title: Imported malaria in pregnant women: A retrospective pooled analysis.
abstract: BACKGROUND
  Data on imported malaria in pregnant women are scarce.
  
  
  METHODS
  A retrospective, descriptive study of pooled data on imported malaria in pregnancy was done using data from 1991 to 2014 from 8 different collaborators in Europe, the United States and Japan. National malaria reference centres as well as specialists on this topic were asked to search their archives for cases of imported malaria in pregnancy. A total of 631 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 (78.5% of cases). Among the 542 cases where information on the use of chemoprophylaxis was known, 464 (85.6%) did not use chemoprophylaxis. The main reason for travelling was "visiting friends and relatives" VFR (57.8%) and overall, most cases of malaria were imported from West Africa (57.4%). Severe anaemia was the most frequent complication in the mother. Data on offspring outcome were limited, but spontaneous abortion was a frequently reported foetal outcome (n = 14). A total of 50 different variants of malaria treatment regimens were reported.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Zürich Travel Clinic, Infectious Diseases, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.
authors.forename: Annina K
authors.initials: AK
authors.lastname: Käser
authors.affiliation: Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arguin
authors.affiliation: Public Health England, Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK; Department of Clinical Parasitology, Hospital for Tropical Diseases, University College London Hospitals, NHS Foundation Trust, London, UK.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Chiodini
authors.affiliation: Public Health England, Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Valerie
authors.initials: V
authors.lastname: Smith
authors.affiliation: University Hospital Institute for Infectious and Tropical Diseases, Hospital Nord, AP-HM, Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Delmont
authors.affiliation: Department of Internal Medicine, University Hospital Fuenlabrada, Madrid, Spain.
authors.forename: Beatriz C
authors.initials: BC
authors.lastname: Jiménez
authors.affiliation: Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Färnert
authors.affiliation: Department of Internal Medicine, Shin-Yamanote Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ramharter
authors.affiliation: Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
authors.affiliation: University of Zürich Travel Clinic, Infectious Diseases, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. Electronic address: pat@ifspm.uzh.ch.
authors.forename: Patricia
authors.initials: P
authors.lastname: Schlagenhauf
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008288:Malaria / Q000453:epidemiology*; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D012189:Retrospective Studies; D014195:Travel / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Chemoprophylaxis; Imported malaria; Pregnancy; Travel; Treatment