First Trimester Use of Artemisinin-Based Combination Therapy and Risk of Low Birth Weight

Abstract

Introduction: There is a lack of sufficient evidence on the safety of use of artemisinin-based combination therapies (ACT) among pregnant women, especially during early pregnancy. We determined the association between exposure to ACT during the first trimester of pregnancy and occurrence of low birth weight (LBW), and small for gestational age (SGA) among the offspring of pregnant women. Methods: We performed a secondary analysis of data from a prospective cohort study of pregnant women recruited at three health and demographic surveillance system (HDSS) sites in the sub-Saharan African countries of Mozambique, Burkina Faso and Kenya. Data from the HDSS allowed earlier pregnancy identification and linkage and tracking of pregnancy outcomes to determine birth weight and gestational age at delivery. Exposure to any antimalarials was ascertained through a combination of data collected from clinic registers, prescription records and self-reported usage by the women. Results: There was no difference in the pooled prevalence of LBW among children born to pregnant women who were exposed to quinine, ACT and had no exposure to antimalarials, 21.0%, 11.3% and 10.2%, respectively. Children whose mothers had exposure to ACTs during the first trimester had 21% lower occurrence of LBW when compared to children born to mothers exposed to ACTs in second or third trimester, this difference was not statistical significant (95%CI: -7-49%). Conclusion: ACT exposure during the first trimester was not associated with an increased risk of LBW. Our findings support the use of ACT for treatment of malaria during the first trimester of pregnancy.