TreatPreg

The challenge

Parasite infections can be particularly dangerous during pregnancy. An estimated one in four maternal deaths is due to parasite infections, which can also cause a range of adverse birth outcomes such as stillbirth, prematurity and low birth weight. Many of these effects are mediated by parasites’ sequestration of iron, leading to anaemia.

Because of these effects, the WHO recommends that pregnant women be offered a range of preventive treatments against malaria (intermittent preventive treatment in pregnancy, for example, with sulfadoxine–pyrimethamine), soil-transmitted helminths (albendazole or mebendazole) and schistosomes (praziquantel). 

Although there is strong evidence that these interventions improve maternal health and reduce neonatal mortality, they are only partially implemented in sub-Saharan Africa. Key issues include health workers' concerns about giving drugs to pregnant women and the differing dosing and schedules of the recommended treatments. 

The project

The TreatPregproject aims to improve the uptake of preventive treatments during pregnancy by gathering evidence on the safety and efficacy of combined anti-parasite treatments.

Each treatment is known to be safe for use in pregnant women on its own. However, there is limited evidence of their use together, although albendazole and praziquantel have been used together in pregnant women and young children; co-administration appears to have no impact on safety or efficacy. Given what is known about how the drugs are metabolised, there is no reason to think that their use together will raise safety concerns or diminish efficacy.

To confirm this in practice, the TreatPreg project is conducting a clinical trial in which praziquantel is administered alongside either albendazole or mebendazole during an antenatal care visit at which preventive malaria treatment is provided. The study, conducted in Benin, the Republic of the Congo, Gabon, and Ghana, will assess safety and tolerability, including impacts on maternal health, birth outcomes, and the health of young infants. 

The trial will include pharmacokinetic studies to assess whether co-administration affects blood levels of the individual drugs. A cost-effectiveness analysis will also be carried out.

Impact

The TreatPregproject will address key barriers to implementing evidence-based strategies to protect maternal health. It will:

• Demonstrate whether preventive treatment for three critical types of parasite infection can be safely given to pregnant women at the same time.
• Provide further evidence on their benefits to pregnant women and their offspring.

Generating this evidence would provide a strong impetus to expand access to preventive anti-parasite treatments during pregnancy, helping to reduce the number of maternal and neonatal deaths in sub-Saharan Africa.