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COCHRANE REVIEW: DEWORMING DURING PREGNANCY

Thursday, 30th of August 2012

COCHRANE REVIEW: DEWORMING DURING PREGNANCY

Effect of administration of antihelminthics for soil transmitted helminths during pregnancy

Note to readers: Is it time to update this review, last updated to September 2008?

Haider BA, Humayun Q, Bhutta ZA

Published Online: April 15, 2009

Intestinal worms (helminths) contribute to iron deficiency anaemia as they feed on blood and cause further bleeding by releasing anticoagulant compounds. They also affect the supply of nutrients and cause anorexia, vomiting and diarrhoea. Pregnancy complicated by maternal hookworm infection poses a serious threat to the health of mothers and their babies, especially in developing countries. Women who are anaemic during pregnancy are more likely to have ill health, give birth prematurely, and have low birthweight babies with low iron reserves. Antihelminthic drugs are highly effective and have minimal side-effects but information on their use during pregnancy is limited. The major concern is that the drugs may cause malformation of the fetus (teratogenic effects).

The review authors found only three randomised controlled trials evaluating the impact of giving a single antihelminth treatment in the second trimester of pregnancy. The studies were conducted in Sierra Leone, Peru and Entebbe Uganda. A total of 1329 women were randomly assigned to receive a single dose of albendazole or mebendazole, or a placebo. In one study, and a subset of another, the women were also given a daily iron or iron-folate supplement. Analysis of the impact of antihelminth intervention on maternal anaemia including all results showed that the intervention was not associated with any clear impact on maternal anaemia or on low birthweight, perinatal deaths or preterm births. Analysis of studies in which iron or iron-folate was also given to pregnant women along with antihelminths also failed to show any impact on maternal anaemia. The impact on infant survival at six months of age could not be evaluated because data were not available. Evidence provided so far from randomised controlled trials is, therefore, insufficient to recommend use of antihelminthics for pregnant women after the first trimester of pregnancy.

Background:

Helminthiasis is infestation of the human body with parasitic worms and it is estimated to affect 44 million pregnancies, globally, each year. Intestinal helminthiasis is associated with blood loss and decreased supply of nutrients for erythropoiesis, resulting in iron deficiency anaemia. Over 50% of the pregnant women in low- and middle-income countries suffer from iron deficiency anaemia. Though iron deficiency anaemia is multifactorial, hook worm infestation is a major contributory cause in women of reproductive age in endemic areas. Antihelminthics are highly efficacious in treating hook worm but evidence of their beneficial effect and safety, when given during pregnancy, has not been established.

Objectives:

To determine the effects of administration of antihelminthics for soil transmitted helminths during the second or third trimester of pregnancy on maternal anaemia and pregnancy outcomes.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2008).

Selection criteria:

All prospective randomised controlled trials evaluating the effect of administration of antihelminthics during the second or third trimester of pregnancy.

Data collection and analysis:

Two review authors independently assessed trial quality and extracted the data.

Main results:

Three studies (1329 women) were included in this review. Analysis showed that administration of a single dose of antihelminth in the second trimester of pregnancy is not associated with any impact on maternal anaemia in the third trimester (risk ratio (RR) 0.90; 95% confidence interval (CI) 0.68 to 1.19, random effects (2 studies, n = 1075)). Subgroup analysis on the basis of co-interventions other than antihelminthics which included iron supplementation given to both groups in the study by Larocque et al, and a subset of the study by Torlesse et al, showed that a single dose of antihelminth along with iron supplementation throughout the second and third trimester of pregnancy was not associated with any impact on maternal anaemia in the third trimester as compared to iron supplementation alone (RR 0.76; 95% CI 0.39 to 1.45, random-effects (2 studies, n = 1017)). No impact was found for the outcomes of low birthweight (RR 0.94; 95% CI 0.61 to 1.42 (1study; n = 950)), perinatal mortality (RR 1.10; 95% CI 0.55 to 2.22 (2 studies, n = 1089)) and preterm birth (RR 0.85; 95% CI 0.38 to 1.87 (1 study, n = 984)). Impact on infant survival at six months of age could not be evaluated because no data were available.

Authors' conclusions:

The evidence to date is insufficient to recommend use of antihelminthics for pregnant women after the first trimester of pregnancy. More well-designed, large scale randomised controlled trials are needed to establish the benefit of antihelminthic treatment during pregnancy.

This record should be cited as:

Haider BA, Humayun Q, Bhutta ZA. Effect of administration of antihelminthics for soil transmitted helminths during pregnancy. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD005547. DOI: 10.1002/14651858.CD005547.pub2

Assessed as up to date:

September 30, 2008