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, Flory T.; Chaabane, Sonia; Boukhris, Takoua; Santos, Fabiano; Sheehy, Odile; Perreault, Sylvie; Blais, Lucie; Bérard, Anick

doi:10.1186/s12916-015-0429-x

Cited by 25 publications

(25 citation statements)

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“…Two systematic reviews with 25 (37 981 women) 44 and 17 (14 481 women) 43 RCTs and quasi-RCTs evaluated the effect of antimalarial drugs for preventing malaria during pregnancy and the risk of LBW (see online supplementary table 14). Both reviews found a 27% reduction of LBW for women receiving antimalarial drugs compared with women not receiving these drugs during pregnancy.…”

Section: Preventive Antimalarial Drugsmentioning

confidence: 99%

Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews

et al. 2017

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IntroductionLow birth weight (LBW, birth weight less than 2500 g) is associated with infant mortality and childhood morbidity. Poor maternal nutritional status is one of several contributing factors to LBW. We systematically reviewed the evidence for nutrition-specific (addressing the immediate determinants of nutrition) and nutrition-sensitive (addressing the underlying cause of undernutrition) interventions to reduce the risk of LBW and/or its components: preterm birth (PTB) and small-for-gestational age (SGA).MethodsWe conducted a comprehensive literature search in MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews (September 2015). Systematic reviews of randomised controlled trials focusing on nutritional interventions before and during pregnancy to reduce LBW and its components were eligible for inclusion into the overview review. We assessed the methodological quality of the included reviews using A Measurement Tool to Assess Reviews (AMSTAR), PROSPERO: CRD42015024814.ResultsWe included 23 systematic reviews which comprised 34 comparisons. Sixteen reviews were of high methodological quality, six of moderate and only one review of low quality. Six interventions were associated with a decreased risk of LBW: oral supplementation with (1) vitamin A, (2) low-dose calcium, (3) zinc, (4) multiple micronutrients (MMN), nutritional education and provision of preventive antimalarials. MMN and balanced protein/energy supplementation had a positive effect on SGA, while high protein supplementation increased the risk of SGA. High-dose calcium, zinc or long-chain n-3 fatty acid supplementation and nutritional education decreased the risk of PTB.ConclusionImproving women’s nutritional status positively affected LBW, SGA and PTB. Based on current evidence, especially MMN supplementation and preventive antimalarial drugs during pregnancy may be considered for policy and practice. However, for most interventions evidence was derived from a small number of trials and/or participants. There is a need to further explore the evidence of nutrition-specific and nutrition-sensitive interventions in order to reach the WHO’s goal of a 30% reduction in the global rate of LBW by 2025.

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Section: Preventive Antimalarial Drugsmentioning

confidence: 99%

Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews

et al. 2017

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“…22 The causes of low birth weight differ between rural, tropical Africa and developed or non-tropical settings: for example, malaria (an important cause of low birth weight) is restricted to the tropics 23 and prophylactic antimalarial drugs in pregnancy reduce the risk of low birth weight. 24,25 We hypothesized that the relationship between birth weight and BP in African settings might differ from that commonly observed in HICs.…”

Section: Introductionmentioning

confidence: 99%

Is birth weight associated with blood pressure among African children and adolescents? A systematic review

Lule

Elliott

Smeeth

et al. 2018

J Dev Orig Health Dis

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We conducted a review of the evidence on the relationship between birth weight and BP among African children and adolescents. Medline, EMBASE, Global Health and Web of Science databases were searched for publications to October 2016. Papers reporting the relationship between birth weight and BP among African children and adolescents were assessed. Bibliographies were searched for further relevant publications. Selected papers were summarized following the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. In total, 16 papers from 13 studies conducted in nine African countries (Nigeria, Republic of Seychelles, Gambia, Democratic Republic of Congo, Cameroon, South Africa, Algeria, Zimbabwe and Angola) were reviewed. Eight studies were cohorts, while five were cross-sectional. The relationship between birth weight and later BP varied with age of the participants. Studies in neonates showed a consistently positive association, while predominantly inverse associations were seen among children, and studies in adolescents were inconsistent. Based on the limited number of studies identified, the relationship between birth weight and later BP may vary with age in African children and adolescents. Not all studies adequately controlled for confounding, notably gender or age. Whether the inverse relationship between birth weight and BP in later life observed in Western settings is also seen in Africa remains unclear.

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“…Our study also showed that antimalarial drugs appear to be less effective at reducing the risk of LBW in RCTs published before 1996 compared to those published after this period. A potential explanation for this finding is the prevalence of antimalarial drug resistance in those studies that were, on average, 20.32% (median rate of resistance: 21.45%, interquartile range (IQR), 14.7–25.95%), which was above the cut‐off recommended (10%) by the World Health Organization (WHO) for policy change in malaria areas .…”

Section: Discussionmentioning

confidence: 91%

Methodological quality of antimalarial randomized controlled trials during pregnancy and its impact on the risk of low birth weight

Muanda

Bérard

2016

Brit J Clinical Pharma

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Aim To describe biases in antimalarial randomized controlled trials (RCTs) during pregnancy and their influence on antimalarial drug efficacy to reduce the risk of low birth weight (LBW). Methods RCT characteristics and results were retrieved from a previous systematic review on the efficacy of antimalarials. The Cochrane risk of bias assessment was used to investigate source of biases in each RCT. The quality of RCT reporting published after the introduction of the CONSORT statement in medical literature in 1996 were compared to those published before 1996. A meta‐regression analysis was performed to examine the impact of bias on the efficacy of antimalarials to reduce LBW after controlling for the time period prior to 1996. Results Twenty out of 25 RCTs (80%) had a high risk of bias. The proportion of RCTs having a low risk of bias was higher in manuscripts published after the introduction of CONSORT compared to those published before 1996 for sequence generation (P = 0.04) and allocation concealment (P = 0.04). Heterogeneity between RCTs was associated with an overestimation of the efficacy of antimalarial drugs in reducing LBW in RCTs with inadequate methods for randomization, allocation concealment or not being free of other bias. Conclusion Antimalarial RCTs during pregnancy are poorly reported but may be improved by using the CONSORT statement. After taking into account the time period before 1996, we found that biases had an impact on the efficacy of antimalarials to reduce the risk of LBW.

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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

Cited by 25 publications

References 55 publications

Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews

Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews

Is birth weight associated with blood pressure among African children and adolescents? A systematic review

Methodological quality of antimalarial randomized controlled trials during pregnancy and its impact on the risk of low birth weight

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