THE SAFETY OF ANTIMALARIAL-DRUGS IN PREGNANCY

Alternative drugs to chloroquine are required to prevent the deleterio us effects of malaria in pregnancy. Fear of potential toxicity has lim ited antimalarial drug use in pregnancy. Animal toxicity studies have documented teratogenicity when antimalarials are administered at high dosages. Excepting the tetracyclines, there is no evidence to suggest that, at standard dosages, any of the antimalarial drugs are teratogen ic. Primaquine is not recommended because of the potential risk of hae molytic effects in the fetus, Rates of spontaneous abortion and birth defects were comparable in pregnant women taking mefloquine, compared with chloroquine-proguanil, or pyrimethamine-sulfadoxine prophylaxis, in the first trimester of pregnancy, Standard doses of quinine do not increase the risk of abortion or preterm delivery, Therapeutic mefloqu ine does not provoke hypoglycaemia. There is no evidence in the litera ture to support the hypothetical risk of kernicterus in the newborn, f ollowing exposure to antimalarial drugs containing sulphonamides or su lphones prior to delivery, Documentation of the safety of doxycycline, halofantrine, and the artemisinin derivatives in the treatment of mal aria in pregnant women is currently limited.