Prevention versus treatment for malaria in pregnant women

Abstract

Objectives: Malaria contributes to antenatal anaemia and slowing of fetal growth, especially in first-time mothers. It is thought that these effects harm the mother and baby, and interventions to prevent or mitigate the effects of malaria are often recommended. The objective of this review was to assess the effects of anti-malarial interventions in pregnant women living in malarial areas on the mother and the infant.

Search strategy: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase. We contacted researchers in the field.

Selection criteria: Randomised and quasi-randomised trials in pregnant women of interventions that aim to mitigate the effects of malaria in pregnancy, including drugs given routinely and mosquito control measures.

Data collection and analysis: Trial quality was assessed. Data extraction was done by two reviewers using standard criteria.

Main results: Fifteen trials were included. Drugs given regularly and routinely were associated with fewer episodes of fever in the mother, fewer women with severe anaemia antenatally, and higher average birthweight in infants. These effects appear to be greater in primigravidae. No difference in perinatal, neonatal and infant mortality were detected in studies of prophylaxis in all parity groups, or studies confined to women of low parity.

Reviewer's conclusions: Drugs locally effective for malaria when given routinely for malaria during pregnancy may reduce the incidence of low birth weight and anaemia. This effect appears to be limited to low parity women. Given the costs and inputs required to effectively deliver widescale prophylaxis programmes, we believe a large simple placebo- controlled trial testing the impact of drugs given routinely on pregnancy outcome and neonatal/infant survival is warranted.