title: Treatment with anthelminthics during pregnancy: what gains and what risks for the mother and child?
abstract: 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.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda. alison.tom@infocom.co.ug
authors.forename: Alison M
authors.initials: AM
authors.lastname: Elliott
authors.forename: Juliet
authors.initials: J
authors.lastname: Ndibazza
authors.forename: Harriet
authors.initials: H
authors.lastname: Mpairwe
authors.forename: Lawrence
authors.initials: L
authors.lastname: Muhangi
authors.forename: Emily L
authors.initials: EL
authors.lastname: Webb
authors.forename: Dennison
authors.initials: D
authors.lastname: Kizito
authors.forename: Patrice
authors.initials: P
authors.lastname: Mawa
authors.forename: Robert
authors.initials: R
authors.lastname: Tweyongyere
authors.forename: Moses
authors.initials: M
authors.lastname: Muwanga
mesh_terms: D015766:Albendazole / Q000009:adverse effects / Q000627:therapeutic use; D000723:Ancylostomatoidea / Q000187:drug effects; D000740:Anemia / Q000469:parasitology; D000818:Animals; D000871:Anthelmintics / Q000009:adverse effects / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use; D001724:Birth Weight / Q000187:drug effects; D002648:Child; D003876:Dermatitis, Atopic / Q000139:chemically induced; D004311:Double-Blind Method; D005260:Female; D006725:Hookworm Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D054238:Perinatal Mortality; D011223:Praziquantel / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy*; D011256:Pregnancy Outcome; D015995:Prevalence; D012550:Schistosoma mansoni / Q000187:drug effects; D012555:Schistosomiasis mansoni / Q000188:drug therapy*; D016896:Treatment Outcome; D014454:Uganda
chemical_list: D000871:Anthelmintics; D001562:Benzimidazoles; D011223:Praziquantel; C031000:benzimidazole; D015766:Albendazole