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Credit: Rama George-Alleyne, World Bank
This systematic review by Prabin Dahal and colleagues found that reports on the occurrence of Visceral Leishmaniasis (VL) in pregnant women are rare in published literature, are not systematically captured, and cases are rarely followed-up to detect the consequences of infection and treatment on the pregnant woman and foetus.
The review identifies reported cases and assesses the risk-benefit balance of antileishmanial therapies to the pregnant woman and the child. It brings together scattered observations of VL in pregnant women in the clinical literature and highlights that the disease in pregnancy is under-reported and under-studied. The authors found that information was often incomplete and it was difficult to derive generalisable information on outcomes, however, the findings suggest that liposomal amphotericin B (L-AmB) should be the preferred treatment for VL during pregnancy.
In practice, pregnant and lactating women are regularly excluded from clinical studies and are considered “therapeutic orphans”. Existing knowledge on drug efficacy is derived from a study population that is heavily skewed towards adult males while, substantially less is known about the optimal treatment response in female patients. This means that existing therapeutic guidelines regarding drug usage in pregnancy are guided by limited evidence generated from case reports and small case series
Better understanding of the treatment of VL in pregnancy is important because of the severe impact of VL on pregnant women in low-income settings.