Safety of Artemisinin Derivatives in the First Trimester of Pregnancy: A Controversial Story

Artemisinin combination therapy (ACT) is recommended by the World Health Organization (WHO) as first line treatment for uncomplicated malaria both in adults and children. During pregnancy, ACT is considered safe only in the second and third trimester, since animal studies have demonstrated that arte...

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Bibliographic Details
Published in:Molecules (Basel, Switzerland) Switzerland), 2020-07, Vol.25 (15), p.3505
Main Authors: D'Alessandro, Sarah, Menegola, Elena, Parapini, Silvia, Taramelli, Donatella, Basilico, Nicoletta
Format: Article
Language:English
Subjects:
Acids
Anemia
Angiogenesis
Animals
Antimalarials - adverse effects
Antimalarials - pharmacology
Antimalarials - therapeutic use
Artemisinin
artemisinins
Artemisinins - adverse effects
Artemisinins - pharmacology
Artemisinins - therapeutic use
Birth weight
Clinical trials
Congenital defects
Drug dosages
Embryogenesis
Embryonic growth stage
embryotoxicity
Erythrocytes
Erythropoiesis
Female
Guidelines as Topic
Hematopoiesis - drug effects
Humans
Infections
Low birth weight
Malaria
Malaria - drug therapy
Malaria - pathology
Mortality
Pregnancy
Pregnancy Trimester, First
Review
safety
Stillbirth
Vector-borne diseases
Vitamin B
Womens health
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Summary:Artemisinin combination therapy (ACT) is recommended by the World Health Organization (WHO) as first line treatment for uncomplicated malaria both in adults and children. During pregnancy, ACT is considered safe only in the second and third trimester, since animal studies have demonstrated that artemisinin derivatives can cause foetal death and congenital malformation within a narrow time window in early embryogenesis. During this period, artemisinin derivatives induce defective embryonic erythropoiesis and vasculogenesis/angiogenesis in experimental models. However, clinical data on the safety profile of ACT in pregnant women have not shown an increased risk of miscarriage, stillbirth, or congenital malformation, nor low birth weight, associated with exposure to artemisinins in the first trimester. Although further studies are needed, the evidence collected up to now is prompting the WHO towards a change in the guidelines for the treatment of uncomplicated malaria, allowing the use of ACT also in the first trimester of pregnancy.
ISSN:1420-3049
1420-3049
DOI:10.3390/molecules25153505