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J Travel Med. 2019 Oct 23. pii: taz079. doi: 10.1093/jtm/taz079. [Epub ahead of print]

Treatment of Soil-Transmitted Helminth Infections in Pregnancy: A Systematic Review and Meta-Analysis of Maternal Outcomes.

Author information

1
Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada.
2
Department of Medicine, NorthShore University Health System, Evanston, USA.
3
Department of Microbiology and Immunology, University of Ottawa, Ottawa, Canada.
4
Tropical Disease Unit, Toronto General Hospital, Toronto, Canada.
5
School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Canada.
6
Department of Psychology, University of Toronto, Canada.
7
Faculty of Medicine, University of Toronto, Toronto, Canada.
8
Department of Microbiology and Immunology, Western University, London, Canada.
9
Department of Science Education, Faculty of Education and Humanities, Suleyman Demirel University, Almaty, Kazakhstan.
10
Department of Biology, School of Science and Technology, Nazarbayev University, Astana, Kazakhstan.
11
Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada.
12
Department of Medicine, University of Toronto, Toronto, Canada.

Abstract

BACKGROUND:

Gestational helminth infections are correlated to adverse outcomes including maternal anemia; as such, treatment is recommended. However, little published high-quality data exist around the efficacy, safety, and tolerability of anti-helminthics in pregnancy. We therefore conducted a systematic review and synthesized the available data on maternal outcomes following gestational treatment of intestinal nematodes to help guide clinical decision-making.

METHODS:

Five electronic databases were searched for studies reporting the efficacy, safety, or tolerability of anti-helminthic drugs for gestational treatment of intestinal nematodes. Studies were systematically screened, followed by data extraction. Trial quality was assessed using the GRADE approach. We conducted a narrative synthesis followed by meta-analyses using random-effects models as appropriate. Data were summarized using qualitative and quantitative measures for specific parasitic infections as well as efficacy and safety of anti-parasitic agents. Outcomes of interest included: maternal anemia, minor adverse outcomes, pregnancy loss, pre-mature delivery, prevalence of infection, and cure rate.

RESULTS:

23 studies were included. Gestational treatment with albendazole had cure rates up to 90% for hookworm and Ascaris, but only 50% for Trichuris. Mebendazole had an overall cure rate of ≤70% for Ascaris, hookworm, and Trichuris. Pooled relative risk reduction of hookworm prevalence at delivery with albendazole compared to placebo was 90% (95%CI 0.09-0.15, n=2, I2=0%). Rate of pregnancy loss and hemoglobin concentration did not differ between albendazole or mebendazole versus placebo, and rates of pre-term delivery were similar in albendazole-treated pregnant women versus controls. Ivermectin demonstrated a cure rate of 29% for hookworm and 56% for Trichuris in pregnant women. No serious adverse events were attributable to any drug studied.

CONCLUSIONS:

With increased international travel and migration of vulnerable populations, practitioners will encounter nematode infections in pregnant patients. Our analysis supports that albendazole in pregnancy has high cure rates for STHs and is safe for the mother.

KEYWORDS:

Ascaris ; Enterobius ; Strongyloides ; Trichuris ; Albendazole; hookworm; ivermectin; mebendazole; pregnancy; soil transmitted helminth

PMID:
31641774
DOI:
10.1093/jtm/taz079

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