The effects of quinine and chloroquine antimalarial treatments in the first trimester of pregnancy

Quinine (n = 246) was used to treat uncomplicated Plasmodium falciparum and chloroquine (n = 130) was used to treat P. vivax, in a total of 376 episodes of malaria in the first trimester of pregnancy, in 300 Karen women (Thailand 1995–2000). Parasites were still present on day 6 or 7 in 4·7% (11/234) of episodes treated with quinine. The overall 28 day parasite reappearance rate following quinine was 28·7% (60/209) for primary treatments and 44% (11/25) for re-treatments. Quinine treatment resulted in a high rate of gametocyte carriage: person-gametocyte-weeks = 42·5 (95% CI 27·8–62·1) per 1000 woman-weeks. For P. vivax, the reappearance rate for all episodes by day 28 was 4·5% (5/111). Significantly more women complained of tinnitus following quinine treatment compared to on admission: 64·5% (78/121) vs 31·6% (59/187), P < 0·001. Using survival analysis, the community rate of spontaneous abortion in women who never had malaria in pregnancy, 17·8% (16·5–19·0), did not differ significantly from rates in women treated with quinine: 22·9% (95% CI 15·5–30·3), or chloroquine: 18·3% (95% CI 9·3–27·3), P = 0·42. Pregnancies exposed to quinine or chloroquine and carried to term did not have increased rates of congenital abnormality, stillbirth or low birthweight. These results suggest that therapeutic doses of quinine and chloroquine are safe to use in the first trimester of pregnancy.