Antimalarial

THE SAFETY OF ANTIMALARIAL MEDICATIONS DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

THIS MEDICATION CAN CAUSE HARM TO YOUR BABY:
Malaria can cause serious harm to your baby, including premature delivery, low birth weight, miscarriage, or death. The benefits of treatment with most antimalarial medications outweigh the potential risks to your baby.

What are antimalarial medications?

Antimalarial medications are drugs that are used to kill the parasites that cause malaria. These medications are often recommended by your doctor prior to traveling to a region of the world where malaria is present. If you are taking these medications to prevent malaria, they should be taken before traveling, while you are staying in the area, and for a short time after you return home. Types of antimalarial medications that are available include: chloroquine (Aralen), quinine sulfate (Qualaquin), hydroxychloroquine (Plaquenil), mefloquine (Lariam), and atovaquone/proguanil (Malarone). These medications are only available by prescription from your doctor. 

What are antimalarial medications used to treat?

Antimalarial medications are used to treat malaria in people who are infected with the disease or to prevent malaria in those who are traveling to areas where malaria is present. Malaria is a disease that is caused by a parasite. Humans can get this parasite if they are bitten by an infected mosquito in certain parts of the world with tropical and subtropical climates. This disease is also spread by the blood of an infected individual, so you can get malaria by sharing needles used to inject drugs or by receiving a blood transfusion.

After the parasite has infected you, it causes repeated episodes of high fever, moderate to severe chills, and sweating. The symptoms of the disease will usually develop within a few weeks after a bite from an infected mosquito, but the parasites can remain in your body for up to 1 year without causing symptoms. In severe cases, malaria can cause death. There is currently no vaccine available for this disease, so antimalarial drugs are used instead to prevent malaria.

How do antimalarial medications work?

There are many different classes of antimalarial medications available, but they all act to kill the parasites that cause malaria. Each antimalarial medication targets different types of parasites, so a medication will be chosen based on which parasite the person is infected with and the severity of the disease. Many types of malaria-causing parasites have also developed resistance to antimalarial medications, which complicates treatment.  

If I am taking an antimalarial medication, can it harm my baby?

Expecting moms who become infected with malaria are 3 times more likely to develop a severe form of the disease than women who are not pregnant. Malaria also presents a high risk for serious problems in your baby, including premature delivery, miscarriage, low birth weight, or death. Expecting moms who become infected with malaria during pregnancy can pass this disease to their baby. Due to the serious health risks that a malaria infection poses to both the mom and the baby, the CDC recommends that pregnant women obtain treatment for this disease if they become infected. In this case, the benefits of antimalarial medications to both you and your baby outweigh potential risks.

The CDC recommends that pregnant women avoid traveling to areas where malaria is present. You can determine if the area you are traveling to has malaria by looking at the Malaria Maps available from the CDC. If you must travel to a country with malaria, it is important to speak with your doctor about your traveling plans so that an antimalarial medication can be prescribed prior to your trip. Additionally, you should take proper precautions to protect yourself from mosquito bites when traveling to these areas, including wearing long-sleeved clothing and pants, using a bed net for sleeping, staying in an area with screens over windows and doors, and using insect repellant for flying insects. You can read more about using insect repellant during pregnancy here.

Which antimalarial medications are prescribed for treatment?

Each recommendation will differ depending on the type of parasite that you are infected with. Chloroquine or hydroxychloroquine are the antimalarial drugs that are recommended for treatment of pregnant women with malaria. They are considered safe when used in all trimesters of pregnancy. Some types of parasites will be resistant to certain antimalarial medications, making these medications ineffective. For expecting moms who have a chloroquine-resistant disease, mefloquine or the combination of quinine sulfate and clindamycin are recommended.

Mefloquine: The CDC concluded in 2011 that expecting moms who took mefloquine at doses used for the treatment and prevention of malaria did not have an increased risk of birth defects or health problems in their baby. 

Quinine: There are concerns that quinine may be harmful to your baby or induce labor when used late in pregnancy, but there is no evidence that these consequences occur at the doses used for treatment of malaria. Another concern is that when quinine is taken late in pregnancy, the medication is passed to the baby and may cause low blood sugar.

Which antimalarial medications are used for prevention?

Chloroquine or mefloquine are recommended for prevention of malaria in expecting moms who are traveling to areas where malaria is present.

Which antimalarial medications can harm my baby and should be avoided?

