Schistosomiasis in pregnancy and lactation

Almost 140 million individuals are infected with one of three primary species of schistosomes globally, including an estimated 35 million women of reproductive age. Women of reproductive age also bear the burden of pregnancy, with additional risks of schistosomiasis to both pregnant women and their offspring. Both prospective studies and randomised controlled trials have implicated schistosomiasis in a range of maternal and newborn adverse outcomes. Schistosomiasis has most clearly been associated with maternal risk for anaemia and iron insufficiency. Three randomised controlled trials conducted across the three primary schistosome species that infect humans have supported the safety of praziquantel during the second and third trimesters. These studies, as well as formal drug labelling changes to allow treatment of pregnant women, have culminated in stronger guidance from WHO to include them in mass drug administration (MDA) programmes as well as other delivery systems. Many barriers to implementation still exist, including MDA programmes that only deliver to schools in many endemic nations, donation programmes that supply praziquantel only for school-aged children, frequent drug shortages, operational challenges to delivering in communities versus schools, and a lack of praziquantel available at antenatal clinics. We advocate for the inclusion of pregnant women in the second and third trimesters in MDA programmes as well as using a targeted approach to treatment during routine antenatal visits to mitigate known morbidities. Pairing rapid diagnostic tests for schistosomiasis in antenatal clinics and providing pregnancy testing during community MDA to reassure women that they are not in the first trimester of pregnancy could both improve praziquantel uptake.