Misuse of malaria medication increases risks of miscarriages, deformity in early pregnancy – Gynaecologists
Chijioke Iremeka
Using certain medications to treat malaria in pregnancy causes permanent deformity in foetuses, gynaecologists warn, stressing that using antimalarial drugs must be done under the supervision of a qualified physician.
They noted that untreated malaria causes miscarriages and complications in early pregnancy and that treating the disease must be done under the supervision of qualified medical personnel.
The specialists said since the first trimester is the time of organogenesis, wrong medications at this stage may leave the baby with permanent deformity and other serious medical conditions if miscarriage does not happen.
According to the University of Virginia School of Medicine, United States of America, organogenesis is the process of the formation of organs of the body from three germ layers, during which the organs of the foetus are formed.
“Organogenesis concerns cell-cell interaction, cell fate determination, cell proliferation and survival, cell and tissue shape and size, and arrangement of cells into tissues and ultimately functional organs,” it stated.
Speaking exclusively with PUNCH Healthwise in different interviews, the experts said while malaria can lead to miscarriages, wrong use of antimalarials for treatment in early pregnancy may also lead to permanent deformity.
A Consultant Obstetrician and Gynaecologist at the Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Dr Babatunde Rosiji said malaria can adversely affect pregnancy in all trimesters of pregnancy.
The expert, who is also the Chief Medical Director, State Specialist Hospital, Ikole Ekiti, said it is well documented that malaria is a confirmed cause of pregnancy losses or abortion in the first trimester.
He said, “We also know that in the first trimester, especially the very first eight weeks in the first trimester, which we call embryogenesis, is when the main organs of the body have their foundation laid down.
“So, we have to be very careful about the drugs we use in the treatment of malaria in the first trimester. But during this period, you need to be sure whether you are dealing with malaria or symptoms of pregnancy because sometimes, they share the same symptoms like vomiting.
“So, we need a laboratory assessment to be sure of what we are dealing with. When we are sure, then we can make the choice of medication. Drugs including water are a potential poison when not taken in the right proportion.
“So, for any drug we use, we must ascertain its safety. We look at the risk-benefit ratio of the drug and ensure that the benefits outweigh the risks of. Malaria, if untreated. It will not only lead to loss of pregnancy but also affect the woman adversely.”
Rosiji stated that due to this, physicians always look out for the risk-benefit ratio of the drugs to determine what should be given, saying that artemisinin-based combination therapy is usually recommended.
He, however, noted that there is a high theoretical concern that these drugs should be avoided, saying “This is why we tell women once they miss their period; they should go to the hospital.”
The Chairman, Nigerian Medical Association Southwest Zone said, “When the benefits outweigh the risks, we begin treatment with those drugs.
“Another drug people talk about is quinine, a major drug we consider during trimester but it has its side effects too. So, if you miss your period, go see your doctor; if you feel sick, go to an approved hospital and let the physician review and determine the next line of action for you.
“We also serve a note of caution to the citizens that it is cheaper to go to the hospital than to self-medication. The attitude of self-medication is bad.”
He warned that pregnant women may be harming their foetuses, especially when they are ignorant of their pregnancy.
Rosiji also noted that drugs like tetracycline may cause permanent damage to the foetus, insisting that foetuses are being harmed when there is self-medication.
He advised pregnant women who mistakenly take the wrong medication that may put their babies at risk of deformity to visit the hospital immediately.
“The physicians will take the medication history and assess the risk on an individual basis. This will bring about greater foetal surveillance.
“There will be some series of tests to be conducted on the foetus to know the impact of the medication on its organs and this will result in a clinical decision,” Rosiji added.
Also speaking, a Consultant Obstetrician and Gynaecologist at the Niger Delta University Teaching Hospital, Bayelsa State, Dr Judiet Ugbechie, said physicians are very careful when prescribing antimalarials during the first trimester of pregnancy, especially during the first eight weeks.
She said, “This period of organogenesis is when the organs of the baby are being formed and any wrong medication will lead to either miscarriage or deformity.
“We don’t give medications during this stage. We try to manage malaria till the end of the first trimester and begin the treatment to avoid complications.
“However, when the malaria becomes severe enough that the baby and mother are threatened, we can then commence treatment with some special medications.”
In a study to assess the effects of malaria and its treatment in the first trimester of pregnancy, published in the National Library of Medicine by R. McGready and his team, the authors stated that malaria in pregnancy is a major cause of maternal mortality and low birth weight, which predisposes to neonatal mortality.
The research titled, ‘Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: A population-based study,’ indicates that drug safety concerns still restrict the recommended treatment for falciparum malaria in the first trimester to a seven-day course of quinine.
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