Atovaquone-proguanil exposure in pregnancy and risk for adverse fetal and infant outcomes: A retrospective analysis,Travel Medicine and Infectious Disease

当前位置： X-MOL 学术 › Travel Med. Infect. Dis. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Atovaquone-proguanil exposure in pregnancy and risk for adverse fetal and infant outcomes: A retrospective analysis
Travel Medicine and Infectious Disease ( IF 12.0 ) Pub Date : 2019-11-17 , DOI: 10.1016/j.tmaid.2019.101519
Julie R Gutman ₁ , Clinton Hall ₂ , Zeina G Khodr ₂ , Anna T Bukowinski ₂ , Gia R Gumbs ₂ , Ava Marie S Conlin ₃ , Natalie Y Wells ₃ , Kathrine R Tan ₁

Affiliation

Background

Malaria in pregnancy can cause severe maternal and fetal complications. Chloroquine (CQ) and mefloquine (MQ) are recommended for chemoprophylaxis in pregnancy, but are not always suitable. Atovaquone-proguanil (AP) might be a viable option for malaria prevention in pregnancy, but more safety data are needed.

Methods

Data for pregnancies and live births among active duty military women, 2003–2014, from the Department of Defense Birth and Infant Health Research program were linked with pharmacy data to determine antimalarial exposure. Multivariable Cox and logistic regression models were used to assess the relationship of antimalarial exposure with fetal and infant outcomes, respectively.

Results

Among 198,164 pregnancies, 50 were exposed to AP, 156 to MQ, and 131 to CQ. Overall, 17.6% of unexposed pregnancies and 28.0%, 16.0%, and 6.1% of pregnancies exposed to AP, MQ, and CQ, respectively, ended in fetal loss (spontaneous abortion or stillbirth) (adjusted hazard ratios [aHR] = 1.46, 95% confidence interval [CI] 0.87–2.46; aHR = 1.06, 95% CI 0.72–1.57; and aHR = 0.47, 95% CI 0.24–0.94, respectively).

Conclusions

The small number of AP exposed pregnancies highlights the difficulty in assessing safety. While definitive conclusions are not possible, these data suggest further research of AP exposure in pregnancy and fetal loss is warranted.

Twitter line

More research on fetal loss following atovaquone-proguanil exposure in pregnancy is warranted.

中文翻译：

妊娠期 Atovaquone-proguanil 暴露和不良胎儿和婴儿结局的风险：一项回顾性分析

背景

妊娠期疟疾可导致严重的母婴并发症。氯喹 (CQ) 和甲氟喹 (MQ) 被推荐用于妊娠期的化学预防，但并不总是适用。Atovaquone-proguanil (AP) 可能是预防妊娠期疟疾的可行选择，但需要更多的安全数据。

方法

来自国防部出生和婴儿健康研究计划的 2003-2014 年现役军人怀孕和活产数据与药房数据相关联，以确定抗疟药物暴露情况。多变量 Cox 和逻辑回归模型分别用于评估抗疟药暴露与胎儿和婴儿结局的关系。

结果

在 198,164 例妊娠中，50 例暴露于 AP，156 例暴露于 MQ，131 例暴露于 CQ。总体而言，17.6% 的未暴露妊娠和 28.0%、16.0% 和 6.1% 的暴露于 AP、MQ 和 CQ 的妊娠分别以流产（自然流产或死产）告终（调整后的风险比 [aHR] = 1.46， 95% 置信区间 [CI] 0.87–2.46；aHR = 1.06，95% CI 0.72–1.57；aHR = 0.47，95% CI 0.24–0.94）。