Malaria in Pregnancy

Anopheles (/əˈnɒfɪliːz/) is a genus of mosquito first described and named by J. W. Meigen in 1818. About 460 species are recognized; while over 100 can transmit human malaria, only 30–40 commonly transmit parasites of the genus Plasmodium, which cause malaria in humans in endemic areas.

The infection also through transfusion of infected blood and from mother to child through the placenta

The plasmodium parasite species causing this infection are- P.falciparum, P.malariae, P.vivax.

Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. Malaria-associated maternal illness and low birth weight is mostly the result of Plasmodium falciparum infection and occurs predominantly in Africa.

The symptoms and complications of malaria in pregnancy vary according to malaria transmission intensity in the given geographical area, and the individual’s level of acquired immunity.

In high-transmission settings, where levels of acquired immunity tend to be high, P. falciparum infection is usually asymptomatic in pregnancy.

Yet, parasites may be present in the placenta and contribute to maternal anemia even in the absence of documented peripheral parasitemia

Both maternal anemia and placental parasitemia can lead to low birth weight, which is an important contributor to infant mortality.

In high-transmission settings, the adverse effects of P. falciparum infection in pregnancy are most pronounced for women in their first pregnancy

In low-transmission settings, where women of reproductive age have relatively little acquired immunity to malaria, malaria in pregnancy is associated with anemia, an increased risk of severe malaria, and it may lead to spontaneous abortion, stillbirth, prematurity and low birth weight.

In such settings, all pregnant women, regardless of the number of times they have been pregnant, are highly vulnerable to malaria.

Infection with P. vivax, as with P. falciparum, leads to chronic anemia and placental malaria infection, reducing the birth weight and increasing the risk of neonatal death.

For women in their first pregnancy, the reduction in birth weight is approximately two thirds of what is associated with P. falciparum, but with P. vivax the effect appears to increase with successive pregnancies.

About 40% of people worldwide are exposed

Endemic in Nigeria, responsible for >60% of clinic attendance in Nigeria.

Associated with 11% of maternal deaths worldwide

Causes about 15% of anemia in pregnancy

Accounts for 5-14% of low birth weight

Economic loss due to malaria > US$3bn annually

• Level of individual innate immunity
• Genotype –common in HbSS
• Primigravida
• HIV positive status of the woman
• Overcrowding accommodation
• Poverty
• High rainfall area pattern
• Humidity > 60mm Hg
• Temperature of 20-30 degrees C
• Altitude < 2000 meters

• Anemia, mild to moderate degree
• Spontaneous abortion
• Intra Uterine Growth Restriction
• Fetal distress
• Premature death
• Stillbirth
• Low Birth Weight
• High infant death
• Maternal mortality

WHO recommends IPTp with sulfadoxine-pyrimethamine (IPTp-SP) in all areas with moderate to high malaria transmission in Africa. It is to be 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 reduces maternal malaria episodes, maternal and fetal anemia, placental parasitemia, low birth weight, and neonatal mortality.

Long Lasting Insecticide Treated Nets (PermaNet) – kills or repels mosquitoes that touch net. Also effective against other insects.

Other methods of prevention also encouraged are:

• Provision of mosquito nets on windows & doors, wearing protective clothing that covers arms & legs when outside the house, use of mosquito repellant, spray rooms with aerosol.
• Remove breeding sites by; disposing of old &unused containers, removal of stagnant water, cutting of bushes around dwelling places

From history taken & physical examination, diagnosis of mild or severe malaria variety should be made:

• Mild variety - fever, chills, headache, muscle/joint pains, nausea, vomiting.
• Severe variety – impaired consciousness, respiratory distress, multiple convulsions, circulatory collapse, pulmonary edema, abnormal bleeding, jaundice, severe anemia, renal failure, etc.

Laboratory investigations

Blood smear for malaria parasite, thick & thin films. Packed cell Volume, Genotype, Urinalysis, Blood glucose, Lumber puncture (in the unconscious patient).

Principle is - prompt diagnosis and effective treatment of malaria infections.

Treatment – drug of choice is QUININE oral or parenteral. It is safe at all stages of pregnancy. 2nd line drug is Artemisinine combination therapy (ACT).

Support therapy may be needed with, analgesics/antipyretic, intravenous fluids, steroids, blood transfusion, oxygen, etc.

On Wednesday, 6 October 2021 17:52 GMT, WHO backs rollout of malaria vaccine (GSK’s Mosquirix) for African children

GlaxoSmithKline’s Mosquirix, 30 years in making, is 1st malaria vaccine

WHO recommendation comes after pilot in 3 African countries - Ghana, Kenya & Malawi.