Impact of prophylactic antimalarials in pregnant women living with Human Immunodeficiency Virus on birth outcomes in Botswana.

Autor: Olaleye OA; College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas, USA.; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Zash R; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Diseko M; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Mayondi G; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Mabuta J; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Lockman S; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Melton ML; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Mmalane M; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Makhema J; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Shapiro RL; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
Jazyk: angličtina
Zdroj: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2022 Nov; Vol. 27 (11), pp. 990-998. Date of Electronic Publication: 2022 Oct 31.
DOI: 10.1111/tmi.13823
Abstrakt: Objectives: Until late 2015, Botswana recommended preventive treatment for pregnant women in malarial regions with chloroquine and proguanil (CP). The guideline change provided an opportunity to evaluate CP and adverse birth outcomes.
Methods: The Tsepamo Study performed birth outcomes surveillance at large delivery centres throughout Botswana. We evaluated adverse birth outcomes from 2015 to 2017 at three hospitals where 93% of CP use was recorded. Outcomes included neonatal death (NND), small for gestational age (SGA), very SGA, stillbirth (SB), preterm delivery (PTD) and very PTD. Logistic regression analysis (unadjusted and adjusted) was conducted for each adverse birth outcome.
Results: During the study period, 5883 (26%) of 23,033 deliveries were exposed to CP, with the majority (65%) in the most malaria-endemic region. At this site, there was a trend or an association between CP use and reduction of three adverse birth outcomes: PTD (aOR 0.85, 95% CI 0.76-0.96), vPTD (aOR 0.83, 95% CI 0.68-1.01) and NND (aOR 0.65, 95% CI 0.42-1.00). However, at the least malaria-endemic site, the association was in the opposite direction for SB (aOR 1.54, 95% CI 1.08-2.22), SGA (aOR 1.24, 95% CI 1.06-1.44) and vSGA (aOR 1.42, 95% CI 1.14-1.77). The association between CP and reduced PTD was present among women without HIV (aOR 0.77, 95% CI 0.67-0.89) but not among women with HIV (aOR 1.09, 95% CI 0.78-1.35).
Conclusions: Antimalarial prophylaxis was associated with improved birth outcomes in the most malaria-endemic region of Botswana, but not elsewhere. This finding supports current WHO guidance to use prophylaxis strategies among pregnant women in highly malaria-endemic regions. Further studies of the risks and benefits of specific antimalarial regimens in pregnancy are warranted, particularly in areas with lower incidence of malaria.
(© 2022 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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