There is even less data for praziquantel and, in 2005, a World Health Organization working group called for placebo-controlled trials of praziquantel during pregnancy.
HOOKWORMS IN HUMANS PREGNANT TRIAL
Observational studies of mebendazole during pregnancy in Sri Lanka and albendazole in Nepal suggested a benefit for birth weight and for infant survival, but the Peru trial showed no effect of mebendazole on these outcomes, except for the rare outcome of very low birth weight. A benefit of albendazole for maternal anemia in a small study in Sierra Leone where albendazole and iron-folate supplementation were examined in a factorial design was not confirmed by a larger trial of mebendazole in Peru, in which all women received iron supplements. Recommendations of benzimidazoles during pregnancy are supported by a small number of studies, and the results reported are inconclusive. Therefore, in 1994, the World Health Organization recommended the treatment of hookworm during pregnancy in areas where hookworm is endemic, and in 2002, it recommended the use of praziquantel during pregnancy in areas where schistosomiasis is endemic, in addition to evaluation of birth outcomes. Moreover, detrimental effects of helminths on maternal anemia, fetal growth, and infant mortality have been suggested. Previously, deworming has been avoided during pregnancy and lactation because of safety concerns however, in areas where women are pregnant or lactating for over half of their reproductive lives, this may result in treatment delays and morbidity. Two billion people are estimated to be infected with schistosomes and geohelminths, and mass deworming programs are widely advocated. The possible benefit of albendazole against anemia in pregnant women with heavy hookworm infection warrants further investigation. Anthelminthic use during pregnancy showed no effect on perinatal mortality or congenital anomalies.Ĭonclusions.In our study area, where helminth prevalence was high but infection intensity was low, there was no overall effect of anthelminthic use during pregnancy on maternal anemia, birth weight, perinatal mortality, or congenital anomalies. There was no effect of either anthelminthic treatment on mean birth weight (difference in mean associated with albendazole: −0.00 kg 95% CI, −0.05 to 0.04 kg difference in mean associated with praziquantel: −0.01 kg 95% CI, −0.05 to 0.04 kg) or on proportion of low birth weight. At delivery, 35% were anaemic there was no overall effect of albendazole (odds ratio, 0.95 95% confidence interval, 0.79–1.15) or praziquantel (OR, 1.00 95% CI, 0.83–1.21) on maternal anemia, but there was a suggestion of benefit of albendazole among women with moderate to heavy hookworm (OR, 0.45 95% CI, 0.21–0.98 P=.15 for interaction). Results.At enrollment, 68% of women had helminths, 45% had hookworm, 18% had Schistosoma mansoni infection 40% were anemic (hemoglobin level, <11.2 g/dL). Maternal and perinatal outcomes were recorded. Hematinics and sulphadoxine-pyrimethamine for presumptive treatment of malaria were provided routinely. Methods.In Entebbe, Uganda, 2507 pregnant women were recruited to a randomized, double-blind, placebo-controlled trial investigating albendazole and praziquantel in a 2×2 factorial design. Deworming during pregnancy has therefore been strongly advocated, but its benefits have not been rigorously evaluated. Background.Helminth infections during pregnancy may be associated with adverse outcomes, including maternal anemia, low birth weight, and perinatal mortality.