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Antimalarial drugs for preventing malaria during pregnancy and the risk of low birth weight: a systematic review and meta-analysis of randomized and quasi-randomized trials.

Muanda FT, Chaabane S, Boukhris T, Santos F, Sheehy O, Perreault S, Blais L, Bérard A - BMC Med (2015)

Bottom Line: Compared to no use, all combined antimalarial drugs were associated with a 27% (RR 0.73, 95% CI 0.56-0.97, ten studies) reduction in the risk of LBW.Sulfadoxine-pyrimethamine was not associated with a reduction in the risk of LBW in regions where the prevalence of the dihydropteroate synthase 540E mutation exceeds 50% (RR 0.99, 95% CI 0.80-1.22, three studies).The risk of LBW was similar when sulfadoxine-pyrimethamine was compared to mefloquine (RR 1.05, 95% CI 0.86-1.29, two studies).

View Article: PubMed Central - PubMed

Affiliation: Faculty of Pharmacy, University of Montreal, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada. flory.muanda-tsobo@umontreal.ca.

ABSTRACT

Background: It is known that antimalarial drugs reduce the risk of low birth weight (LBW) in pregnant patients. However, a previous Cochrane review did not evaluate whether the level of antimalarial drug resistance could modify the protective effect of antimalarial drugs in this regard. In addition, no systematic review exists comparing current recommendations for malaria prevention during pregnancy to alternative regimens in Africa. Therefore, we conducted a comprehensive systematic review and meta-analysis to assess the efficacy of antimalarial drugs for malaria prevention during pregnancy in reducing the risk of LBW.

Methods: We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for articles published up to 21 November 2014, in English or French, and identified additional studies from reference lists. We included randomized and quasi-randomized studies reporting LBW as one of the outcomes. We extracted data and assessed the risk of bias in selected studies. All pooled analyses were based on a random effect model, and we used a funnel plot and trim and fill method to test and adjust for publication bias.

Results: A total of 25 studies met the inclusion criteria (37,981 subjects). Compared to no use, all combined antimalarial drugs were associated with a 27% (RR 0.73, 95% CI 0.56-0.97, ten studies) reduction in the risk of LBW. The level of antimalarial drug resistance modified the protective effect of the antimalarial drug used for prevention of LBW during pregnancy. Sulfadoxine-pyrimethamine was not associated with a reduction in the risk of LBW in regions where the prevalence of the dihydropteroate synthase 540E mutation exceeds 50% (RR 0.99, 95% CI 0.80-1.22, three studies). The risk of LBW was similar when sulfadoxine-pyrimethamine was compared to mefloquine (RR 1.05, 95% CI 0.86-1.29, two studies).

Conclusion: Prophylactic antimalarial drugs and specifically sulfadoxine-pyrimethamine may no longer protect against the risk of LBW in areas of high-level resistance. In Africa, there are currently no suitable alternative drugs to replace sulfadoxine-pyrimethamine for malaria prevention during pregnancy.

No MeSH data available.


Related in: MedlinePlus

Antimalarial drugs compared to no use of antimalarial drugs and risk of LBW. Each study is displayed as a square and horizontal line, representing the relative risk together with its confidence interval. The area of the square represents the weight that the study contributes to the meta-analysis. The combined relative risk and its confidence interval are represented by the diamond. The P value after I2 represents chi-square test for heterogeneity. DerSimonian and Laird were used to calculate the random effect model. CI, confidence interval; LBW, low birth weight; RR, relative risk
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Fig2: Antimalarial drugs compared to no use of antimalarial drugs and risk of LBW. Each study is displayed as a square and horizontal line, representing the relative risk together with its confidence interval. The area of the square represents the weight that the study contributes to the meta-analysis. The combined relative risk and its confidence interval are represented by the diamond. The P value after I2 represents chi-square test for heterogeneity. DerSimonian and Laird were used to calculate the random effect model. CI, confidence interval; LBW, low birth weight; RR, relative risk

Mentions: When all combined antimalarial drugs used for prevention of malaria during pregnancy were compared to no use of antimalarial drug, we detected a significant 27 % reduction in the risk of LBW (RR 0.73, 95 % CI 0.56–0.97; I2 = 70 %, P <0.01, ten studies) (Fig. 2). As heterogeneity was high (hinging I2 statistic = 70 %), we identified an outlier across the ten trials using a Galbraith plot (Additional file 4: Figure S1). The excluded outlying study used a cluster randomized design in which the units of analysis (health centres) were not selected randomly; this may introduce a selection bias. In addition, statistical analysis did not take into account efficiently variability within and between clusters. This may explain why this study was an outlier in our analysis.Fig. 2


Antimalarial drugs for preventing malaria during pregnancy and the risk of low birth weight: a systematic review and meta-analysis of randomized and quasi-randomized trials.

