Malaria in pregnancy is a major cause of maternal morbidity worldwide and leads to poor birth outcomes. Pregnant women are more prone to complications of malaria infection than nongravid women. Treatment involves antimalarial drugs and supportive measures. Prevention involves chemoprophylaxis and mosquito avoidance.
Issues related to treatment and prevention of malaria in pregnant women will be reviewed here. Issues related to the prevalence, epidemiology, pathogenesis, clinical manifestations, diagnosis, and outcome of malaria in pregnancy are discussed separately, as are general details on treatment of uncomplicated and severe malaria.
Malaria in pregnancy is dangerous for both the mother and the fetus. Therefore, pregnant women with malaria must be treated promptly with an effective antimalarial agent to clear parasites rapidly. Safety and efficacy data to guide management are limited . In general, the newer the drug, the more likely it is to be effective (in part because there has been insufficient time for resistance to emerge), but fewer data will be available on safety in pregnancy. Clinicians therefore have to make treatment decisions based on the clinical severity of infection, epidemiologic resistance patterns, and available data regarding safety of the drug or class of drug in pregnancy.
P. falciparum — Pregnant women with severe P. falciparum malaria should receive parenteral therapy; the intravenous route is preferred over the intramuscular route. Options for therapy include artesunate or quinine (plus clindamycin) (table 1). In nonpregnant adults and children with severe malaria, a mortality benefit has been demonstrated with artesunate over quinine [2,3]. No trials have compared the efficacy of these agents in pregnant women. (See "Treatment of severe falciparum malaria" and 'Drug safety' below.)