***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: WHO recommends that anthelmintic treatment be included in strategies to improve maternal nutrition in areas where hookworms are endemic and anaemia is prevalent . At present , few countries have adopted this recommendation , partly owing to the lack of data to support the adverse effects of hookworms on maternal health . A longitudinal study was conducted on 125 women in Sierra Leone ( in 1995/96 ) to measure the impact of single-dose albendazole ( 400 mg ) and daily iron-folate supplements ( 36 mg iron and 5 mg folate ) on haemoglobin and serum ferritin concentration during pregnancy . Women who received both albendazole and iron-folate supplements experienced no significant change ( P > 0.05 ) in the prevalence of anaemia and iron-deficiency anaemia between the first and third trimesters . These prevalence levels significantly increased ( P < 0.05 ) in women who received either albendazole or iron-folate supplements or neither . After controlling for baseline haemoglobin concentration and season , the mean decline in haemoglobin concentration between the first and third trimester in women who received albendazole was 6.6 g/L less than in women who received the control ( P = 0.0034 ) . The corresponding value for iron-folate supplements was 13.7 g/L haemoglobin ( P < 0.001 ) . The effects of albendazole and iron-folate supplements  were additive . These findings lend support to WHO 's recommendation for anthelmintic treatment during pregnancy Background Maternal schistosomiasis and filariasis have been shown to influence infant responses to neonatal bacille Calmette-Guérin ( BCG ) immunisation but the effects of maternal hookworm , and of de-worming in pregnancy , are unknown . Methods In Entebbe , Ug and a , we conducted a r and omised , double-blind , placebo-controlled trial of a single dose of 400 mg of albendazole in the second trimester of pregnancy . Neonates received BCG .  Interferon-gamma ( IFN-γ ) and interleukin (IL)-5 responses to a mycobacterial antigen ( crude culture filtrate proteins ( CFP ) of Mycobacterium tuberculosis ) were measured in a whole blood assay . We analysed results for binary variables using χ2 tests and logistic regression . We analysed continuous variables using Wilcoxon 's tests . Results Maternal hookworm was associated with reduced maternal IFN-γ responses to CFP ( adjusted odds ratio for IFN-γ > median response : 0.14 ( 95 % confidence interval 0.02–0.83 , p = 0.021 ) . Conversely , maternal hookworm was associated with subsequent increased IFN-γ responses in their one-year-old infants ( adjusted OR 17.65 ( 1.20–258.66 ; p = 0.013 ) ) . Maternal albendazole tended to reduce these effects . Conclusion Untreated hookworm infection in pregnancy was associated with reduced maternal IFN-γ responses to mycobacterial antigens , but increased responses in their infants one year after BCG immunisation . The mechanisms of these effects , and their implication s for protective immunity remain , to be determined BACKGROUND Praziquantel treatment of schistosomiasis boosts antischistosome responses , with type 2 helper T cell bias that may contribute to immunologically mediated killing and to protection against reinfection . Praziquantel treatment during pregnancy was recommended in 2002 , but the immunological effects of the treatment had not been investigated . METHODS A cohort of 387 Schistosoma mansoni-infected women were recruited from a larger trial of deworming during pregnancy . Women were r and omized to receive either praziquantel or placebo during pregnancy . Six weeks after delivery , all women received praziquantel .  Cytokine responses to S. mansoni worm and egg antigens were measured in whole blood culture before and 6 weeks after each treatment . RESULTS Schistosome-specific cytokine responses were suppressed during pregnancy . Praziquantel treatment during pregnancy caused significant boosts in interferon-gamma ( IFN-gamma ) , interleukin (IL)-2 , IL-4 , IL-5 , IL-13 , and IL-10 responses to schistosome worm antigen and in IFN-gamma , IL-5 , and IL-13 responses to schistosome egg antigen , but these boosts were not as substantial as those seen for women treated after delivery . CONCLUSION Pregnancy suppresses a potentially beneficial boost in cytokine responses associated with praziquantel treatment . Further studies are needed on the long-term effects that treatment of schistosomiasis during pregnancy have on morbidity and resistance to reinfection among treated women and their offspring Background Helminths have profound effects on the immune response , allowing long-term survival of parasites with minimal damage to the host . Some of these effects “ spill-over ” , altering responses to non-helminth antigens or allergens . It is suggested that this may lead to impaired responses to immunizations and infections , while conferring benefits against inflammatory responses in allergic and autoimmune disease . These effects might develop in utero , through exposure to maternal helminth infections , or through direct exposure in later life . Purpose To determine the effects of helminths and their treatment in pregnancy and in young children on immunological and disease outcomes in childhood . Methods The trial has three r and omized , double-blind , placebo-controlled interventions at two times , in two people : a pregnant woman and her child . Pregnant women are r and omized to albendazole or placebo and praziquantel or placebo . At age 15 months their children are r and omized to three-monthly albendazole or placebo , to continue to age five years . The proposed design ation for this sequence of interventions is a 2 × 2( × 2 ) factorial design . Children are immunized with BCG and against polio , Diphtheria , tetanus , Pertussis , Haemophilus , hepatitis B and measles . Primary immunological outcomes are responses to BCG antigens and tetanus toxoid in whole blood cytokine assays and antibody assays at one , three and five years of age . Primary disease outcomes are incidence of malaria , pneumonia , diarrhoea , tuberculosis , measles , vertical HIV transmission , and atopic disease episodes , measured at clinic visits and twice-monthly home visits . Effects on anaemia , growth and intellectual development are also assessed . Conclusion This trial , with a novel design comprising related interventions in pregnant women and their offspring , is the first to examine effects of helminths and their treatment in pregnancy and early childhood on immunological , infectious disease and allergic disease outcomes . The results will enhance underst and ing of both detrimental and beneficial effects of helminth infection and inform policy Background The ‘ external validity ’ of r and omized controlled trials is an important measure of quality , but is often not formally assessed . Trials concerning mass drug administration for helminth control are likely to guide public health policy and careful interpretation of their context is needed . We aim ed to determine how representative participants in one such trial were of their community . We explore implication s for trial interpretation and result ing public health recommendations . Methods The trial assessed was the Entebbe Mother and Baby Study ( EMaBS ) , a trial of anthelminthic treatment during pregnancy and early childhood . In a novel approach for assessing external validity , we conducted a two-stage cluster sample community survey within the trial catchment area and compared characteristics of potentially-eligible community children with characteristics of children participating in the trial . Results A total of 173 children aged three to five-years-old were surveyed from 480 households . Of children surveyed , we estimated that mothers of 60 % would have been eligible for recruitment , and of these , 31 % had actually been enrolled . Children surveyed were compared to 199 trial children in the same age group review ed at annual trial visits during the same time period . There were significant differences in ethnicity between the trial participants and the community children , and in socioeconomic status , with those in the trial having , on average , more educated parents and higher maternal employment . Trial children were less likely to have barefoot exposure and more likely to use insecticide-treated bed nets . There were no significant differences in numbers of reported illness events over the last year . Conclusions The trial had not enrolled all eligible participants , and those enrolled were of higher socioeconomic status , and had lower risk of exposure to the parasitic infections targeted by the trial interventions . It is possible the trial may have underestimated the absolute effects of anthelminthic treatment during pregnancy and early childhood , although the fact that there were no differences in reported incidence of common infectious diseases ( one of the primary outcomes of EMaBS ) between the two groups provides reassurance . Concurrent community surveys may be an effective way to test the external validity of trials . EMaBS Trial registration IS RCT N32849447 , registered 22 July Background : Pregnant women who live in hookworm-endemic areas may benefit from deworming during their pregnancy . The benefit derives from reducing anemia , primarily iron-deficiency anemia caused by hookworm infection-attributable blood loss . Where the prevalence of hookworm is more than 20 % to 30 % , the World Health Organization recommends that pregnant women receive anthelminthic treatment ( mebendazole , albendazole , levamisole or pyrantel ) after their first trimester . The objective of this study is to report , describe and compare the occurrence of adverse birth outcomes in a large r and omized , controlled trial of antenatal mebendazole ( 500 mg single dose ) plus iron supplements versus placebo plus iron supplements conducted between April 2003 and June 2004 in the Amazon region of Peru . Methods : Physician-recorded data on adverse birth outcomes occurring during the trial ( N = 1042 ) were obtained . Proportions were compared using χ2 analysis . Results : No statistically significant difference ( P = 0.664 ) was found between the mebendazole group and the placebo group in terms of numbers of miscarriages , malformations , stillbirths , early neonatal deaths and premature babies ( 28 versus 31 , respectively ) . Conclusions : The evidence provided by this large r and omized , controlled trial of mebendazole administered during pregnancy indicates that deworming with mebendazole can be safely included in antenatal care programs in hookworm-endemic areas Objective : Intervention with iron supplementation , deworming , and information , education and communication ( IEC ) to improve the haematological status among each of the three trimesters of pregnant women in a rural community . Design : A community-based study was carried out using a two-group pre – post experimental design in a rural community . Setting : Two rural blocks in Vellore district were selected for the study . KV Kuppam block with a population of 120 , 000 and the adjacent Gudiyatham block with a population of 132 , 000 served as study and control areas for the study .Subjects : Using a multistage sampling , initially 50 % of the panchayats , the local village administrative units , were r and omly selected and all pregnant women were the subjects . In the pre-intervention survey 458 and 387 pregnant women had haemoglobin tested and the post-intervention survey covered 403 and 425 pregnant women in the study and control areas , respectively . Similarly serum ferritin was tested in a r and omly selected sub- sample with 254 and 191 pregnant women before intervention and in 216 and 223 pregnant women after intervention in both study and control areas , respectively . Intervention : Iron supplementation and deworming were provided to all pregnant women in the study area from the fourth month of their pregnancy . An intensive information , education and communication was carried out with facts on anaemia and diet modification to each pregnant woman , using a one-to-one approach in the community , and a group method in the mobile clinics . This was carried out for a period of 18 months . Results : A significant decrease in the prevalence of anaemia was found , from 56.1 % to 25.07 % ( P<0.001 ) , 73.4 % to 49.2 % ( P<0.001 ) and 68.8 % to 56.8 % ( P<0.01 ) among women in the first , second and third trimesters , respectively , in the intervention area . Significant ( P<0.001 ) increases in the mean haemoglobin of 0.85 g/dl ( 95 % CI 10.18–10.84 , 11.09–11.63 ) , 0.59 g/dl ( 95 % CI 9.98–10.34 , 10.55–10.95 ) and 0.36 g/dl ( 95 % CI 9.93–10.33 , 10.25–10.73 ) were also observed in each of the groups . Conclusion : A comprehensive community-based intervention with iron supplementation , helminthic treatment and increase in knowledge using IEC through effective strategies can improve the haematological status of pregnant women in each trimester . Sponsorship : Mother Care Project , John Snow Inc. , Funded by the United States Agency for International Development (USAID).European Journal of Clinical Nutrition ( 2000 ) 54 , BACKGROUND Severe anemia ( hemoglobin < 70 g/L ) in pregnancy may increase the risk of maternal and perinatal 
    Output:
    
The evidence to date is insufficient to recommend use of antihelminthic for pregnant women after the first trimester of pregnancy .