More Research Needed For Treating Malaria During Pregnancy

Editor's Choice
Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Pregnancy / Obstetrics;  Tropical Diseases
Article Date: 17 Jun 2008 - 0:00 PDT

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An essay written by a team of malaria experts and published in the open-access journal PLoS Medicine argues that there needs to be more research on how best to treat malaria during pregnancy - a situation that puts both mother and child at risk of death.

Nicholas J. White (Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand) and colleagues write that the medical community is currently in a "catch-22" situation that is making it difficult to assess the efficacy and safety of new drugs for malaria during pregnancy.

White and colleagues explain that, "Since the disaster of thalidomide 50 years ago the medical profession has been rightfully very cautious about giving newly developed drugs to pregnant women, for fear that they might damage the unborn baby." This has led to new medicines that come with instructions prohibiting use during pregnancy. Although this caution may have some merit, it is not based on any specific results from reproductive toxicology tests; instead it is derived from insufficient clinical information. The result is that pregnant women with life-threatening diseases receive treatment with inferior drugs in order to reduce a supposed risk to the unborn child - as well as the liability that follows.

The authors liken this situation to a "dangerous catch-22" - potentially life-saving medicines are not prescribed to pregnant women making it impossible to know if the new drugs are safe and effective. Man regulatory authorities in developed countries have tried to tackle this problem by pushing pharmaceutical companies to collect data on the use of new medications for pregnant women. In developing world, however, there is a paucity of research that analyzes how most drugs treating tropical diseases (such as malaria) affect pregnant women. Recommendations for treating these infections, therefore, are not the result of good medical research.

White and colleagues maintain that, "International agencies and funders need to provide adequate support for quality studies in pregnancy and, in an increasingly litigious climate, to underwrite the liabilities." They conclude: "there are few more challenging areas of drug development than establishing drug safety in pregnancy. Add to this the difficulties in conducting clinical trials and pharmacokinetic studies in pregnancy in most tropical countries, and it is not difficult to understand our current state of ignorance. We do not know how best to treat most tropical infectious diseases in pregnancy. It is a difficult problem, but one that should no longer be ignored."

New medicines for tropical diseases in pregnancy: Catch-22
White NJ, McGready RM, Nosten FH
PLoS Medicine (2008). 5(6): e133.
doi:10.1371/journal.pmed.0050133
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About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org

Written by: Peter M Crosta
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