Drugs for preventing malaria in pregnant women

  • Review
  • Intervention

Authors

  • Paul Garner,

    Corresponding author
    1. Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK
    • Paul Garner, International Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK. pgarner@liv.ac.uk.

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  • A Metin Gülmezoglu

    1. World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
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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.

摘要

背景

孕婦預防瘧疾的藥物

瘧疾在孕婦上會促成母體疾病及貧血, 特別是在首次懷孕的母親,和可能傷害母親和嬰孩.藥物定期地被給予在懷孕期間經常被推薦來防止或緩和瘧疾的作用。

目標

估計對於居住在有瘧疾疫區的孕婦給予藥物防止瘧疾傳染和它的後果。這包括預防和斷續的預防治療(IPT) 。

搜尋策略

我們搜尋了Cochrane 傳染病小組專業專業登錄資料(2006,3月), CENTRAL (The Cochrane 圖書室 2006, 期號1), MEDLINE (1966 至 2006,3月), EMBASE (1974 至 2006,3月), LILACS (1982 至 2006,3月), 和參考目錄. 我們並且與服務在這領域的研究員聯繫.

選擇標準

以隨機化和quasi隨機化的受控試驗來比較對於居住於瘧疾地方性區域的孕婦給抗瘧疾藥物及沒有給抗瘧疾藥物之差異.

資料收集與分析

兩位作者提取資料和估計方法學質量.二分可變物被結合,使用相對風險(RR)和權重平均差(WMD) 為平均值, 兩者以95%為信賴區間(CI)。

主要結論

16個試驗(12,638 個參加者) 符合了包括標準;兩種使用適當的方法隱藏其分派.抗瘧疾藥物給所有孕婦減少了胎兒寄生蟲血症(相對風險 0.53, 95% 信賴區間0.33 至 0.86; 328 位參加者, 2 個試驗),胎盤瘧疾(相對風險 0.34, 95%信賴區間 0.26 至 0.45; 1236 位參加者, 3個試驗), 但在出生時期前後的死亡是沒有作用的(2890 個參加者, 4 個試驗).在婦女裡,在他們的第一次或第二次懷孕, 抗瘧疾藥物減少了嚴重胎兒貧血症(相對風險0.62, 95%信賴區間 0.50 至 0.78,2809 個參加者、1 個預防和2 個斷斷續續的預防治療試驗), 胎兒寄生蟲血症(相對風險 0.27, 95% 信賴區間 0.17 至 0.44, 隨機作用模式; 2906 位參加者, 6 個試驗), 和 出生時期前後的死亡(相對風險0.73, 95% 信賴區間 0.53 至 0.99; 1986 位參加者,2 個預防和1 個斷續的預防治療試驗),平均出生體重值是較高的 (重量平均差126.70 克, 95% 信賴區間88.64 至 164.75 克; 2648 位參加者, 8 個試驗),和低出生體重是較不頻繁(相對風險 0.57, 95%信賴區間 0.46 至 0.72; 2350 位參加者, 6 個試驗). Proguanil 執行比 chloroquine 較好在一個同等婦女相關於母體發燒事件的試驗裡. Sulfadoxinepyrimethamine 執行比chloroquine 較好 在兩個低同等婦女的試驗裡.

作者結論

化學預防法或IPT可減少胎兒寄生蟲流行和胎盤瘧疾當給所有同等婦女的小組。他們也有正面效果在出生嬰兒體重和可能在出生時期前後的死亡在低同等婦女。

翻譯人

本摘要由三軍總醫院陳佳宏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

藥物使孕婦防止與瘧疾相關的病症為他們和他們的嬰兒.瘧疾是一種寄生疾病由蚊子傳播.它影響成千上萬人全世界和導致病症和死亡。不複雜的瘧疾有症狀譬如發燒、頭疼, 肌肉痛,和嘔吐, 和孩子共同呈現以呼吸急促或咳嗽。嚴重瘧疾導致無意識和死亡。居住在瘧疾地區的婦女是懷孕在第一或第二次是較可能成為瘧疾的傳染。這帶來嚴重貧血症導致母親虛弱和疲倦, 和減慢嬰孩的成長.試驗回顧估計是否經常給予抗瘧疾藥物來防止瘧疾會有好處根據健康獲取為母親和嬰孩,如同這必須平衡在藥物的副作用,和瘧疾對這些抗瘧疾藥物產生抗藥性的風險。回顧發現七個試驗觀察藥物被給所有孕婦並沒有好處在母親或嬰孩。回顧並且發現六次試驗涉及2495 名孕婦有他們的第一個或第二個嬰孩。藥物, 像chloroquine, pyrimethamine, proguanil,和 mefloquine, 定期地被給婦女在他們的第一次或第二次懷孕,減少嚴重貧血數量在懷孕婦女。他們並且有更高的出生體重值在嬰兒上和可能較少的出生時期前後的死亡。它是不能估計對藥物抵抗性任何潛在的影響。

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.

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