Pregnancy-associated malaria is challenging, resulting in low birth-weights, maternal anaemia and other unfavourable outcomes. An intervention is effective case management with artemisinin-based combination therapy. One option is dihydroartemisinin-piperaquine (DHA-PPQ) for which limited efficacy and safety data in pregnancy exists. With its introduction in Ghana and anticipated access by pregnant women, we assessed its use in pregnant women.
Pregnant women of gestation 15-32 weeks in a moderate transmission zone of Ghana were screened for parasitaemia using rapid diagnostic test (RDT) and microscopy. Those positive in both and eligible were randomized to DHA-PPQ or artesunate-amodiaquine (AS-AQ). Baseline clinical and haematological assessments were conducted. They were actively followed up on days 1, 2, 3, 7, 14, 28, 42, at delivery and at 6 weeks postpartum to ensure adherence to study drugs, assess adverse events, collect blood samples for haematological and parasitological assessments and gather data on neonatal morbidity and mortality.
Parasite clearance at day 28 was 99.4% in the DHA-PPQ group and 98.0% in the AS-AQ group. There was no difference in mean haemoglobin concentration between groups at baseline and at day 28 (10.5 vrs 10.7; p=0.113). Mean white blood cell count was similar across study groups on days 14, 28 and 42. There was a higher prevalence of anorexia, general weakness and dizziness noted with AS-AQ
DHA-PPQ is a potential addition to the antimalarials used in pregnancy but this would require studying larger populations of pregnant women. The greater tolerance will likely make for better compliance when used to treat for malaria in pregnancy.