Muanda FT, Chaabane S, Boukhris T, Santos F, Sheehy O, Perreault S, Blais L, Bérard A - BMC Med (2015)

Antimalarial drugs compared to no use of antimalarial drugs and risk of LBW. Each study is displayed as a square and horizontal line, representing the relative risk together with its confidence interval. The area of the square represents the weight that the study contributes to the meta-analysis. The combined relative risk and its confidence interval are represented by the diamond. The P value after I2 represents chi-square test for heterogeneity. DerSimonian and Laird were used to calculate the random effect model. CI, confidence interval; LBW, low birth weight; RR, relative risk
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4537579&req=5

Fig2: Antimalarial drugs compared to no use of antimalarial drugs and risk of LBW. Each study is displayed as a square and horizontal line, representing the relative risk together with its confidence interval. The area of the square represents the weight that the study contributes to the meta-analysis. The combined relative risk and its confidence interval are represented by the diamond. The P value after I2 represents chi-square test for heterogeneity. DerSimonian and Laird were used to calculate the random effect model. CI, confidence interval; LBW, low birth weight; RR, relative risk
Mentions: When all combined antimalarial drugs used for prevention of malaria during pregnancy were compared to no use of antimalarial drug, we detected a significant 27 % reduction in the risk of LBW (RR 0.73, 95 % CI 0.56–0.97; I2 = 70 %, P <0.01, ten studies) (Fig. 2). As heterogeneity was high (hinging I2 statistic = 70 %), we identified an outlier across the ten trials using a Galbraith plot (Additional file 4: Figure S1). The excluded outlying study used a cluster randomized design in which the units of analysis (health centres) were not selected randomly; this may introduce a selection bias. In addition, statistical analysis did not take into account efficiently variability within and between clusters. This may explain why this study was an outlier in our analysis.Fig. 2

Bottom Line: Compared to no use, all combined antimalarial drugs were associated with a 27% (RR 0.73, 95% CI 0.56-0.97, ten studies) reduction in the risk of LBW.Sulfadoxine-pyrimethamine was not associated with a reduction in the risk of LBW in regions where the prevalence of the dihydropteroate synthase 540E mutation exceeds 50% (RR 0.99, 95% CI 0.80-1.22, three studies).The risk of LBW was similar when sulfadoxine-pyrimethamine was compared to mefloquine (RR 1.05, 95% CI 0.86-1.29, two studies).

View Article: PubMed Central - PubMed

Affiliation: Faculty of Pharmacy, University of Montreal, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada. flory.muanda-tsobo@umontreal.ca.

ABSTRACT

Background: It is known that antimalarial drugs reduce the risk of low birth weight (LBW) in pregnant patients. However, a previous Cochrane review did not evaluate whether the level of antimalarial drug resistance could modify the protective effect of antimalarial drugs in this regard. In addition, no systematic review exists comparing current recommendations for malaria prevention during pregnancy to alternative regimens in Africa. Therefore, we conducted a comprehensive systematic review and meta-analysis to assess the efficacy of antimalarial drugs for malaria prevention during pregnancy in reducing the risk of LBW.

Methods: We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for articles published up to 21 November 2014, in English or French, and identified additional studies from reference lists. We included randomized and quasi-randomized studies reporting LBW as one of the outcomes. We extracted data and assessed the risk of bias in selected studies. All pooled analyses were based on a random effect model, and we used a funnel plot and trim and fill method to test and adjust for publication bias.

Results: A total of 25 studies met the inclusion criteria (37,981 subjects). Compared to no use, all combined antimalarial drugs were associated with a 27% (RR 0.73, 95% CI 0.56-0.97, ten studies) reduction in the risk of LBW. The level of antimalarial drug resistance modified the protective effect of the antimalarial drug used for prevention of LBW during pregnancy. Sulfadoxine-pyrimethamine was not associated with a reduction in the risk of LBW in regions where the prevalence of the dihydropteroate synthase 540E mutation exceeds 50% (RR 0.99, 95% CI 0.80-1.22, three studies). The risk of LBW was similar when sulfadoxine-pyrimethamine was compared to mefloquine (RR 1.05, 95% CI 0.86-1.29, two studies).

Conclusion: Prophylactic antimalarial drugs and specifically sulfadoxine-pyrimethamine may no longer protect against the risk of LBW in areas of high-level resistance. In Africa, there are currently no suitable alternative drugs to replace sulfadoxine-pyrimethamine for malaria prevention during pregnancy.

No MeSH data available.


Related in: MedlinePlus