Effects of Deworming during Pregnancy on Maternal and Perinatal Outcomes in Entebbe, Uganda: A Randomized Controlled Trial

Two billion people are estimated to be infected with schistosomes and geohelminths, and mass deworming programs are widely advocated [1]. Previously, de-worming has been avoided during pregnancy and lactation because of safety concerns; however, in areas where women are pregnant or lactating for over half of their reproductive lives, this may result in treatment delays and morbidity [2]. Moreover, detrimental effects of helminths on maternal anemia, fetal growth, and infant mortality have been suggested [2-4]. Therefore, in 1994, the World Health Organization recommended the treatment of hookworm during pregnancy in [2] areas where hookworm is endemic, and in 2002, it recommended the use of praziquantel during pregnancy in areas where schistosomiasis is endemic, in addition to evaluation of birth outcomes [5]. Recommendations of benzimidazoles during pregnancy are supported by a small number of studies [6], and the results reported are inconclusive. A benefit of albendazole for maternal anemia in a small study in Sierra Leone where albendazole and iron-folate supplementation were examined in a factorial design [7] was not confirmed by a larger trial of mebendazole in Peru, in which all women received iron supplements [8]. Observational studies of mebendazole during pregnancy in Sri Lanka [9] and albendazole in Nepal [3] suggested a benefit for birth weight and for infant survival, but the Peru trial showed no effect of mebendazole on these outcomes, except for the rare outcome of very low birth weight [8]. There is even less data for praziquantel and, in 2005, a World Health Organization working group called for placebo-controlled trials of praziquantel during pregnancy [10]. Therefore, in a large placebo-controlled trial of albendazole and praziquantel during pregnancy in Uganda (ISRCTN32849447; designed to address effects on immune responses and disease susceptibility in offspring [11]), we examined important additional outcomes: maternal anemia, birth weight, perinatal death, and congenital anomalies.