ArticleMalaria journal2015
Risks of miscarriage and inadvertent exposure to artemisinin derivatives in the first trimester of pregnancy: a prospective cohort study in western Kenya.
Article in Malaria journal, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05757167 (Improving Neonatal Health Through Rapid Malaria Testing in Early Pregnancy With High-Sensitivity), which is not on this map. Cited by 14 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Improving Neonatal Health Through Rapid Malaria Testing in Early Pregnancy With High-Sensitivity
Who cites it
14 citing papers in PubMed, 5 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Fetal sex and risk of pregnancy-associated malaria in Plasmodium falciparum-endemic regions: a meta-analysis.Scientific reports · 2023Pooled it
- Pregnancy outcomes after first-trimester treatment with artemisinin derivatives versus non-artemisinin antimalarials: a systematic review and individual patient data meta-analysis.Lancet (London, England) · 2023Pooled it
- Systematic literature review and meta-analysis of the efficacy of artemisinin-based and quinine-based treatments for uncomplicated falciparum malaria in pregnancy: methodological challenges.Malaria journal · 2017Pooled it
- Malaria, malnutrition, and birthweight: A meta-analysis using individual participant data.PLoS medicine · 2017Pooled it
- First-trimester artemisinin derivatives and quinine treatments and the risk of adverse pregnancy outcomes in Africa and Asia: A meta-analysis of observational studies.PLoS medicine · 2017Pooled it
- Clinical management of Plasmodium knowlesi malaria.Advances in parasitology · 2021Review
- Safety of Artemisinin Derivatives in the First Trimester of Pregnancy: A Controversial Story.Molecules (Basel, Switzerland) · 2020Review
- First trimester use of artemisinin-based combination therapy and the risk of low birth weight and small for gestational age.Malaria journal · 2020Article
- Treatment of uncomplicated and severe malaria during pregnancy.The Lancet. Infectious diseases · 2018Review
- Malaria during Pregnancy.Cold Spring Harbor perspectives in medicine · 2017Review
- New developments in anti-malarial target candidate and product profiles.Malaria journal · 2017Review
- Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific.BMJ open · 2016Article
- Safety of artemisinins in first trimester of prospectively followed pregnancies: an observational study.The Lancet. Infectious diseases · 2016Observational
- Weekly miscarriage rates in a community-based prospective cohort study in rural western Kenya.BMJ open · 2016Article
Corrections and comments
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Authors and funding
18 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe artemisinin anti-malarials are widely deployed as artemisinin-based combination therapy (ACT). However, they are not recommended for uncomplicated malaria during the first trimester because safety data from humans are scarce.
methodsThis was a prospective cohort study of women of child-bearing age carried out in 2011-2013, evaluating the relationship between inadvertent ACT exposure during first trimester and miscarriage. Community-based surveillance was used to identify 1134 early pregnancies. Cox proportional hazard models with left truncation were used.
resultsThe risk of miscarriage among pregnancies exposed to ACT (confirmed + unconfirmed) in the first trimester, or during the embryo-sensitive period (≥6 to <13 weeks gestation) was higher than among pregnancies unexposed to anti-malarials in the first trimester: hazard ratio (HR) = 1.70, 95 % CI (1.08-2.68) and HR = 1.61 (0.96-2.70). For confirmed ACT-exposures (primary analysis) the corresponding values were: HR = 1.24 (0.56-2.74) and HR = 0.73 (0.19-2.82) relative to unexposed women, and HR = 0.99 (0.12-8.33) and HR = 0.32 (0.03-3.61) relative to quinine exposure, but the numbers of quinine exposures were very small.
conclusionACT exposure in early pregnancy was more common than quinine exposure. Confirmed inadvertent artemisinin exposure during the potential embryo-sensitive period was not associated with increased risk of miscarriage. Confirmatory studies are needed to rule out a smaller than three-fold increase in risk.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.