Malarial infection is transmitted by the bite of a female anopheles mosquito. Infection during pregnancy poses substantial risks to the pregnant woman, her fetus and the newborn child. If left untreated, it is detrimental to both.
The symptoms vary according to malaria transmission intensity in the given geographical area, and the individual’s level of acquired immunity.
Parasitic invasion of the red blood cell consumes haemoglobin and causes anaemia and microcirculatory disturbances.
Symptoms of malaria
The malaria signs and symptoms include
- Muscle pain
- General malaise
How should we diagnose malaria in pregnancy?
Microscopic diagnosis by thick and thin films and rapid diagnostic tests are the gold standard for diagnosis.
How does malaria affect pregnancy?
It can present as maternal and fetal mortality, miscarriage, stillbirth and premature birth, fetal growth restriction and low birth weight, maternal and fetal anaemia. Morbidity is higher with P. falciparum than non-falciparum infections.
What is congenital malaria?
In the newborn results from the passage of parasites or infected red blood cells from the mother to the newborn while in utero or during delivery. Peripartum malaria is an indication for placental histology and placenta, cord and baby blood films to detect congenital malaria at an early stage.
Treatment of malaria during pregnancy
It should be treated like an emergency with admission to hospital in uncomplicated cases and to ICU in the case of complicated malaria. Intravenous artesunate is the treatment of choice for severe falciparum malaria and intravenous quinine if artesunate is not available. Quinine and clindamycin are to be used to treat uncomplicated P. falciparum and chloroquine for P. vivax, P. ovale or P. malariae. Fever should be treated with antipyretics.
Does pregnancy affect the efficacy of malaria treatment?
Treatment in pregnancy may have lower efficacy and women should be informed about the risk of recurrence. Weekly screening of blood film until delivery is recommended for early detection.
How should we monitor for complications?
Regular monitoring of blood sugar levels, CVP (central venous pressure) monitoring and test for secondary bacterial infection if there is hypotension are done along with fetal surveillance.
Specific pregnancy complications due to malaria
Common obstetric problems are preterm labour, fetal growth restriction and fetal heart rate abnormalities and stillbirths. A multidisciplinary team approach is required to plan most advantageous management of mother and baby.