A double‐blind randomized controlled trial of antenatal mebendazole to reduce low birthweight in a hookworm‐endemic area of Peru

Abstract

Summaryobjective To assess the effect on birthweight of antenatal mebendazole plus iron vs. placebo plus iron in a highly hookworm-endemic area.methods Double-blind, randomized controlled trial set in rural and peri-urban communities in the Peruvian Amazon region. A total of 1042 second trimester pregnant women between the ages of 18 and 44 years were recruited from April to November 2003, and followed to July 2004. Women were randomly assigned to receive either mebendazole (500 mg single dose) plus iron supplements (60 mg elemental iron daily) or placebo plus iron supplements. The primary outcome was mean infant birthweight and secondary measures included proportion of low birthweight babies and maternal anaemia.results The prevalence of hookworm infection was 47.5%. There were no differences between intervention groups in mean birthweight (3104 g vs. 3090 g, P ¼ 0.629), proportion of low birthweight (<2500 g; 8.1% vs. 8.7%, P ¼ 0.755) or maternal anaemia in the third trimester [33.0% (158/479) vs. 32.3% (152/471), P ¼ 0.815]. However, the proportion of very low birthweight (<1500 g) was significantly lower in the mebendazole group [0% (0/479) vs. 1.5% (7/471),conclusions This trial provides additional evidence for the use of anthelmintics, over and above iron supplementation, within antenatal care programmes in hookworm-endemic areas. Benefits of de-worming may be higher in countries not having an antenatal iron supplementation programme or where intensity of hookworm infections is higher.

Worms at Work: Long-run Impacts of a Child Health Investment

“…Intense infections lead to lethargy, anemia, and growth stunting (Stephenson et al 1993;Stoltzfus et al 1997;Guyatt et al 2001;Silva et al 2003) and may weaken the immunological response to other infections (Kjetland et al 2006;Kirwan et al 2010). Chronic parasitic infections in childhood may lead to inflammation and elevated cortisol that produce adverse health consequences later in life (Crimmins QUARTERLY JOURNAL OF ECONOMICS and Finch 2005), as well as increased maternal morbidity, low birth weight, and miscarriage (Larocque et al 2006;Hotez 2009). …”

Helminth infections: the great neglected tropical diseases

“…These concerns, together with a need to better understand a number of fundamental clinical and epidemiological aspects of human helminth infections as well as their interactions with geographically overlapping coinfections (e.g., malaria and HIV/AIDS) have created an urgency for stepped up clinical research activities as they relate to largescale helminth control. Such activities have focused around three major areas: first, a reexamination of the health impact of human helminthic infections, with particular interest in the effects of mono- and polyparasitism on childhood growth and development as well as their effects on pregnancy and birth outcomes (63,(136)(137)(138)(139)(140); second, large-scale monitoring and evaluation of MDA and integrated control, along with operational research with goals to improve the access of populations to anthelminthic drugs and to monitor for possible drug resistance (141)(142)(143)(144)(145); and third, the development of new tools to control helminth infections, that is, drugs, diagnostics, and vaccines (19,146).…”

Birthweight in Offspring of Mothers with High Prevalence of Helminth and Malaria Infection in Coastal Kenya

“…6 A study with mebendazole in Peru showed a reduction in very low birthweight in those receiving anti-helminthic drugs, but not an overall improvement in mean birthweights. 16 Based on these data and others, a Cochrane review demonstrated no definitive benefit of anti-helminth treatment in pregnant women and did not recommend routine use. 17 Given these mixed results and the potential harm of these infections, more data on the effects of helminth infections and particularly, co-infection with malaria on perinatal outcomes are clearly needed.…”

“…13,14 However, studies of helminth infections during pregnancy and of the benefits of treating pregnant women are still few in number and have shown mixed results. 6,15,16 The consensus is now shifting to giving pregnant women anti-helminth treatment because of apparent safety after years of inadvertent doses given to women unknowingly pregnant. Lack of adverse outcomes in animal studies, reports from mass campaigns, and a randomized trial in Uganda of ivermectin and albendazole also support treating pregnant women.…”