Drugs for preventing malaria-related illness in pregnant women and death in the newborn.
Background: Malaria contributes to maternal illness and anaemia in pregnancy, especially in first-time mothers, and could harm the mother and the baby. Interventions 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.
Search strategy: We searched the Cochrane Infectious Diseases Group trials register (July 2002); the Cochrane Controlled Trials Register (Issue 3, 2002); MEDLINE (1966-July 2002); EMBASE (1974-July 2002); and LILACS (accessed July 2002). We contacted researchers in the field.
Selection criteria: Randomised and quasi-randomised trials in pregnant women of drugs given regularly that aim to mitigate the effects of malaria in pregnancy.
Main results: 14 trials included, reporting on 8768 women. Only 2 trials were adequately concealed. For women of all parity groups, antenatal and placental parasitaemia tended to be lower in the intervention arm in studies reporting this. There is no evidence for a trend in perinatal death (RR 1.02, 95% CI 0.73 to 1.43, 4 studies, n=2890). Nine studies reported women having the first or second baby. In the intervention groups, severe antenatal anaemia was less common (RR 0.62, 95%CI 0.50 to 0.78, 4 studies, n=2809) and maternal parasitaemia lower (RR 0.24, 95%CI 0.14 to 0.42, random effects model, 6 studies, n=2495). In the infant, no effect on stillbirth was detected (RR 0.87, 95%CI 0.62 to 1.21); there were fewer perinatal deaths (RR 0.73, 95% CI 0.53 to 0.99, 3 studies, n=1986). Mean birthweight was higher (WMD 122.62 g, 95% CI 81.49 to 163.75 g, 8 studies, n=2245), and low birthweight less common (RR 0.55, 95%CI 0.43 to 0.70 , 6 studies, n=1947).
Authors' conclusions: Drugs given routinely for malaria during pregnancy reduce severe antenatal anaemia in the mother, and are associated with higher birthweight in the baby and probably fewer perinatal deaths. This effect appears to be limited to low parity women.
The Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD000169. DOI: 10.1002/14651858.CD000169.