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Treatment with anthelminthics during pregnancy: what gains and what risks for the mother and child?

  • ALISON M. ELLIOTT (a1) (a2), JULIET NDIBAZZA (a1), HARRIET MPAIRWE (a1), LAWRENCE MUHANGI (a1), EMILY L. WEBB (a2), DENNISON KIZITO (a1), PATRICE MAWA (a1), ROBERT TWEYONGYERE (a3) and MOSES MUWANGA (a4)
  • DOI: http://dx.doi.org/10.1017/S0031182011001053
  • Published online: 03 August 2011
Abstract
SUMMARY

In 1994 and 2002, respectively, the World Health Organisation proposed that treatment for hookworm and schistosomiasis could be provided during pregnancy. It was hoped that this might have benefits for maternal anaemia, fetal growth and perinatal mortality; a beneficial effect on the infant response to immunisation was also hypothesised. Three trials have now been conducted. Two have examined the effects of benzimidazoles; one (the Entebbe Mother and Baby Study) the effects of albendazole and praziquantel. All three were conducted in settings of high prevalence but low intensity helminth infection. Results suggest that, in such settings and given adequate provision of haematinics, the benefit of routine anthelminthics during pregnancy for maternal anaemia may be small; none of the other expected benefits has yet been demonstrated. The Entebbe Mother and Baby Study found a significant adverse effect of albendazole on the incidence of infantile eczema in the whole study population, and of praziquantel on the incidence of eczema among infants of mothers with Schistosoma mansoni. Further studies are required in settings that differ in helminth species and infection intensities. Further research is required to determine whether increased rates of infantile eczema translate to long-term susceptibility to allergy, and to explore the underlying mechanisms of these effects. The risks and benefits of routine anthelminthic treatment in antenatal clinics may need to be reconsidered.

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Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <http://creativecommons.org/licenses/by-nc-sa/2.5/>. The written permission of Cambridge University Press must be obtained for commercial re-use.
Corresponding author
Corresponding author: Alison M. Elliott, MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda. Tel: +256 752 720609; Fax: +256 414 321137; E-mail: alison.tom@infocom.co.ug
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