5 The burden of disease that is associated with schisto- some and soil-transmitted helminth infections remains a massive health problem in developing countries. Ap- proximately 2 billion people are affected, and approxi- mately 300 million people have severe morbidity. The World Health Organization (WHO) estimated that these infections caused at least 40% of the burden of ill health from tropical diseases, excluding malaria. 1 In 1990, ap- proximately 44 million pregnancies were reckoned to be complicated by hookworm infections. 2 Impaired iron status, iron deficiency anemia, low birth weight, and neonatal and maternal deaths are some of the outcomes of hookworm infection during pregnancy. Currently, 85% of the 200 million people who are plagued by schis- tosomiasis live in Africa, 3 where 10 million women annu- ally have the infection during pregnancy. 4 Women in developing countries may be pregnant or lactating for as much as one half of their reproductive lives. 5 Excluding such women from treatment may have the effect of denying them treatment for years. Until re- cently, their exclusion from treatment against hookworm, schistosome, and other helminth infections resulted from a combination of understandable anxieties that were based on a lack of relevant information and a failure to carry out appropriate risk:benefit analyses about the use of anthelminthic drugs during pregnancy and lacta- tion. Key questions include whether pregnancy outcomes would improve if anthelminthic treatment were to be available for mothers, whether birth defect rates would increase if anthelminthic treatment were to be given dur- ing pregnancy, and whether breast-feeding infants could be affected adversely by their mothers having taken an- thelminthic drugs? Generally, praziquantel, a WHO-recommended drug, 6 has not been used to treat pregnant and lactating women who were infected with schistosomes. Similarly, adolescent girls have not been treated in case they were pregnant. Health professionals have been reluctant to treat although these blood flukes impair growth and fitness, exacerbate the appearance of iron deficiency and anemia, and in the case of schistosomiasis haematobium, cause genital lesions in about a one third of the infected women. 7 Recent evi- dence suggests that female genital schistosomiasis may fa- cilitate the spread of the human immunodeficiency virus. 8 This reluctance stems from the fact that answers to ques- tions, such as those posed earlier, were not available. Praziquantel was released by Bayer AG (Leverkusen, Germany) in 1979 after mandatory toxicologic tests and trials. Despite little reason to indicate any potential ad- verse effects on pregnancy, praziquantel was not tested on pregnant and lactating women before its release. 8 Ac- cordingly, praziquantel was classified as a pregnancy cate- gory B drug, which should be presumed to be safe on the basis of animal studies but should be used with caution during pregnancy. The prescribing advice during lacta- tion was to cease breast-feeding for up to 72 hours after treatment to avoid any possible toxicity to the infant. Such advice was impractical; food cannot be withheld from infants for such a long period. The practice of excluding women (and adolescents) of childbearing age from drug safety trials has led to unwar- ranted restrictions on the treatment of those women who might be pregnant. Women must be protected from un- necessary exposure to the deleterious effects of chemo- therapy, but they should not be denied treatment without sound reason. The situation concerning schistosomiasis, pregnancy, and lactation has now been addressed by a meeting of experts held at the WHO in Geneva in April 2002. After reviewing two decades of clinical experience with praziquantel and examining new data and the re- sults of an extensive risk/benefit analysis, the experts rec- ommended that, in areas where schistosomiasis is endemic, all pregnant and lactating women should be considered as a high-risk group and that treatment should be available for them either individually or during wider campaigns to reduce and control morbidity. 4 In this issue of the American Journal of Obstetrics and Gy- necology, Diav-Citrin and colleagues present the results of a prospective study into the use of mebendazole in 192 pregnant women who were infected with Enterobius ver- micularis. 9 This is the first report of the use of this drug during pregnancy against an irritating helminthiasis that From Communicable Diseases Control, Prevention, and Eradication, World Health Organization, a and the World Health Organization Col- laborating Centre for Soil-transmitted Helminthiases, University of Glas- gow. b Received for publication September 20, 2002; accepted October 2, 2002. Reprint requests: Lorenzo Savioli, MD, Parasitic Diseases and Vector Control, Communicable Diseases Control, Prevention, and Eradication, World Health Organization, 1211, Geneva, 27, Switzerland. E-mail: [email protected] Am J Obstet Gynecol 2003;188:5-6. © 2003, Mosby, Inc. All rights reserved. 0002-9378/2003 $30.00 + 0 doi:10.1067/mob.2003.78 Use of anthelminthic drugs during pregnancy Lorenzo Savioli, MD, a D. W. T. Crompton, OBE, b and Maria Neira, MD a Geneva, Switzerland, and Glasgow, United Kingdom
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Related Documents
