Malaria eradication impossible without addressing pregnancy treatment and prevention options

Malaria eradication impossible without addressing pregnancy treatment and prevention options

Pregnant women are particularly vulnerable to malaria, but have woefully few options. Changes to data collection and the way trials are run could speed up the search for suitable medicines, and are a crucial part of eradicating the disease.

Anastasia Mboshe, a pregnant woman from a rural Zambian village, where malaria is endemic and commonly affects pregnant women

Photo: Toby Madden/Transaid


Malaria is particularly devastating during pregnancy. It increases the risk of gestational hypertension, anaemia and miscarriage for the mother, as well as preterm birth and low birthweight in the infant.1

The only way to prevent infection is monthly sulfadoxine-pyrimethamine (SP-IPTp). However, it can’t be used in the first trimester, when 60% of malaria infections occur.1 “There really are no approved medicines to prevent malaria in first-trimester pregnancy,” says Wiweka Kaszubska, head of product development at Medicines for Malaria Venture (MMV) in Geneva, Switzerland.

The options for treatment were equally limited until late 2022, when the World Health Organization recommended artemether-lumefantrine (AL) for use during first-trimester pregnancy.1 It took almost 25 years for this medicine to be recommended, mainly owing to a lack of evidence. “It's very difficult to collect data on safety in pregnancy, particularly in the first trimester,” explains Kaszubska.

One reason for the data gap is because pregnant women are systematically excluded from clinical trials for fear of causing harm. Instead, safety and efficacy data for use in pregnancy often come from inadvertent exposure, when someone takes the medicine before they realize they’re pregnant. Relying on this chance event delays recommendation for first-trimester use of malaria drugs by decades. A more systematic way of collecting data is needed.

Read the full op-ed on the Nature Portfolio website.