Malarial infection during pregnancy is a major public health problem with substantial risks for the mother, her fetus and the neonate. Pregnant women are especially at high risk for malaria because of their change in the immune system during pregnancy and the presence of a new organ (placenta). With new places for the parasite to bind, pregnant women lose their immunity. Anti-malarial drugs have been used in various ways to prevent malaria in the resident population of endemic areas for nearly 100 years.
Chemoprophylaxis is highly effective in reducing mortality and morbidity from malaria in young children and pregnant women living in endemic areas. Malaria during pregnancy is a major cause of anemia and neonatal death and one of the main causes of low birth weight. The unique treatment of malaria in pregnancy was first described 75 years ago. Several chemoprophylaxis has been used for decades. The IPTp was first tested in 1995. WHO recommends IPTp with sulfadoxine (500mg)-pyrimethamine (25mg) (IPTp-SP) in all areas with moderate to high malaria transmission.
Malaria infection during pregnancy can have adverse effects on both mother and fetus including maternal anemia, fetal loss, premature delivery, intrauterine growth retardation and low birth weight infants. It is a particular problem for women in their pregnancy and for women in their first and second pregnancy and HIV positive women. In Africa, malaria infection in pregnancy is a major threat to the lives of all the mothers and fetuses and mothers.
Main points in preventive treatment according to WHO recommendations are-
Intermittent Preventive Treatment in Pregnancy (IPTp) with sulfadoxine and pyrimethamine is given to all pregnant women starting as early as possible in the second trimester. The women should receive at least 3 doses of SP during her pregnancy, with each dose being given at least 1 month apart – SP can safely be administered up until the time of delivery.
IPTp in pregnancy is a full therapeutic course of anti-malarial medicine given to pregnant women at routine antenatal care visits, regardless the women are infected with malaria or not. The symptoms and complications of malaria in pregnancy vary according to malaria transmission intensity in the given geographical area- stable (high) or unstable (low) transmission.
Use of insecticide-treated bed nets.
Intermittent preventive treatment for women in high transmission areas.
Effective case management.
Women should also receive iron-folate supplementation to protect against anemia, a common occurrence among all pregnant women. However high doses of folic acid counteract the effect of SP, therefore it is preferred that women take the only 0.4mg daily recommended dose of folic acid. Sometimes it is recommended to withhold folic acid supplementation for 2 weeks.
Duration for post-treatment prophylaxis is likely to be an important determinant of the benefit of IPTp.
More effective anti-malarial drugs need to be evaluated for IPtp in both low and high transmission areas.