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Pregnant women are at an increase risk of both developing severe malaria and fatality when compared to non pregnant women.
- diagnosis of falciparum malaria in pregnancy can be particularly difficult as parasites may not be detectable in blood films due to sequestration in the placenta.
- if malaria is suspected expert advice should be sought at an early stage
- complications such as severe anaemia, hypoglycaemia, jaundice, renal failure, hyperpyrexia and pulmonary oedema may occur
- malaria may result in miscarriage, premature delivery, maternal and/or neonatal death
Congenital malaria is rare, but occurs more commonly with Plasmodium vivax than with the other malaria parasites of humans
Pregenant women should be advised against traveling to a malarious area. If it is unavoidable, inform about the risks which malaria present and the risks and benefits of antimalarial prophylaxis.
- advice about avoidance of mosquito bite since pregnant women are particularly
attractive to mosquitoes
- if possible pregnant women should remain indoors between dusk and dawn
and if this is unavoidable they should adhere rigorously to bite precautions
- DEET should be used in a concentration of not more than 50%
- nursing mothers should wash repellents off their hands and breast skin
prior to handling infants
- chloroquine and proguanil:
- safe in all trimesters of pregnancy
- useful in in areas where P. falciparum strains are
- if proguanil is used, prescribe folic acid 5 mg daily
- can be used in the second and third trimesters (caution in first trimester)
- women who have taken mefloquine inadvertently just prior to or during
the first trimester should be advised that this does not constitute
an indication to terminate the pregnancy
- use of mefloquine prophylaxis in pregnancy requires careful harm-benefit
analysis. In instances where transmission and drug resistance is high
and mefloquine is the agent of first choice, mefloquine may be advised
in the second and third trimesters of pregnancy.
- generally contraindicated in pregnancy (can be considered under special
circumstances before 15 weeks' gestation )
- Advisory Committee on Malaria Prevention in UK Travellers (ACMP's) view
is that doxycycline should not be used in breast feeding unless there
is no alternative agent and its use is felt to be essential
- ACMP advises against the use of atovaquone/proguanil for antimalarial
chemoprophylaxis in pregnancy
The amount of medication in breast milk will not protect the infant from malaria.
Therefore, the breastfeeding child needs his or her own prophylaxis (1)
Check the respective summary of product characteristics before prescribing
any of the medications mentioned above.
- (1) Public Health England (PHE) 2019. Guidelines for malaria prevention
in travelers from the United Kingdom
Last edited 12/2019 and last reviewed 08/2020