Birth Outcomes in Pregnant Women Treated with Artemisinin-Based Combination Therapies at Tema General Hospital

Abstract

INTRODUCTION: In the treatment of malaria in pregnant women in Ghana, the treatment regimen for first trimester is different from the treatment regimen for second and third trimesters. Quinine is the recommended treatment regimen in the first trimester of pregnancy but this is not well accepted by both prescribers and patients. This seems to be due to perception of likely unwanted side effects that may lead to spontaneous abortion and its longer treatment duration, (anecdotal evidence)1. Hence other antimalarials are being used but there is little evidence on the birth outcomes associated with the use of these antimalarials. METHOD: This study used a retrospective cohort design to examine birth outcomes in two groups of women who received malaria treatment in all the trimesters of pregnancy at the maternity wing of Tema General Hospital. The first group received artemisinin-based combination therapies in pregnancy, and the second group received any other malaria treatment or no treatment at all during pregnancy. Case Report Forms (CRFs) were used in collecting relevant information from maternal record cards of the new mothers. Clarifications were obtained from the new mothers when needed. There were 72 women in each group. This study was conducted from May - June 2015, when deliveries were highest at the Tema General Hospital. RESULTS: There was no significant differences (p=0.48, 0.52, 0.70, 0.70) in all the four birth outcomes, normal birth outcome, birth weight of the baby, stillbirth and premature birth in the two groups of new mothers. Increasing number of doses of sulphadoxine-pyrimethamine (SP) was observed to result in favourable birth outcomes. Women who took up to two doses of Intermittent Preventive Treatment during Pregnancy (IPTp) had a 1 The reference for this statement is from series of verbal discussions with different prescribers in Tema, as there were no documented evidence of spontaneous abortion with quinine use in early pregnancy at the facilities visited. 38% decreased odds of normal birth outcome (AOR 0.62, p=0.34), while those who took up to four doses of IPTp had 120% increased odds of having normal birth outcome. DISCUSSION/CONCLUSION: This study found that birth outcomes in pregnant women who were treated with ACTs in all trimesters of pregnancy were slightly different from birth outcomes in pregnant women who were not treated with ACTs in all trimesters of pregnancy, but these differences were not statistically significant.