Abstract
Artemisinin combination therapy (ACT) is recommended by the World Health Organization (WHO) as first line treatment for uncomplicated malaria both in adults and children. During pregnancy, ACT is considered safe only in the second and third trimester, since animal studies have demonstrated that artemisinin derivatives can cause foetal death and congenital malformation within a narrow time window in early embryogenesis. During this period, artemisinin derivatives induce defective embryonic erythropoiesis and vasculogenesis/angiogenesis in experimental models. However, clinical data on the safety profile of ACT in pregnant women have not shown an increased risk of miscarriage, stillbirth, or congenital malformation, nor low birth weight, associated with exposure to artemisinins in the first trimester. Although further studies are needed, the evidence collected up to now is prompting the WHO towards a change in the guidelines for the treatment of uncomplicated malaria, allowing the use of ACT also in the first trimester of pregnancy.
Highlights
Malaria continues to be a major threat in the developing world, with 228 million clinical episodes and 405,000 deaths in 2018 [1]
Artemisinin combination therapy (ACT) are recommended by the World Health Organization (WHO) for adults and children first line treatment for uncomplicated malaria but in pregnant women ACTs are restricted to the as first line treatment for uncomplicated malaria but in pregnant women ACTs are restricted to second and third trimester (Table 1)
The gap between high antenatal care (ANC) attendance and the low proportion of eligible pregnant women receiving IPTp3 largely reflects a failure of the health system to provide Intermittent preventive treatment during pregnancy (IPTp)-SP at ANC facilities [31]
Summary
Malaria continues to be a major threat in the developing world, with 228 million clinical episodes and 405,000 deaths in 2018 [1]. It is a sesquiterpene lactone with a peroxide properties, bridge essential for the antimalarial derivatives of artemisinin with improved pharmacological including artemether, effect. Artemisinins aresemisynthetic safe and well derivatives of artemisinin withrapid improved pharmacological properties, including tolerated drugs, with a very cytotoxic action against all parasite stages,artemether, including artesunate early ring and dihydroartemisinin (DHA), were developed Artemisinins are safe well tolerated stage [5,6,7,8] They are active against early stage gametocytes, responsible for and transmission from drugs, with a very rapid cytotoxic against all parasite stages, including early ringcombination stage [5,6,7,8]. Several studies recently concluded indicate that artemisinins are safe and could be used
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