Malaria in pregnancy

What is malaria?

Malaria is a disease caused by a parasite which infects a certain type of mosquito. These infected mosquitoes spread malaria when they feed on humans.

There are four types of malaria parasites which infect humans. 

They are:

plasmodium falciparum

plasmodium vivax

plasmodium ovale

plasmodium malariae

Plasmodium falciparum and plasmodium vivax are the most common. Plasmodium falciparum is the most deadly.

What are the symptoms of malaria?

The symptoms of malaria usually begin to show seven days or more (usually 10 to 15 days) after you've been bitten. They are similar to flu symptoms, which can make diagnosis difficult.

Symptoms include:

high fever, headache, muscle pain, chills, sweats, cough, diarrhoea, nausea and vomiting.

In some cases of malaria, the fever occurs in 48-hour cycles of shivering and then extreme sweating.

In pregnancy, symptoms may be slightly different. For example, the fever may be very slight or very high, and it may not happen in its usual 48-hour cycle.

As these symptoms are common to other infections such as the flu, only a blood test will confirm whether you have malaria, and the type of malaria that you have. So, if you come down with a high fever and chills, contact your doctor immediately to avoid any serious complications. You may need to be admitted to hospital for tests to check the severity of your symptoms, and for treatment.

It's also possible to have malaria without specific or obvious symptoms, but this is more likely to be the case in countries such as sub-saharan Africa, where natural immunity is high.

When am I most at risk of getting malaria?

The mosquitoes that spread the disease are most active at night, during the period between dusk and dawn.

While malaria occurs all year round, the number of cases shoots up during the monsoon season (end June-mid September). This is because warm, humid weather and stagnant water provide the perfect breeding ground for mosquitoes.

Malaria is widespread in India but is known to be most common in Maharashtra, Gujarat, Rajasthan and Karnataka. The hilly regions of the north and the north-eastern part of the country have fewer cases.

What can I do to prevent?

As mosquitoes cause this disease, it is important to keep mosquitoes at bay. Try to keep your surroundings free of mosquito breeding grounds, such as stagnant water, especially during the monsoon season. Empty all containers such as old flowerpots and vases of old water, and either put them away or keep them overturned so they cannot collect more water.

You can follow other preventive measures:

Wear light coloured clothing. Mosquitoes are attracted to dark colours.

Avoid skin exposure by wearing long sleeved and full length garments.

Stay in air-conditioned or cool areas. Mosquitoes do not thrive in cold temperatures.

Use mosquito repellents and mosquito nets to ward off bites.

Mosquito repellents with up to 50 percent DEET, picaridin, IR3535 or oil of lemon eucalyptus are considered safe to use during pregnancy. Products containing 20 to 30 per cent DEET provide protection against 90 per cent of mosquito bites. You could also apply repellent directly to your clothing.

Can malaria harm my pregnancy or growing baby?

Malaria in pregnancy:

If you are pregnant, you are more susceptible to malaria. This means that you are more likely to become infected than a woman who isn't pregnant.

Some studies have also suggested that if you get malaria while you are pregnant, you are more likely to have a recurrence or develop complications. This is thought to be because your immunity is naturally lowered during pregnancy, to protect your growing baby.

Malaria in pregnant women can lead to complications. During pregnancy, malaria, and in particular malaria which is caused by the plasmodium falciparum parasite, can be very serious. It can even be fatal if it is not treated. It can lead to serious complications in a mum-to-be including:

anaemia, jaundice, chronic low blood sugar (hypoglycaemia), low blood pressure (hypotension), fluid collecting in the air sacs of the lungs (pulmonary oedema), making it difficult to breathe, kidney failure, liver failure.

Effect on babies:

Complications in babies resulting from the fever and infection include:

miscarriage, stillbirth, premature birth, fetal distress, Parasites infect the placenta, interfering with the flow of nutrients, and in some cases lead to:

fetal growth restriction

low birth weight (although most babies born to women with malaria have normal birth weight), a baby being more susceptible to malaria

If a pregnant woman has malaria, there is a greater risk of:

stillbirth, miscarriage, low birth weight babies, neonatal death.

There is also a small risk of the baby being born with malaria.

So, it is important to treat malaria in pregnancy as soon as it is detected, before it can lead to complications.

Transmission from mother to baby:

Malaria may be passed on from the mother to her unborn baby. However, it is thought to be rare in countries where malaria is common.

Most babies are thought to remain unharmed if the mum-to-be has malaria, as long as the malaria is treated promptly and effectively.

In some cases the baby can catch the disease through the infected placenta (vertical transmission) during pregnancy, despite treatment. When this happens it can cause serious complications, such as fetal distress during labour.

However, if caught early it can be treated so make sure to keep an eye out for symptoms, such as fever. Other signs and symptoms of malaria in babies (congenital malaria) may include jaundice and anaemia.

If you had malaria during labour, or your baby develops symptoms such as a fever, the placenta may need to be tested after birth, and your baby may need a blood test to check whether he has malaria.

What is the treatment for malaria and it is safe during pregnancy?

It's very important to take any medicines prescribed for malaria during pregnancy, because the risk of complications from untreated malaria far outweigh those of any treatment.

For severe malaria that is caused by p. falciparum parasite, the drug artesunate is usually recommended. This is given via a drip (intravenously). In less severe cases of falciparum malaria, a combination of quinine and clindamycin is often used.

Not all malaria medicines are safe to take in pregnancy. Primaquine is not generally recommended for pregnant women because there's not enough information about its safety in pregnancy, and it has been linked to complications in the third trimester.

For some types of malaria, the drug chloroquine is often recommended as it is thought to be a safer option. It should be taken weekly until your baby is born. Quinine may still be used for the treatment of malaria, particularly in the first trimester.

It's important to treat the fever of malaria in pregnancy. Paracetamol is usually recommended, a maximum of four times a day.

If you develop anaemia as a result of malaria, this is usually treated with iron and folic acid supplements. Severe malaria may need to be treated with a blood transfusion.

Some evidence suggests that in pregnancy, malaria can be particularly difficult to treat, and established treatments may not work as well. If, after treatment, your symptoms or fever return, contact your doctor immediately. You may need another blood test to confirm that the infection has gone.

Once you've recovered from an episode of malaria during pregnancy, it's important to have regular pregnancy check-ups, including blood tests to check your haemoglobin, platelet and blood sugar levels. You may need more frequent ultrasound scans to check your baby's growth.

If I've had malaria before, can I get it again?

Yes. Unfortunately, you cannot be completely immune to malaria, if you have had it just once. Your body gradually acquires some natural immunity, but only after repeated bouts of the disease.

Your immunity will wane if you are not constantly re-exposed to the disease. So protecting yourself against malaria is very important.

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