Malaria in pregnancy

In 2018 alone, 11 million pregnancies in sub-Saharan Africa were exposed to malaria, resulting in high levels of maternal anaemia and 872,000 low-birthweight babies.1  

Pregnant women infected with malaria are at increased risk of cerebral malaria and severe anaemia, as well as outcomes such as miscarriage, premature delivery and low-birthweight babies.2 

Sulfadoxine-pyrimethamine (SP), an effective intermittent preventive treatment for pregnant women 

To protect pregnant women, the WHO recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), starting as early as possible in the second trimester.  

Despite increased mobilisation from the global malaria community in recent years, among 36 African countries  that  reported  on  IPTp  coverage  levels  in  2018 only 31% of eligible pregnant women received the recommended three doses of SP.3 

Beyond SP, there are currently no alternative options for IPTp, which is especially problematic for HIV-positive pregnant women who are not eligible for the intervention. 

Treating malaria in pregnancy 

For pregnant women who become infected with malaria during their second or third trimester, the WHO recommends ACTs, which are the first-line treatment for patients with acute uncomplicated malaria. Even though they are recommended by the WHO, limited data are available in second and third trimester for the more recently approved ACTs. 

This is because pregnant women are generally excluded from research and clinical trials for fear of causing harm. As a result, when a new drug is registered, its safety and efficacy profiles in pregnancy are unknown. As additional data is required, most drugs become available to pregnant women 5–10 years later.