INFORMATION FOR WOMEN WHO HAVE MALARIA DURING PREGNANCY OR BREASTFEEDING
What is malaria and how does it differ from sickle cell disease?
Malaria is an infectious disease resulting from a parasite called Plasmodium that can infect red blood cells, the liver, and other parts of the body, including the placenta. There are several species of Plasmodium that cause malaria in humans and all of them are carried to humans by a type of mosquito called Anopheles. Because Anopheles lives only in certain ranges of temperature, and because of public health measures that have been carried out since the early 20th century, people contract malaria today mostly in tropical areas. However, because of frequent intercontinental travel, the disease can occur anywhere, even in a cold, western city in the middle of winter. Malaria presents itself with severe fever and chills, along with sweating, fatigue, headache, muscle pains, and nausea and vomiting. It also causes anemia low number of red blood cells which, if severe, can lead to heart failure.
How common is malaria during pregnancy?
Malaria affects millions of people around the world every year, accounting for approximately 15 percent of anemia occurring in pregnant women, 14 percent of infants born underweight, 30 percent of low birth weight cases that are preventable, 70 percent of intrauterine growth retardation (the fetus stops growing within the womb), 36 percent of premature births, and 8 percent of infant deaths.
How is malaria during pregnancy diagnosed?
Usually, malaria is initially based on a combination of your symptoms and travel history. For instance, if you have a very severe fever with sweating, headaches, nausea and vomiting, and muscle pains, and you have just returned home from an area of the world where malaria is endemic (present all the time), malaria is very high on the list of possible diseases you may have. However, the diagnosis is confirmed with laboratory testing of a blood smear (a sample of your blood is smeared onto a glass slide that is observed under a microscope) showing the Plasmodium parasite. Along the way, other tests would be performed, such as a complete blood count (CBC), which can reveal anemia, antibody tests, and genetic tests. Once the parasite is found, there will also be tests to see whether they resist certain anti-malaria medications.
Does malaria cause problems during pregnancy?
If left untreated, malaria could be fatal, especially among those people with little or no immunity to the condition. Those most vulnerable both to getting malaria and to serious complications and death are people who are immunocompromised (such as those infected with human immune deficiency virus (HIV, which causes AIDS) and those who are not native to regions where malaria is common. In parts of the world where plasmodium parasites are common, women have a certain amount of immunity and, therefore, they often do not develop the severe kind of malaria. In such cases, however, infection with the plasmodium parasites often does produce anemia in pregnant women. People who do not have sickle cell trait, thalassemia trait, or minor forms of genetic conditions that affect hemoglobin are at higher risk of contracting severe malaria, whereas those with those genetic conditions are somewhat protected.
Does malaria during pregnancy cause problems for the baby?
Full-blown malaria (the type with high fever and chills) can lead to the baby’s death, even when the mother survives. In parts of the world where Plasmodium parasites are common (called high transmission areas), women have a certain amount of immunity and, therefore, they often do not develop the severe type of malaria. However, in such cases, infection with the Plasmodium parasites may produce anemia in pregnant women and can lead to “placental malaria”. Placental malaria is a Plasmodium infection of the placenta which can cut off the supply of blood and nutrients to the developing baby, leading to spontaneous abortion (or the baby’s death without expulsion from the womb), intrauterine growth retardation (the fetus does not grow within the womb), or low birth weight. These problems are more common in women who are in their first or second pregnancy compared to women who have been pregnant more times.
What to consider about taking medications when you are pregnant or breastfeeding:
- Any risks to yourself and your baby if you do not treat malaria.
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat malaria during pregnancy?
Malaria could be a fatal disease. Even when it is not fatal to the mother, it can still cause very severe damage to the baby. Thus, antimalarial medication has to be initiated as soon as the diagnosis is made. Furthermore, antimalarial medication to prevent malaria is recommended for people who are traveling in malaria-infested parts of the world. The following anti-malaria drugs are considered safe and approved for use during pregnancy (for prevention or treatment): chloroquine, amodiaquine, azithromycin, sulfadoxine-pyrimethamine, quinine, mefloquine, dapsone-chlorproguanil, lumefantrine, artemisinin derivatives, atovaquone-proguanil.
Who should NOT stop taking medication for malaria during pregnancy?
Everybody who is found to have malaria must take anti-malaria medication. Furthermore, if you are traveling in a region where malaria is present, you must take medication to prevent infection, which is a far better option than carrying the risk of getting the disease whether or not you are pregnant. The US Center for Disease Control and Protection recommends that pregnant women traveling in malaria-infested regions follow the same recommended treatment (medication type and dosage) that is issued for anybody, pregnant or not, traveling in the region.
What should I know about choosing a medication for malaria during pregnancy?
You may find Pregistrys expert reports about the individual medications to treat malaria here. Additional information can also be found in the sources listed at the end of the report.
What should I know about taking a medication for my malaria when I am breastfeeding?
If you contract malaria, it is highly unlikely that you will be breastfeeding, as you will probably be too ill to do it. If you are traveling in a region where malaria is present, you must take medication to prevent infection in the first place. This this does pose any problem with breastfeeding. The US Center for Disease Control and Protection recommends that women who are nursing and traveling in malaria-infested regions follow the same recommended treatment (medication type and dosage) that is issued for anybody traveling in the region.
What alternative therapies besides medications can I use to treat my malaria during pregnancy?
No alternatives to drugs are available for treating malaria. However, for the prevention of malaria, one of the most effective measures is in
secticide-treated netting (ITN). Drainage or elimination of standing water sources is also helpful since mosquitos are attracted to standing water. Insect repellent is helpful too, plus it is prudent to dress in clothing that covers your entire body. It is nevertheless a good idea to take the type of anti-malaria medication that is recommended to travelers for the prevention of infection because ITN and clothing are not 100 percent reliable.
Various high-tech options are also under development. One such option is a malaria vaccine, the development of which the Bill and Melinda Gates Foundation has been supporting for many years. Another option that looks promising involves genetically modified male Anopheles mosquitos that can be introduced into malaria-infested regions of the world. Only female mosquitos bite humans, but the modified male mosquitos mate with the females to produce either sterile baby mosquitos or mosquitos that never hatch. The most advanced genetic modification project involves what is called a “gene drive”. In this method, experimental male mosquitos carry a gene that makes mosquitos immune to Plasmodium parasites, and that gene is transmitted through succeeding generations of mosquitos until the entire population of the insects is immune to the parasite.
What can I do for myself and my baby when I have malaria during pregnancy?
Were you to contract malaria while pregnant, you would be admitted to the hospital, in which case there wouldnt be much to decide.
Resources for malaria in pregnancy:
For more information about malaria during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:
- US Food and Drug Administration: Malaria Fast Facts.
- World Health Organization: Malaria in Pregnant Women.