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5.3: Malaria in Pregnancy

Table of Contents

Malaria is an important cause of morbidity and mortality for the pregnant woman, the foetus and the newborn. The effects of malaria in pregnancy are related to the malaria endemicity, with abortion more common in areas of low endemicity and intrauterine growth retardation more common in areas of high endemicity. Hence, early diagnosis and effective case management of malaria illness in pregnant women is crucial in preventing the progression of uncomplicated malaria to severe disease and death.

5.3.1  Uncomplicated Malaria In Pregnancy

In high-transmission areas (moderate to high immunity); malaria is usually asymptomatic in pregnancy or is associated with only mild, non-specific symptoms. (See section 5.1 above)

Pharmacological Treatment 

First trimester of pregnancy

A: Quinine tablets 10mg/kg 8 hourly

Second and third trimester of pregnancy

During the second and third trimesters of pregnancy artemether-umefantrine is the drug of choice

5.3.2 Severe Malaria In Pregnancy

In low-transmission areas (low malaria immunity); women in the second and third trimesters of pregnancy are more likely to develop severe malaria than other adults, often complicated by pulmonary oedema and hypoglycaemia.

The following are common features of severe malaria during pregnancy:

  • High fever
  • Hyperparasitemia
  • Low blood sugar
  • Severe haemolytic anaemia
  • Cerebral malaria
  • Pulmonary oedema

Pharmacological Treatment 

The management of severe malaria in pregnant women does not differ from the management of severe malaria in other adult patients. (See section 5.2 on Management of Severe Malaria).

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