A woman in Sub-Saharan Africa who develops malaria during her pregnancy is at greatly increased risk of severe illness and death, both for herself and for her unborn child. Malaria during pregnancy kills 10,000 women and 200,000 fetuses and newborns each year. Malaria and pregnancy are mutually aggravating conditions. Pregnancy alters the ability of the woman’s immune system to combat malarial parasitemia, so the chances of severe complications such as hypoglycemia and cerebral malaria are greatly increased. The parasite also invades the placenta, causing intrauterine growth retardation and fetal death. Some otherwise effective medications are also contraindicated during pregnancy, either because of known toxicity or because their risk is unknown.
Two preventive interventions have been proven to reduce the incidence and morbidity of malaria during pregnancy. One is the use of insecticide treated bed nets. The other is intermittent preventive treatment with a dose of sulfadoxine-pyrimethamine with each prenatal visit. (NOTE: should not be given during the first trimester of pregnancy.) Both of these preventive measures are currently underutilized. Overall estimates of the use of bed nets during pregnancy are 39% as of 2010. Most pregnant women who have bed nets use them, so the problem lies with distribution and access. The use of intermittent antimalarial treatment during pregnancy is estimated at only 22% as of 2012, although the drug is inexpensive and available in the majority of prenatal clinics. Investigations have shown that the main problem is inadequate instruction of clinic personnel in the timing and importance of treatment.
Our support of the Imagine No malaria Campaign needs to include an awareness of this important information, and the need to emphasize the use of bed nets and intermittent preventive doses of sulfadoxine-pyrimethamine during pregnancy.
Ref: Lynch et al. Malaria in pregnancy: increasing access and improving delivery of interventions. www.thelancet.com/infection Vol. 13, December 2013.
Submitted by Roger Boe MD