The safety of artemisinins during pregnancy: a pressing question
Ishag Adam, university of khartoum
26 February 2007
There is few data concern drugs exposure in the first trimester of human pregnancy. Since the tragedy of thalidomide, the medical profession has been alerted to the teratogenic effects of the drugs. Thalidomide, a seemingly harmless effective hypnotic, had been promoted as a drug to suit pregnant women and resulted in most severe forms of deformity, namely phacomelia [1]. As a result, few data are available concerning the drugs administered in the first trimester of pregnancy, including old antimalarial drugs such as chloroquine and quinine [2-3].
As mentioned in the paper, artemisinin-based combination therapy has now become the first-line treatment in many countries, and it is given free-of-charge in some countries, including Sudan. This and the high parity of women, the absence of accurate diagnosis, will definitely lead to inadvertent exposure to these drugs in the first trimester.
One of the recommendations is post-marketing pharmacovigilance. This and pharmacokinetic studies of these drugs during pregnancy are urgently needed.
1. Chamberlain, G: The obstetrics problems of the thalidomide children. BMJ 1989; 298, 6
2. McGready R, Thwai KL, Cho T, Samuel, Looareesuwan S, White NJ, Nosten F. The effects of quinine and chloroquine antimalarial treatments in the first trimester of pregnancy. Trans R Soc Trop Med Hyg 2002; 96:180-184.
3. Adam I, Idris HM, Elbashir MI: Quinine for chloroquine-resistant falciparum malaria in pregnant Sudanese women in the first trimester.
The safety of artemisinins during pregnancy: a pressing question
26 February 2007
There is few data concern drugs exposure in the first trimester of human pregnancy. Since the tragedy of thalidomide, the medical profession has been alerted to the teratogenic effects of the drugs. Thalidomide, a seemingly harmless effective hypnotic, had been promoted as a drug to suit pregnant women and resulted in most severe forms of deformity, namely phacomelia [1]. As a result, few data are available concerning the drugs administered in the first trimester of pregnancy, including old antimalarial drugs such as chloroquine and quinine [2-3].
As mentioned in the paper, artemisinin-based combination therapy has now become the first-line treatment in many countries, and it is given free-of-charge in some countries, including Sudan. This and the high parity of women, the absence of accurate diagnosis, will definitely lead to inadvertent exposure to these drugs in the first trimester.
One of the recommendations is post-marketing pharmacovigilance. This and pharmacokinetic studies of these drugs during pregnancy are urgently needed.
1. Chamberlain, G: The obstetrics problems of the thalidomide children. BMJ 1989; 298, 6
2. McGready R, Thwai KL, Cho T, Samuel, Looareesuwan S, White NJ, Nosten F. The effects of quinine and chloroquine antimalarial treatments in the first trimester of pregnancy. Trans R Soc Trop Med Hyg 2002; 96:180-184.
3. Adam I, Idris HM, Elbashir MI: Quinine for chloroquine-resistant falciparum malaria in pregnant Sudanese women in the first trimester.
East Mediterr Health J 2004; 10:560-565.
Competing interests
None declared