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Evidence summaries

Drugs for Preventing Malaria-Related Illness in Pregnant Women and Death in the Newborn

Routine chemoprevention for malaria during pregnancy for low parity women appear to reduce severe antenatal anaemia and parasitaemia in the mother and increase birthweight. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 17 trials (14 481 women), of which only 6 were adequately concealed. Chloroquine (given weekly), pyrimethamine (weekly or monthly), proguanil (daily), pyrimethamine-dapsone (weekly or fortnightly), and mefloquine (weekly), or intermittent preventive therapy with sulfadoxine-pyrimethamine (given twice, three times or monthly) were evaluated against placebo or no intervention.

Antimalarials reduced placental parasitaemia (RR 0.54, 95% CI 0.43 to 0.69; 7 trials, n=2 830), increased mean birthweight by around 93 g (MD 92.72 g, 95% CI 62.05 to 123.39; 9 trials, n=3936), reduced low birthweight (RR 0.73, 95% CI 0.61 to 0.87; 8 trials, n=3619). Trials were underpowered to detect differences in perinatal deaths. In women in their first or second pregnancy, antimalarial drugs reduced severe antenatal anaemia by around 40% (RR 0.60, 95% CI 0.47 to 0.75; n=2503; 3 trials, high quality evidence) and the risk of any anaemia by around 17% (RR 0.83, 95% CI 0.74 to 0.93; 5 trials, n=3662), antenatal parasitaemia by around 61% (RR 0.39, 95% CI 0.26 to 0.58; 7 trials, n=3663, high quality evidence).

Comment: The quality of evidence is downgraded by limitations in study quality (e.g., inadequate or unclear allocation concealment and lack of blinding).

    References

    • Radeva-Petrova D, Kayentao K, ter Kuile FO et al. Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment. Cochrane Database Syst Rev 2014;(10):CD000169 [Review content assessed as up-to-date: 1 June 2014].[PubMed]

Primary/Secondary Keywords