MALARIA PROPHYLAXIS IN PREGNANCY

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(Date of issue: February 2019, Version: 3)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on malaria prophylaxis in pregnancy is available at www.medicinesinpregnancy.org.

Summary

Malaria is caused by a protozoan parasite, Plasmodium and transmitted by the Anopheles mosquito insect vector.

Malaria in pregnancy is associated with high rates of maternal and fetal mortality. Adverse effects of malaria in pregnancy include miscarriage, stillbirth, low birth weight, preterm delivery, fetal growth restriction, congenital malaria, susceptibility to malaria in the offspring, and maternal anaemia, hypoglycaemia, jaundice, renal failure, hyperpyrexia and pulmonary oedema.

It is recommended that pregnant women avoid travel to malaria-prone areas. If travel is unavoidable, the use of chemoprophylaxis and personal protective measures are strongly recommended.

Personal protective measures include the use of insect repellents containing 20-50% diethyl-m-toluamide (DEET), sleeping under insecticide-impregnated nets, wearing long sleeved clothes and full legged trousers to reduce exposed surface area, and avoiding going outside during dusk and dark when the insect vector is most active.

Chemoprophylactic antimalarials typically include chloroquine, mefloquine, proguanil, Malarone® (atovaquone-proguanil combination) and doxycycline. Choice of medication for effective chemoprophylaxis is guided by the existing patterns of parasite resistance in the area of travel, the possibility of adverse maternal side effects and patient-specific medical history. Please refer to the specific UKTIS monographs on individual antimalarials for further information.

Considering the maternal and fetal risks posed by gestational malaria infection, antimalarials should not be withheld during pregnancy where clinically indicated. Therapeutic antimalarial exposure in pregnancy would not usually be regarded as medical grounds for termination. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments. Discussion with UKTIS is recommended in all cases.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.