In 2005, 99 per cent of maternal deaths occurred in the developing world. Despite this, the number of new drugs being created for maternal health is alarmingly small, write Nicholas J. White, Rose M. McGready and François H. Nosten in PLoS Medicine.
Currently, only 17 drugs are under active development for maternal health. This is in part due to caution about giving newly developed drugs to pregnant women following the thalidomide crisis half a century ago.
But this caution comes with a price. Malaria poses a particular risk to pregnant women, but there are too few trials of antimalarial drugs in pregnancy.
The authors write, "Of over 500 antimalarial drug trials conducted between 1966 and December 2006, only 31 evaluated antimalarial treatments (including intermittent preventive treatments) specifically in pregnant women (and 14 of these were from a single centre)."
Evidence is needed to inform practice, say the authors. Although industry is usually reluctant to underwrite studies of new pregnancy drugs, research centres should be encouraged to study the treatment of diseases in pregnancy.
We are too risk-averse, and can no longer afford to ignore the problem of how best to treat tropical infectious diseases in pregnancy, the authors say.