Malaria in pregnant women
Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. Malaria-associated maternal illness and low birth weight is mostly the result of Plasmodium falciparum infection and occurs predominantly in Africa.
The symptoms and complications of malaria in pregnancy vary according to malaria transmission intensity in the given geographical area, and the individual’s level of acquired immunity.
In high-transmission settings, where levels of acquired immunity tend to be high, P. falciparum infection is usually asymptomatic in pregnancy. Yet, parasites may be present in the placenta and contribute to maternal anaemia even in the absence of documented peripheral parasitaemia.
Both maternal anaemia and placental parasitaemia can lead to low birth weight, which is an important contributor to infant mortality. In high-transmission settings, the adverse effects of P. falciparum infection in pregnancy are most pronounced for women in their first pregnancy.
In low-transmission settings, where women of reproductive age have relatively little acquired immunity to malaria, malaria in pregnancy is associated with anaemia, an increased risk of severe malaria, and it may lead to spontaneous abortion, stillbirth, prematurity and low birth weight. In such settings, malaria affects all pregnant women, regardless of the number of times they have been pregnant.
Infections with P. vivax
Infection with P. vivax, as with P. falciparum, leads to chronic anaemia and placental malaria infection, reducing the birth weight and increasing the risk of neonatal death. For women in their first pregnancy, the reduction in birth weight is approximately two thirds of what is associated with P. falciparum, but with P. vivax the effect appears to increase with successive pregnancies.
WHO recommends the following package of interventions for the prevention and treatment of malaria during pregnancy:
- use of long-lasting insecticidal nets (LLINs);
- in all areas with moderate to high malaria transmission in Africa, intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), as part of antenatal care services;
- prompt diagnosis and effective treatment of malaria infections.
Intermittent preventive treatment in pregnancy
IPTp reduces maternal malaria episodes, maternal and fetal anaemia, placental parasitaemia, low birth weight, and neonatal mortality. Furthermore, all pregnant women should receive iron and folic acid supplementation as a part of routine antenatal care.
- Malaria prevention works: let's close the gap (2017)
- Recommendations on intermittent screening and treatment in pregnancy and the safety of ACTs in the first trimester (2015)
- Guidelines for the treatment of malaria, third edition (2015)
- WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP), April 2013 (revised January 2014)
WHO Evidence Review Group: intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), July 2012