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Impact of prophylactic antimalarials in pregnant women living with Human Immunodeficiency Virus on birth outcomes in Botswana
Author(s) -
Olaleye Omonike Arike,
Zash Rebecca,
Diseko Modiegi,
Mayondi Gloria,
Mabuta Judith,
Lockman Shahin,
Melton M. Lendsey,
Mmalane Mompati,
Makhema Joseph,
Shapiro Roger L.
Publication year - 2022
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13823
Subject(s) - medicine , obstetrics , malaria , small for gestational age , adverse effect , pregnancy , premature birth , logistic regression , gestational age , pediatrics , immunology , biology , genetics
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.