Malaria in Pregnancy Scientific Group

The Malaria in Pregnancy (MiP) Consortium is working in partnership with WWARN to track the severity and spread of antimalarial drug resistance and develop a better understanding of the impact of drug resistance on the efficacy of intermittent preventive treatment (IPT) strategies to control malaria in pregnancy. The group will also collate data on the efficacy, tolerability, safety and pharmacokinetic properties of antimalarial medicines used both for prevention of malaria and treatment during pregnancy. 

Overview

The Malaria in Pregnancy (MiP) Consortium is working in partnership with WWARN to track the severity and spread of antimalarial drug resistance and develop a better understanding of the impact of drug resistance on the efficacy of intermittent preventive treatment (IPT) strategies to control malaria in pregnancy. The group will also collate data on the efficacy, tolerability, safety and pharmacokinetic properties of antimalarial medicines used both for prevention of malaria and treatment during pregnancy.  Our aim is to ensure that all pregnant women receive effective chemoprevention (prophylaxis) to prevent malaria and, if needed, receive safe and effective treatment at the appropriate dose level.Together we will gather individual patient data (IPD) from completed clinical trials, facilitate pooled analyses (IPD meta-analyses), and ask valuable research questions to support the creation of evidence-driven pregnancy treatment and prevention policies and programmes.  

The Consortium develops projects within four key research areas:

  • Burden - Obtain a better understanding of the burden of malaria in pregnancy in regions outside Africa where malaria is common but less is known than for Africa;
  • Treatment - Further evaluate which of the new generation of antimalarial drugs can be used safely and effectively for the treatment of pregnant women with malaria in Africa, Asia and Latin America;
  • Prevention - Identify safe alternative antimalarials for the prevention of malaria in pregnancy in Africa to replace the commonly used antimalarial drug sulphadoxine-pyrimethamine – a treatment which many malaria parasites have developed resistance to;
  • Health impact - Establish the best way to increase the coverage and utilisation of existing strategies to control malaria in pregnancy.

The MiP Consortium is working in partnership with WWARN to develop a MiP programme on the WWARN platform. This partnership will enable the pooled analysis of the MiP data sets to support the creation of evidence-driven policies and programmes. This collaborative project will track the severity and spread of antimalarial drug resistance and develop a better understanding of the impact of resistance on the effectiveness of current prevention strategies during pregnancy.

Goals of the MiP Consortium partnership

Develop the evidence dossiers required for the WHO Evidence Review Group (ERG) committee meetings on malaria in pregnancy. The evidence will help to:

  • Understand the safety of a range of antimalarials used in all trimesters of pregnancy in Africa and Asia
  • Explore factors affecting malaria drug efficacy in pregnant women during second and third trimester in various endemic areas
  • Identify the modifying effects of sulfadoxine-pyrimethamine (SP) resistance and malaria transmission intensity on the clinical effectiveness of intermittent preventive treatment of malaria in pregnancy (IPTp) with SP.
  • Better define areas appropriate for the different drug-based control strategies based on prevailing levels of SP resistance and transmission intensity.
  • Understand the safety and efficacy of novel strategies for the control of malaria in pregnancy including IPTp with dihydroartemisinin-piperaquine (DP) and intermittent screening and treatment with artemether-lumefantrine (AL) 

Filling the research gaps

To deliver this, the group will:

  • Identify the data structures, variables, dictionaries and curation parameters needed to integrate data collected by the MiP Consortium, and other investigators outside of the consortium, and integrate this in the WWARN Data Repository
    • Provide a platform to host the Malaria in Pregnancy Library
    • Coordinate pooled analyses of clinical  data  through five collaborative Study Groups that will:
      • Conduct a meta-analysis of the effectiveness of IPTp with SP as function of the prevailing levels of drug resistance and produce a map demonstrating the impact of SP resistance on the effectiveness of IPTp-SP
      • Conduct a IPD meta-analysis of the safety and effectiveness of the novel strategies for the control of malaria in pregnancy including IPTp with DP and intermittent screening and treatment in pregnancy
      • Conduct a IPD meta-analysis of the safety of a range of antimalarials used in the first trimester of pregnancy in Africa and Asia
      • Conduct a IPD meta-analysis of the efficacy of a range of antimalarials used for treatment of malaria in all trimesters of pregnancy in Africa and Asia
      • Conduct IPD meta-analyses of the pharmacokinetic and pharmacodynamic properties of antimalarials, in order to provide evidence to help optimise antimalarial dosing in pregnant women 

Encouraging quality-assured data collection

  • Procedures and tools: step-by-step methods for conducting tests, for recording clinical observations used to investigate patient and parasite responses to malaria drugs, and for data collection, during pregnancy

For further information, please contact Jenny Hill jenny [dot] hill [at] lstmed [dot] ac [dot] uk