Schistosomiasis morbidity has been reported to be associated with adverse pregnancy outcomes like low birth weight, prenatal death and maternal death. The most implicating risk factor is anaemia. Recent studies have also stressed the poor immunogenicity of vaccine in neonates of untreated infected mothers and there have been reports on the occurrence of proinflammatory cytokines associated with Schistosoma fibrosis in neonates of infected mothers suggesting a possibility of congenital transmission and adverse effects in neonates. While the WHO has recommended the administration of praziquantel to infected mothers during pregnancy (though without many randomized control trials as at the time of the recommendation), recent evidences have however shown beneficial effects as regards non-treatment during pregnancy. In one study, the children of treated women were reported to show high prevalence of eczema! Furthermore, the most acclaimed risk factor of infection (anaemia) which is the major cause of LBW, prenatal death etc was reported not to be associated with schistosomiasis ruling out coinfection with hookworm and Plasmodium falciparum. Infact another observation showed no association between mother's infection and response to vaccination in children. I want your opinion in this regards as Schistosoma researcher. If you have done something related to this subject matter, I would love to know your findings.
It's something to study case-to-case...
Praziquantel, the drug of choice is considered safe in pregnancy, but schistossomiasis is a disease usually with chronic and slow evolution, if you're near the patient, I think that you may wait for birth to treat the mother.
Praziquantel treats all forms of schistosomiasis with minimal side effects and an excellent pregnancy safety profile in terms of reported adverse effects. It is not expensive. The WHO recommendation is to treat and I would concur with this advice. Of course treating it once doesn't mean the mother-child dyad will not become infected again, so sanitation and hygiene advice should also be offered. Co-exisitng anaemia should be treated. This anaemia can be multifactorial and not merely an anaemia that will respond to iron alone. I note the concerns based on a few observational trials but you must be cautious of trials not identifying and controlling for all comorbidies in their comparison population or producing a type 1 error. It is reasonable to put your concerns in regards to timing of treatment to the patient as long as you also inform them about WHO advice to treat and let the patient be involved in shared decision making.
Patricia, you may read more about this here:
Article Administration of Praziquantel to pregnant and lactating women
and here:
https://www.cdc.gov/parasites/schistosomiasis/health_professionals/index.html
Intestinal schistosomiasis infect the intestines and result to abdominal pain, diarrhea and other symptoms. The usual treatment for schistosomiasis is praziquantel which proves effective treatment in all forms of schistosomiasis. Pregnant woman who has schistosomiasis should be treated as it affect the uterine during pregnancy. Infection of schistosomiasis are also proven to be transmitted by the child thus having congenital infection. Praziquantel can be recommended to pregnant woman as WHO stated that it can decrease the burden and improve the pregnancy and fetal outcomes. There are also studies stated that “animal reproduction studies have failed to demonstrate a risk to the fetus” (Friedman et al., 2017). This explains that it can also be administered to humans with high possibility that it will not risk the fetus as well. But for now, as WHO recommended, praziquantel can be used to treat pregnant patients with schistosomiasis.
References:
https://emedicine.medscape.com/article/228392-treatment#d12
https://www.who.int/bulletin/volumes/96/1/17-198879/en/
https://www.who.int/news-room/fact-sheets/detail/schistosomiasis
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