Drugs for preventing malaria in pregnant women
Abstract
Background
Malaria contributes to maternal illness and anaemia in pregnancy, especially in first‐time mothers, and can harm the mother and the baby. Drugs given routinely to prevent or mitigate the effects of malaria during pregnancy are often recommended.
Objectives
To assess drugs given to prevent malaria infection and its consequences in pregnant women living in malarial areas. This includes prophylaxis and intermittent preventive treatment (IPT).
Search methods
We searched the Cochrane Infectious Diseases Group Specialized Register (March 2006), CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to March 2006), EMBASE (1974 to March 2006), LILACS (1982 to March 2006), and reference lists. We also contacted researchers working in the field.
Selection criteria
Randomized and quasi‐randomized controlled trials comparing antimalarial drugs given regularly with no antimalarial drugs for preventing malaria in pregnant women living in malaria‐endemic areas.
Data collection and analysis
Both authors extracted data and assessed methodological quality. Dichotomous variables were combined using relative risks (RR) and mean differences (MD) for mean values, both with 95% confidence intervals (CI).
Main results
Sixteen trials (12,638 participants) met the inclusion criteria; two used adequate methods to conceal allocation. Antimalarials reduced antenatal parasitaemia when given to all pregnant women (RR 0.53, 95% CI 0.33 to 0.86; 328 participants, 2 trials), placental malaria (RR 0.34, 95% CI 0.26 to 0.45; 1236 participants, 3 trials), but no effect was detected with perinatal deaths (2890 participants, 4 trials). In women in their first or second pregnancy, antimalarial drugs reduced severe antenatal anaemia (RR 0.62, 95% CI 0.50 to 0.78; 2809 participants, 1 prophylaxis and 2 IPT trials), antenatal parasitaemia (RR 0.27, 95% CI 0.17 to 0.44, random‐effects model; 2906 participants, 6 trials), and perinatal deaths (RR 0.73, 95% CI 0.53 to 0.99; 1986 participants, 2 prophylaxis and 1 IPT trial; mean birthweight was higher (MD 126.70 g, 95% CI 88.64 to 164.75 g; 2648 participants, 8 trials), and low birthweight less frequent (RR 0.57, 95% CI 0.46 to 0.72; 2350 participants, 6 trials).
Proguanil performed better than chloroquine in one trial of women of all parities in relation to maternal fever episodes. Sulfadoxine‐pyrimethamine performed better than chloroquine in two trials of low‐parity women.
Authors' conclusions
Chemoprophylaxis or IPT reduces antenatal parasite prevalence and placental malaria when given to women in all parity groups. They also have positive effects on birthweight and possibly on perinatal death in low‐parity women.
PICOs
Plain language summary
Drugs for pregnant women to prevent malaria‐related illness for them and their babies
Malaria is a parasitic disease spread by mosquitoes. It affects millions of people worldwide and causes illness and mortality. Uncomplicated malaria has symptoms such as fever, headache, muscle pain, and vomiting, and children commonly present with rapid breathing or cough. Severe malaria causes unconsciousness and death. Women living in malarial areas and who are pregnant for the first or second time are more likely to become infected with malaria. This brings severe anaemia causing weakness and tiredness for the mother, and slows the growth of the baby. The review of trials assessed whether giving drugs on a regular basis to prevent malaria would have advantages in terms of health gains for the mother and baby, as this has to be balanced against drug adverse effects, and against risks of the malaria parasite developing resistance to these drugs. The review found seven trials looking at drugs given to all pregnant women where there was no benefit identified for either mother or baby. The review also found six trials involving 2495 pregnant women having their first or second babies. Drugs, like chloroquine, pyrimethamine, proguanil, and mefloquine, given routinely to women in their first or second pregnancy, reduced the number of women with severe anaemia in pregnancy. They were also associated with higher birthweight in the baby and probably fewer perinatal deaths. It was not possible to assess any potential impact on drug resistance.
