Anti-malarial drugs during pregnancy is safe, effective —Experts

Pregnancy increases the risk of malaria and this is associated with poor health outcomes for both the mother and the infant, especially during the first or second trimester. If not treated immediately, it might cause complications for both the mother and the baby.

For this reason, women are encouraged to try and prevent malaria infection during pregnancy and its complications by sleeping under mosquito bed-nets, and by taking drugs effective against malaria throughout pregnancy as chemoprevention. The risk of stillbirth, spontaneous abortion, and other adverse pregnancy outcomes is increased without proper treatment and timely medical intervention.

In 2019, according to World Health Organization (WHO), Nigeria had the highest number of deaths (23%) resulting from malaria infections globally and in 2020, Nigeria also had the highest number of global malaria cases (27%).

Guidelines provided by the WHO say that a pregnant woman should obtain Intermittent Preventive Treatment of Malaria, IPTp, in the form of Sulphadoxine-Pyrimethamine (SP) to avoid malaria symptoms and complications.

However, growing misconceptions about IPTp in pregnancy persist among women known to have attended antenatal care clinics for reasons ranging from personal risk to the fear that the medication could harm their unborn babies, even as public health experts say the treatment therapy is safe for mothers and their unborn babies.

In the view of Dr Olufemi Adesanya, consultant obstetrics and gynaecologist said that Intermittent Preventive Treatment of Malaria, IPTp, in the form of Sulphadoxine-Pyrimethamine (SP) is safe for mothers and their unborn babies.

He added, “Sulphadoxine-Pyrimethamine has been discovered to be safe even in pregnant women. But you cannot rule out adverse reaction to it in one or two cases in a 1000 population because the way individuals react to medications differs based on their body’s idiosyncrasy or unusual features. Even, there are clearer pictures that ACT, another type of antimalarial is also safe in pregnancy. People should not entertain fear.”

Dr Adesanya, however, said that it is advisable that women be wary of taking drugs during prenancy, especially in the first trimester and if required must be discussed with an obstetrics and gynaecologist at the hospital.

Moreover, he stated that just like some people will react to a particular food, so also some will react to certain medicines and so before pregnancy, women must try to understand their bodies, including drugs and food items they reacted to when taking the first time.

DrAdesanya stated that in some instances, individuals had developed Stevens-Johnson syndrome (SJS), usually a severe reaction to a medication.

“That a case of Stevens – Johnson syndrome is reported in a pregnant woman does not mean that every other pregnant woman will have it. So, it is important that any drug intake, not just Sulphadoxine-Pyrimethamine, be looked into.

“For instance, it may not be an anaphylactic reaction, which is a severe allergic reaction that needs to be treated right away. For example, taking non-steroidal anti-inflammatory drugs in the first trimester of pregnancy could be deleterious, especially to the unborn baby because there have been reported cases of premature closure of the front portion of the skull (frontal bone) in a baby developing in the womb. This is a major anomaly.”

Dr Adesanya said signs and symptoms of an adverse drug reaction, including Sulphadoxine-Pyrimethamine, could vary. These could include skin rashes that progresses if the offensive agent is not removed; redness of the eye; difficulty breathing; nausea, vomiting and urination of blood depending on the degree and quantity of the drug that initiated the reaction.

Mr Lukman Akinwande, Director of Pharmaceutical Services at the Oyo state Ministry of health, stated that no drug is 100 per cent safe and the reason abuse of medicines is better avoided even in pregnancy.

He stated that pregnant women are not exempted from drug reactions. He added, “The case of Stevens-Johnson syndrome reported in some pregnant women due to Sulphadoxine–Pyrimethamine occurs in one in 100s of women, and as such, necessitating individuals being knowledgeable about their system and what their bodies cannot tolerate.

“For instance, anybody that has taken a medicine like Sulphadoxine-Pyrimethamine at a time who reacted must try to avoid all other sulphur-containing drugs because it is likely that they would react again in the future.”

Howbeit, MrAkinwande also assured that Sulphadoxine-Pyrimethamine is safe for use in pregnancy although in rare cases, some women have reacted to it because of their body composition too.

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Even if there is any side reaction, he said people should not panic because there are laid down procedures to follow to know if it is due to a drug-drug interaction, food-drug interaction or a drug component.

Moreover, studies suggest that the use of artemisinin-based combination therapy (ACT) for the treatment of uncomplicated malaria during the first trimester of pregnancy was not associated with an increased occurrence of low birth weight (LBW), small for age, miscarriage or premature delivery.

Available evidence continues to show that intermittent preventive treatment in pregnancy (IPTp) with Sulphadoxine-Pyrimethamine is a safe and highly cost-effective strategy for reducing the disease burden in pregnancy and adverse pregnancy and birth outcomes.

Women are susceptible to being affected by malaria during pregnancy but no doubt, taking antimalarial drugs while healthy to avoid becoming sick during pregnancy is safe and effective.