Malaria Treatment for Pregnant Women

Clinical resources

Malaria in pregnant women

While the mechanism is poorly understood, pregnant women have a reduced immune response and, therefore, less effectively clear infections, including with malaria. In addition, malaria parasites sequester and replicate in the placenta. Pregnant women are three times more likely to develop severe disease than non-pregnant women who acquire malaria in the same geographic area. Malaria infection during pregnancy can lead to:

• Miscarriage
• Premature delivery
• Low birth weight
• Congenital infection, and
• Perinatal death

These adverse effects are most associated with Plasmodium falciparum, though they can also be seen with Plasmodium vivax.

Uncomplicated malaria treatment

Acute blood stage treatment regimens for uncomplicated malaria in pregnant women are the same as other adults, except that atovaquone-proguanil and doxycycline/ tetracycline should not be used. See Malaria Treatment Table 4 for specific drug and dosing recommendations.

Atovaquone-proguanil is not indicated for use in pregnant women because of the paucity of data on its safety in pregnant women. However, for pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. falciparum infection, atovaquone-proguanil may be used if other treatment options are not available or are not well tolerated, and if the benefits are deemed to outweigh the potential risks.12

Doxycycline and tetracycline are generally not indicated for use in pregnant women. However, in rare instances, doxycycline (but not tetracycline) can be used in combination with quinine if other treatment options are not available or are not well tolerated, and the benefits of adding doxycycline are deemed to outweigh the risks.

P. vivax or P. ovale anti-relapse treatment

For P. vivax or P. ovale infections, primaquine phosphate and tafenoquine for radical treatment of hypnozoites are contraindicated during pregnancy. Pregnant patients with P. vivax or P. ovale infections should be maintained on chloroquine chemoprophylaxis for the duration of their pregnancy. The chemoprophylactic dose of chloroquine phosphate is 300 mg base (500 mg salt) orally once a week. After delivery, pregnant women with normal quantitative glucose-6-phosphate dehydrogenase (G6PD) activity require subsequent anti-relapse treatment (see anti-relapse treatment for additional information).

For breastfeeding mothers, infants should be tested for G6PD deficiency. If the infant has normal activity, oral primaquine phosphate or tafenoquine can be given to the mother. Women who are unable to take primaquine or tafenoquine after delivery should be maintained on weekly chloroquine chemoprophylaxis for a total of one year following the acute malaria episode. If the infection was acquired in an area with chloroquine resistance, consult with an expert in infectious disease or malaria, such as the CDC Malaria Hotline.

Severe malaria treatment

Pregnant women diagnosed with severe malaria should be closely monitored and treated with parenteral antimalarial therapy. See treatment of severe malaria for additional information.