Single First-Trimester Malaria Episode Ups Miscarriage Risk

Similar miscarriage risk among women treated with chloroquine, quinine, and artesunate

TUESDAY, Dec. 13 (HealthDay News) -- There is an increased risk of miscarriage for women who have a single episode of Plasmodium falciparum or Plasmodium vivax malaria during their first trimester of pregnancy, according to a study published online Dec. 13 in The Lancet Infectious Diseases.

Rose McGready, M.B.B.S., from the Shoklo Malaria Research Unit in Mae Sot, Thailand, and colleagues investigated the outcomes of malaria-exposed versus malaria-unexposed first-trimester pregnancies, and compared outcomes on the basis of the type of antimalarial administered (chloroquine-based, quinine-based, or artemisinin-based). Data were collected from antenatal records of women in their first trimester of pregnancy from 1986 to 2010. A total of 16,668 women had no malaria during pregnancy, and 945 had a single malaria episode in the first trimester.

The investigators found that the women with asymptomatic and symptomatic malaria had higher odds of miscarriage (adjusted odds ratios [OR], 2.7 and 3.99, respectively), which were similar for Plasmodium falciparum and Plasmodium vivax. Smoking, maternal age, previous miscarriage, and non-malaria febrile illness were also associated with increased risk of miscarriage. Other miscarriage risk factors among women with malaria were severe or hyperparasitemic malaria (adjusted OR, 3.63) and parasitemia (adjusted OR, 1.49 for each 10-fold increase in parasitemia). Higher gestational age at the time of infection reduced the risk of miscarriage (adjusted OR, 0.86). Women treated with chloroquine, quinine, and artesunate had comparable miscarriage risk (P = 0.71). There were no adverse effects due to antimalarial treatment.

"A single episode of falciparum or vivax malaria in the first trimester of pregnancy can cause miscarriage," the authors write.

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