Malaria in Pregnancy

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Malaria can contribute to pregnancy complications such as abortion, poor foetal mental development, premature labour, intrauterine growth retardation and foetal death, severe maternal anaemia due to haemolysis, and death.

Complications are more common in mothers of low gravidity (primi- and secundigravidae), HIV positivity, adolescent age, sickle-cell disease, and those from areas of low endemicity, e.g. in Kisoro and Kabale.

See Malaria for more information on features and diagnosis of malaria.

Management of Malaria in Pregnancy

APPROACH

MANAGEMENT

Prophylaxis All pregnant mothers except those with HIV on cotrimoxazole prophylaxis
  • Intermittent Preventive Treatment (IPTp) with Sulphadoxine/ pyrimethamine (SP) once a month starting at 13 weeks until delivery

Treatment of Uncomplicated malaria in 1st trimester
  • Quinine oral 600 mg 8 hourly for 7 days (if Quinine not available, ACT may be used)

Treatment of Uncomplicated malaria in 2nd and 3rd trimesters

First line

  • Artemether/Lumefantrine

80/480 mg 12 hourly for 3 days

First line alternative

  • Dihydroartemisinin/ Piperaquine 3 tablets (1080 mg) once daily for 3 days

And if no response

  • Quinine, oral 600 mg 8 hourly for 7 days

Severe malaria All trimesters and lactation
  • IM/IV Artesunate 2.4 mg/kg at 0, 12 and 24 hours, then once a day until mother can tolerate oral medication. Complete treatment with 3 days of oral ACT

First line alternative

  • IM artemether 3.2 mg/kg loading dose then 1.6 mg/ Kg once daily until mother can tolerate oral medication. Complete treatment with 3 days of oral ACT

If artesunate or arthemeter not available, use

  • Quinine 10 mg/Kg IV every 8 hours in Dextrose 5%

Caution

Quinine is associated with an increased risk of hypoglycaemia in late pregnancy

Prevention and control of malaria in pregnancy

  • Use insecticide-treated mosquito nets (ITN) before, during, and after pregnancy. 
  • Give all pregnant women intermittent preventive treatment (IPTp) with sulfadoxine pyrimethamine (SP) – Except in allergy to sulphonamide
  • Prompt diagnosis and effective treatment of malaria in pregnancy

Education messages to mothers and the community

  • Malaria is transmitted by female anopheles mosquitoes
  • Pregnant women and children are at particular risk of malaria
  • If untreated, malaria can cause severe anaemia and death in pregnant women
  • Malaria can lead to anaemia, miscarriage, stillbirth, mentally-retarded children, or low birth weight children, who are more prone to infant/childhood mortality compared to normal weight children
  • It is better and cheaper to prevent than to treat malaria
  • The individual, family, and the community can control malaria by taking appropriate actions
  • Sleeping under an insecticide-treated mosquito net is the best way to prevent malaria
  • It is very important to complete the course of treatment in order to achieve a cure
  • Severe complicated malaria needs special management, therefore refer