Insecticide-treated nets for the prevention of malaria in pregnancy: a systematic review of randomised controlled trials.
BACKGROUND
Protection from malaria with insecticide-treated bednets (ITNs) during pregnancy is widely advocated, but evidence of benefit has been inconsistent. We undertook a systematic review of randomised trials.


RESULTS
Three cluster-randomised and two individually randomised trials met the inclusion criteria; four from Africa (n = 6,418) and one from Thailand (n = 223). In Africa, ITNs compared to no nets increased mean birth weight by 55 g (95% confidence interval [CI] 21-88), reduced low birth weight by 23% (relative risk [RR] 0.77, 95% CI 0.61-0.98), and reduced miscarriages/stillbirths by 33% (RR 0.67, 0.47-0.97) in the first few pregnancies. Placental parasitaemia was reduced by 23% in all gravidae (RR 0.77, 0.66-0.90). The effects were apparent in the cluster-randomised trials and the one individually randomised trial in Africa. The trial in Thailand, which randomised individuals to ITNs or untreated nets, showed reductions in anaemia and fetal loss in all gravidae, but not reductions in clinical malaria or low birth weight.


CONCLUSIONS
ITNs used throughout pregnancy or from mid-pregnancy onwards have a beneficial impact on pregnancy outcome in malaria-endemic Africa in the first few pregnancies. The potential impact of ITNs in pregnant women and their newborns in malaria regions outside Africa requires further research.
Gamble
Carol
C
Centre for Medical Statistics and Health Evaluation, University of Liverpool, Liverpool, United Kingdom.
Ekwaru
Paul J
PJ
Garner
Paul
P
ter Kuile
Feiko O
FO
D000349:Africa; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage; D001512:Bedding and Linens; D005260:Female; D006801:Humans; D007306:Insecticides / Q000008:administration & dosage*; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*; D009570:Nitriles / Q000008:administration & dosage*; D026023:Permethrin / Q000008:administration & dosage*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011722:Pyrethrins / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D013785:Thailand
D000962:Antimalarials; D007306:Insecticides; D009570:Nitriles; D011722:Pyrethrins; D026023:Permethrin; C052570:cyfluthrin