WHO gives ‘strong recommendation’ which supports using an antimalarial drug to treat pregnant women during the first trimester

In 2020, over 11 million pregnancies (the majority in sub-Saharan Africa) were at risk of health complications such as premature birth, severe anaemia and miscarriage due to malaria. Despite a clear need, there are few medicines available and recommended by the World Health Organization (WHO) to treat malaria in pregnancy. Until now, only one drug, quinine, was recommended to treat women in their first trimester. Although effective, quinine has some shortcomings: it must be taken three times a day for 7 days and is associated with side effects including hearing impairment and dizziness. 

On 25 November, WHO updated its Guidelines for the Treatment of Malaria to include a ‘strong recommendation’ for artemisinin-based combination therapy (ACT) artemether-lumefantrine to treat malaria during the first trimester of pregnancy. The drug was previously only recommended for use in the second and third trimesters. WHO’s evaluation of the drug included evidence from a large meta-analysis coordinated by the Liverpool School of Tropical Medicine (LSTM), with funding from MMV, WHO and WWARN, funded by the Bill and Melinda Gates Foundation. That analysis examined 34,178 pregnancies, including 737 pregnancies exposed to artemisinin. Of these, 525 were treated with artemether-lumefantrine. For more on this story, read here.