Africa: Heat-Stable Drug Carbetocin Could Decrease High Maternal Mortality Rate

A new durable drug formulation called Carbetocin could prevent excessive bleeding after childbirth like the current but highly sensitive drug Oxytocin thus saving thousands of women's lives in the developing world.

Bleeding after childbirth or Postpartum haemorrhage is the leading cause of maternal mortality in low-income countries. In sub-Saharan Africa and Asia where maternal health services are less prevalent. it is the cause of a quarter of all deaths from complications of pregnancy and childbirth according to the World Health Organisation.

Each year around 14 million women globally suffer from PPH each year, and 70,000 women die as a result, according to a study published in the New England Journal of Medicine. These researchers noted that between 2003 and 2009, PPH resulted in 661,000 deaths worldwide and that majority of these deaths occurred within the first 24 hours after birth.

Ironically PPH is treatable through a drug called Oxytocin but the drug must be stored at cool temperatures of between 2 and 8 degrees Celsius (35.6-46.4 degrees Fahrenheit). This is however the crux of the matter as many areas in third world countries do not have the storage capacity to hold Oxytocin according to a WHO study.

"For many years we have been looking for a heat stable product that could be as effective as the oxytocin, and today we can say that we have it," said Ms Mariana Widmer, Technical Officer at WHO Department of Reproductive Health and Research, lead author of the study.

New research has found that there is a version of the drug Carbetocin, that does not require refrigeration and which is just as effective as Oxytocin in preventing PPH. Carbetocin has been shown to remain stable at 30 degrees Celsius (86 degrees Fahrenheit) and at 75% relative humidity for up to 36 months.

"Giving drugs to contract the uterus after childbirth is considered the cornerstone of efforts to prevent post- partum haemorrhage," said Ian Roberts, Professor of Epidemiology & Public Heath at London School of Hygiene & Tropical Medicine, who was not involved in the study. "Oxytocin is the drug currently recommended but it is heat sensitive and loses potency in hot climates - the sorts of places where many mothers die."

"The development of a drug to prevent postpartum haemorrhage that continues to remain effective in hot and humid conditions is very good news for the millions of women who give birth in parts of the world without access to reliable refrigeration," said Dr. Metin Gülmezoglu, the coordinator of maternal and perinatal health and preventing unsafe abortion team at WHO, who also worked on the study.

However there are drawbacks to Carbetocin mostly in the feasibility of rolling it out to the world.

"Heat stable Carbetocin is much more expensive than Oxytocin. The drug company that makes it has an agreement with WHO to make it available at a reasonable price in poor countries but the devil is in the detail," said Roberts.

"What will it actually cost? Which countries will receive it? For how long? Will it reduce availability of the cheaper Oxytocin? And what about poor mothers in rich countries? These are all factors that need to be considered."

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