Maternal malaria

Posted on 23 December 2015

Dr Marlena du Toit, a gynaecologist at Mediclinic Louis Leipoldt, gives expert advice on malaria prevention and treatment during pregnancy.

‘Since a pregnant woman’s immune system is compromised and not responding in the same defensive manner as a non-pregnant woman’s, pregnant women are more likely to contract malaria. The best advice therefore is not to travel to a malaria-prone area when you’re pregnant,’ stresses Dr Du Toit. ‘If a pregnant woman has to travel to such an area, it’s better to do it in the dry season,’ she adds. This is because taking malaria medication is a challenge during pregnancy and during the dry season mosquitoes are less active, although precautions should still be taken.

The World Health Organization recommends the following package of interventions for the prevention and treatment of malaria during pregnancy:
• the use of long-lasting insecticidal nets
• intermittent preventive treatment with sulfadoxine-pyrimethamine – this combination antimalarial drug is the only one suitable for pregnant women
• prompt diagnosis and effective treatment of malaria infections.

‘All pregnant women should be give iron and folate supplements if travelling to a malaria area,’ adds Dr Du Toit.

Remain alert to any flu-like symptoms once you return from travels to an area with a malaria risk, Dr Du Toit advises. The flu incubation period is two weeks. ‘In the first month after their return from the area, pregnant women should be vigilant about seeking help,’ she adds. Symptoms include:
· high fever
· headache
· muscle pain
· chills
· sweats
· coughing
· diarrhea
· nausea and vomiting

Contracting malaria during pregnancy
Pregnant women are in fact three times more likely to develop severe disease than non-pregnant women who acquire infections from the same area, explains Dr Du Toit. ‘Malaria in pregnancy is associated with anaemia, an increased risk of severe malaria (cerebral anaemia and death), and it may lead to spontaneous abortion, stillbirth, prematurity and low birth weight,’ she cautions. ‘The pregnant mom can contract malaria and the placenta can become infected with the parasite, which sequesters and replicates in the placenta. The placental parasitaemia lead to chronic anaemia and placental malaria infection, reducing the birth weight and increasing the risk of neonatal death.’

Treatment of malaria in pregnant women would be the same as for non-pregnant patients, but doxycycline and tetracycline (which are effective in malaria treatment) are contra-indicated in pregnancy, explains Dr Du Toit. ‘Uncomplicated malaria can be treated with oral quinine for at least seven days,’ she says. However, the Falciparum-species of malaria parasites are resistant to quinine, which can make treatment in these cases challenging. ‘Since pregnant patients are more likely to have complicated malaria (with organ involvement), intravenous therapy can be used. Maternal and fetal morbidity and mortality compel health care workers to discourage pregnant women from travelling to malaria-infected areas,’ concludes Dr Du Toit.

Published in Baby

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