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. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. Data extraction was done by two reviewers using standard criteria. MAIN RESULTS: 14 trials included (n=3454); only 2 were adequately concealed. For women of all parity groups, the meta-analysis (n=2890) showed lower parasitaemia and placental malaria in the intervention arm. For women having the first or second baby, there were 9 studies (n=3454). Severe antenatal anaemia was less common (RR 0.62, 95%CI 0.50 to 0.78, 4 studies), perinatal mortality appeared lower (RR 0.73, 95% CI 0.73 to 0.99, 3 studies). Maternal parasitaemia was lower with the intervention (RR 0.24, 95%CI 0.14 to 0.42, random effects model, 6 studies), and mean birthweight higher (WMD 122 g, 95%I 81 to 164 g, 8 studies), and low birthweight was less common (RR 0.49, 95%CI 0.36 to 0.65, 6 studies). REVIEWER'S CONCLUSIONS: Drugs given routinely for malaria during pregnancy reduce severe antenatal anaemia in the mother, and are associated with higher birthweight and probably reduced perinatal mortality. This effect appears to be limited to low parity women.