Therapeutic Management of Schistosomiasis in Pregnancy: A Comprehensive Review of Praziquantel Safety and Clinical Outcomes

Abstract

Background/Objectives: Schistosomiasis affects about 250 million people globally, including an estimated 40 million women of reproductive age and over 10 million pregnant women each year. Praziquantel is a key component of schistosomiasis control and is recommended by the World Health Organization (WHO) for use during pregnancy; nevertheless, its use is uneven due to ongoing safety concerns. Methods: This narrative review synthesizes evidence from randomized controlled trials (with the strongest evidence for the second and third trimesters), observational studies (including limited first-trimester exposures), pharmacokinetic analyses, case series, and WHO policy documents published between 1980 and March 2026. Results: Across all major Schistosoma species, praziquantel demonstrates high efficacy in pregnancy, with cure rates comparable to those in non-pregnant populations. No increased risk of miscarriage, stillbirth, congenital anomalies, preterm birth, or low birth weight has been observed in randomized controlled trials (RCTs) or cohort studies. Treatment of S. haematobium improves maternal anemia and may confer benefits on neonatal iron status and immune development; evidence gaps remain regarding first-trimester exposures and long-term offspring outcomes. Conclusions: Aligning national policies with WHO guidance and integrating praziquantel into antenatal care could substantially reduce maternal morbidity and improve neonatal health.