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BJOG 2011;118:123\u2013135.<\/jats:p><jats:p><jats:bold>Background\u2002<\/jats:bold> Pregnant women are at increased risk from malaria. Resistance to all classes of antimalarials has affected the treatment and prevention of malaria in pregnancy.<\/jats:p><jats:p><jats:bold>Objectives\u2002<\/jats:bold> To review the therapeutic efficacy of antimalarials used for treatment and intermittent preventive treatment (IPT) in pregnancy.<\/jats:p><jats:p><jats:bold>Search strategy\u2002<\/jats:bold> We searched MEDLINE and the Cochrane Library between January 1998 and December 2009 for publications using the medical subject headings: efficacy, antimalarials, malaria, pregnancy, pharmacokinetics, treatment, IPT and placenta positive. In May 2010 we searched the register of clinical trials (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\/\">http:\/\/clinicaltrials.gov\/<\/jats:ext-link>) and of WHO (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/apps.who.int\/trialsearch\/\">http:\/\/apps.who.int\/trialsearch\/<\/jats:ext-link>) using \u2018malaria\u2019, and \u2018pregnancy\u2019 and \u2018treatment\u2019.<\/jats:p><jats:p><jats:bold>Selection criteria\u2002<\/jats:bold> We identified 233 abstracts, reviewed 83 full text articles and included 60 studies.<\/jats:p><jats:p><jats:bold>Data collection and analysis\u2002<\/jats:bold> Two authors entered extracted data to an <jats:sc>excel<\/jats:sc> spreadsheet.<\/jats:p><jats:p><jats:bold>Main results\u2002<\/jats:bold> Parasitological failure rates, placenta positivity rates (assessed by microscopy) or both were reported in 44% (21\/48), 46% (22\/48) and 10% (5\/48) of articles, respectively. Most pharmacokinetic studies (9\/12) suggested dose optimisation. In 23 treatment studies 17 different antimalarial drugs were delivered in 53 study arms; 43.4% (23\/53) reported a failure rate of &lt;\u20035%; 83.3% of sulphadoxine\u2010pyrimethamine (SP) arms and 9% of artemisinin combination therapy (ACT) arms had failure rates \u2265\u200310%. Placenta\u2010positive rates (mostly reported in the context of IPT in pregnancy) were &gt;\u200310% in 68% (23\/34) of SP trial arms and &gt;\u200315% in all seven chloroquine arms. The ACT provided lower parasitological failure and gametocyte carriage rates.<\/jats:p><jats:p><jats:bold>Author\u2019s conclusions\u2002<\/jats:bold> Drugs used in pregnancy should aim for 95% efficacy but many currently deployed regimens are associated with much lower cure rates.<\/jats:p>","DOI":"10.1111\/j.1471-0528.2010.02810.x","type":"journal-article","created":{"date-parts":[[2010,12,15]],"date-time":"2010-12-15T12:53:28Z","timestamp":1292417608000},"page":"123-135","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Parasitological efficacy of antimalarials in the treatment and prevention of falciparum malaria in pregnancy 1998 to 2009: a systematic review"],"prefix":"10.1111","volume":"118","author":[{"given":"R","family":"McGready","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"NJ","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Nosten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2010,12,15]]},"reference":[{"key":"e_1_2_10_2_2","unstructured":"WHO.A strategic framework for malaria control during pregnancy in the african region: WHO Regional Office for Africa; 2004. 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