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Malaria

Malaria in pregnant women

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.

High-transmission settings

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

anaemia even in the absence of documented peripheral parasitaemia.

Both maternal anaemia and placental parasitaemia 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.

Low-transmission settings

In low-transmission settings, where women of reproductive age have

relatively little acquired immunity to malaria, malaria in pregnancy is

associated with anaemia, an increased risk of severe malaria, and it

may lead to spontaneous abortion, stillbirth, prematurity and low birth

weight. In such settings, malaria affects all pregnant women, regardless

of the number of times they have been pregnant.

Infections with P. vivax

Infection with P. vivax , as with P. falciparum, leads to chronic anaemia

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.

WHO recommends the following package of interventions for the

prevention and treatment of malaria during pregnancy:

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use of long-lasting insecticidal nets (LLINs);

in areas of stable malaria transmission of sub-Saharan Africa,intermittent preventive treatment in pregnancy (IPTp) withsulfadoxine-pyrimethamine (SP);

prompt diagnosis and effective treatment of malaria infections.

Intermittent preventive treatment in pregnancyIPTp reduces maternal malaria episodes, maternal anaemia, placental

parasitaemia, low birth weight, and neonatal mortality. Furthermore, all

pregnant women should receive iron and folic acid supplementation as a

part of routine antenatal care.

Read more on Intermittent preventive treatment in pregnancy (IPTp)

Last update: 25 April 2015

Key documents

Guidelines for the treatment of malaria, third edition (2015)

WHO policy brief for the implementation of intermittent preventivetreatment of malaria in pregnancy using sulfadoxine-pyrimethamine(IPTp-SP), April 2013 (revised January 2014)

Complete list of related documents

Related links

Preventive therapies for malaria

Intermittent preventive treatment

for pregnant women (IPTp)

Malaria in infants

Malaria in children under five

 All high-risk groups

WHO Evidence Review Group: intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP),July 2012pdf, 342kb

http://www.who.int/entity/malaria/mpac/sep2012/iptp_sp_erg_meeting_report_july2012.pdf?ua=1http://www.who.int/entity/malaria/areas/high_risk_groups/en/index.htmlhttp://www.who.int/entity/malaria/areas/high_risk_groups/children/en/index.htmlhttp://www.who.int/entity/malaria/areas/high_risk_groups/infants/en/index.htmlhttp://www.who.int/entity/malaria/areas/preventive_therapies/pregnancy/en/index.htmlhttp://www.who.int/entity/malaria/areas/preventive_therapies/en/index.htmlhttp://www.who.int/entity/malaria/publications/high_risk_groups/en/index.htmlhttp://www.who.int/entity/malaria/publications/atoz/policy_brief_iptp_sp_policy_recommendation/en/index.htmlhttp://www.who.int/entity/malaria/publications/atoz/9789241549127/en/index.htmlhttp://www.who.int/entity/malaria/areas/preventive_therapies/pregnancy/en/index.html