A survey on outcomes of accidental atovaquone–proguanil exposure in pregnancy

• Type of Material: Article
• Authors: Kathrine R. Tan, Centers for Disease Control and Prevention; Jessica K. Fairley, Emory University; Mengxi Wang, Emory University; Julie R. Gutman, Emory University
• Language: English
• Date: 2018-05-15
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12936-018-2352-z
• Title of Journal or Parent Work: Malaria Journal
• ISSN: 1475-2875
• Volume: 17
• Issue: 1
• Start Page: 198
• End Page: 198
• Grant/Funding Information: No funding sources.
• Keywords: Prophylaxis; Tropical Medicine; Infectious Diseases; Science & Technology; Life Sciences & Biomedicine; Parasitology; Pregnancy; Atovaquone-proguanil; Malaria; UNCOMPLICATED FALCIPARUM-MALARIA; WOMEN
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background: Malaria chemoprophylaxis options in pregnancy are limited, and atovaquone-proguanil (AP) is not recommended because of insufficient safety evidence. An anonymous, internet-based survey was disseminated to describe outcomes of pregnancies accidentally exposed to AP. Outcomes of interest included miscarriage (defined as pregnancy loss before 20 weeks), stillbirth (defined as pregnancy loss at or after 20 weeks), preterm birth or live birth prior to 37 weeks, and the presence of congenital anomalies. Results: A total of 487 women responded and reported on 822 pregnancies. Of the 807 pregnancies with information available on exposure and outcomes, 10 (1.2%) had atovaquone-proguanil exposure, all in the first trimester, and all resulted in term births with no birth defects. Conclusions: Use of an anti-malarial not recommended in pregnancy is likely to occur before the woman knows of her pregnancy. This study adds to the limited evidence of the safety of AP in pregnancy. Further study on use of AP in pregnancy should be a high priority, as an alternative option for the prevention of malaria in pregnancy in non-immune travellers is urgently needed.