Primaquine is a type of antimalarial medication that should not be used in pregnant women. It can cause a potentially life-threatening blood disorder in babies who have a certain type of genetic disorder. Atovaquone/proguanil and artemether/lumefantrine are types of antimalarial medications that are generally not recommended for expecting moms because there are no studies reviewing the safety of these medications in pregnant women. They still might be used in certain types of malaria infections if other treatments are not available or cant be used, and if the benefits of treatment outweigh potential risks. Doxycycline and tetracycline are antibiotics, but they are sometimes used to treat malaria. These medications are not recommended for use in expecting moms. Tetracycline, which is similar to doxycycline, has been shown to cause discoloration of teeth, problems with tooth enamel, and reduced bone growth in babies exposed to this medication during pregnancy. 

Bottom line: Malaria poses serious risks to both the expecting mom and the baby. Treatment for this disease is recommended because the benefits of treatment outweigh the potential risks to your baby. 

If I am taking an antimalarial medication and become pregnant, what should I do?

If you are taking an antimalarial medication and become pregnant, you should contact your doctor immediately. Your doctor will determine whether your treatment should be continued, or if an alternative antimalarial medication should be used.

If I am taking an antimalarial medication, can I safely breastfeed my baby?

Antimalarial medications that are considered safe for breastfeeding:

Some antimalarial medications may be continued while breastfeeding. Both chloroquine and mefloquine are considered safe for breastfeeding by the CDC because these medications can be safely prescribed to babies. Some guidelines not associated with the CDC recommend the use of hydroxychloroquine instead of chloroquine if an antimalarial medication needs to be taken daily. Hydroxychloroquine is considered acceptable during breastfeeding by international experts. Several case reports have described moms who took hydroxychloroquine while breastfeeding their baby. There were no changes observed in eye sight, hearing, or growth in any of the breastfed babies.

Antimalarial medications that requi
re caution when breastfeeding and should be avoided in some cases:

Primaquine can cause a potentially life-threatening blood disorder in babies who have a certain genetic disorder. Prior to treatment with primaquine, a genetic test is required for both the mom and baby to determine if they have a G6PD deficiency. The CDC recommends that if both the mom and baby have normal G6PD, primaquine can be used while breastfeeding.

The CDC does not recommend using atovaquone/proguanil in moms who are nursing babies that weigh less than 11 pounds. However, there may be some cases where the benefits of using atovaquone/proguanil outweigh the risks. This is a decision that your doctor will help you make.

Some reviews have stated that doxycycline and tetracycline should be avoided while breastfeeding, but other guidelines have determined that these medications are unlikely to harm the baby when used short-term. Doxycycline and tetracycline are usually avoided while breastfeeding due to fears that they can cause discoloration of the babys teeth. However, this side effect has never been reported in babies who were exposed to these medications through breastmilk. It is thought that the calcium in breast milk may interfere with the babys absorption of these medications, so it is likely that the drug has little effect on the baby. No side effects have been reported in moms who have used tetracycline while breastfeeding. There is no data available on the safety of doxycycline while breastfeeding. Both doxycycline and tetracycline are considered acceptable for breastfeeding when used for a short period of time. Moms who take one of these medications while breastfeeding should monitor their baby for a rash, diarrhea, or diaper rash.

If I am taking an antimalarial medication, will it be more difficult to get pregnant?

There are no studies available on the effects of antimalarial medications on fertility. However, one case has been reported of a man who developed problems with sperm counts and function after becoming infected with malaria and taking antimalarial medications. It is unknown whether these effects were due to the malaria infection or the medications. Since evidence is very limited, no conclusions can be made on the effects of these medications on fertility.

Women who are taking antimalarial medications should contact their doctor if they are planning to become pregnant. Due to the severity of malaria and its serious effects on the baby, your doctor may recommend that you finish your treatment prior to becoming pregnant.

If I am taking an antimalarial medication, what should I know?

The benefits of treatment for malaria are considered to outweigh the potential risks to your baby for most antimalarial medications. Expecting moms who are infected with malaria should get treatment for the disease because untreated malaria poses serious health risks to both you and your baby. It is not recommended for expecting moms to travel to regions of the world where malaria is present. If travel is required, you should speak with your doctor about obtaining antimalarial medication to take with you on your trip. Special precautions should also be taken to ensure that expecting moms do not get bitten by mosquitos while staying in areas that have malaria.

Many antimalarial medications are considered safe while breastfeeding. Your doctor will choose the most appropriate antimalarial medication for you depending on the severity of the disease. 

If I am taking any medication, what should I know?

This report provides a summary of available information about the use of antimalarial medications during pregnancy and breastfeeding. Content is from the product label unless otherwise indicated.

You may find Pregistry’s expert report about malaria here.  Additional information can also be found in the resources below. 

Resources for antimalarial medications during pregnancy and breastfeeding:

For more information about antimalarial medications during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:

 

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Last Updated: 31-01-2018
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.