title: Prevention and control of malaria in pregnancy - new threats, new opportunities?
abstract: Over 100 million women and their babies are at risk of malaria in pregnancy each year. Malaria prevention in pregnancy relies on long-lasting insecticidal nets (LLINs), and, in Africa, intermittent preventive treatment in pregnancy (IPTp). Increasing resistance of malaria parasites to sulfadoxine-pyrimethamine, the only drug endorsed for IPTp, and increasing mosquito resistance to pyrethroids used in LLINs, threaten the efficacy of these proven strategies, while operational challenges restrict their implementation in areas of great need. Areas Covered: This review summarizes strategies for malaria prevention in pregnancy (both currently used and those undergoing preclinical and clinical evaluation), primarily drawing on publications and study protocols from the last decade. Challenges associated with each strategy are discussed, including the particular problem of HIV and malaria in pregnancy, and areas of further research are highlighted. Expert Commentary: Alternative drugs for IPTp are needed. Dihydroartemisinin-piperaquine is particularly promising, but requires further evaluation, and might contribute to artemisinin resistance. Intermittent screening and treatment in pregnancy (ISTp) is an alternative to IPTp that could reduce unnecessary antenatal drug exposure and resistance risk, but it is not recommended with current, insensitive screening tests. Optimal strategies for areas of low or declining malaria transmission remain to be determined.
authors.affiliation: a Department of Medicine at the Doherty Institute , University of Melbourne , Melbourne , Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rogerson
authors.affiliation: a Department of Medicine at the Doherty Institute , University of Melbourne , Melbourne , Australia.|b Department of Obstetrics and Gynaecology , Royal Infirmary of Edinburgh , Edinburgh , UK.
authors.forename: Holger W
authors.initials: HW
authors.lastname: Unger
mesh_terms: D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D009033:Culicidae / Q000469:parasitology; D004338:Drug Combinations; D004351:Drug Resistance / Q000187:drug effects; D005260:Female; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D016778:Malaria, Falciparum / Q000469:parasitology / Q000473:pathology / Q000517:prevention & control* / Q000635:transmission; D016780:Malaria, Vivax / Q000469:parasitology / Q000473:pathology / Q000517:prevention & control* / Q000635:transmission; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000473:pathology / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods*; D011739:Pyrimethamine / Q000627:therapeutic use; D011804:Quinolines / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use; D010879:Piperazines
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D011739:Pyrimethamine; D011804:Quinolines; D013413:Sulfadoxine; C001205:fanasil, pyrimethamine drug combination; C039060:artenimol; C031327:artemisinin; C034759:piperaquine; D010879:Piperazines
keywords: Intermittent preventive treatment; Plasmodium falciparum; Plasmodium vivax; dihydroartemisinin-piperaquine; drug resistance; intermittent screening andtreatment; placenta; sulfadoxine-pyrimethamine