag behind targets. {T}he key barriers to uptake are well documented, and many are open to intervention. {O}utside of {A}frica, a single trial suggests a potential role for integrated approaches that combine sulfadoxine-pyrimethamine with azithromycin for {IPT}p in areas of {P}apua {N}ew {G}uinea where malaria transmission is high. {M}odelling analysis suggests the importance of the prevention of malaria early in pregnancy and the need to protect pregnant women declines more slowly than the rate at which transmission declines. {I}mproved funding has led to an increase in the number of prevention trials in the past decade, showing the value of more sustained protection with monthly {IPT}p regimens. {T}here is a need for confirmatory trials of the safety, efficacy, and feasibility of {IPT}p with dihydroartemisinin-piperaquine, for studies of intermittent screening and treatment with more sensitive rapid diagnostic tests, for studies of integrated strategies for malaria and other co-infections, and for studies of prevention strategies for malaria in pregnant women who are {HIV}-positive and living outside of {A}frica. {A}dditional research is required on how to improve uptake of {WHO}'s updated policy on {IPT}p with sulfadoxine-pyrimethamine and insecticide-treated nets.},
  keywords = {},
  booktitle = {},
  journal = {{L}ancet {I}nfectious {D}iseases},
  volume = {18},
  numero = {4},
  pages = {{E}119--{E}132},
  ISSN = {1473-3099},
  year = {2018},
  DOI = {10.1016/s1473-3099(18)30064-1},
  URL = {https://www.documentation.ird.fr/hor/fdi:010072674},
}