Pregnancy

Advise pregnant women to avoid travel to malaria-endemic areas if possible. Women who choose to go to areas with malaria can reduce their risk of acquiring malaria by taking appropriate malaria chemoprophylaxis and following insect precautions (see Chapter 2, Protection against Mosquitoes, Ticks, and Other Insects and Arthropods and Chapter 3, Malaria). Pregnant women should use insect repellents as recommended for adults sparingly, but as needed. Pyrethrum-containing house sprays may also be used indoors, if insects are a problem.

Antimalarial Medications

For pregnant women who travel to areas with chloroquine-sensitive Plasmodium falciparum malaria, chloroquine can be taken for malaria chemoprophylaxis, since it has been used for decades with no documented increase in birth defects. For pregnant women who travel to areas with chloroquine-resistant P. falciparum, mefloquine should be recommended for chemoprophylaxis. Evidence suggests that mefloquine prophylaxis causes no significant increase in spontaneous abortions or congenital malformations when taken during pregnancy. (Updated October 26, 2011)

Because there is no evidence that chloroquine and mefloquine are associated with congenital defects when used for prophylaxis, CDC does not recommend that women planning pregnancy wait a specific period of time after their use before becoming pregnant. However, if women or their health care providers wish to decrease the amount of antimalarial drug in the body before conception, Table 8-07 provides information on the half-lives of selected antimalarial drugs. After 2, 4, and 6 half-lives, approximately 25%, 6%, and 2%, respectively, of the drug remain in the body.

Doxycycline and primaquine are contraindicated for malaria prophylaxis during pregnancy, because both may cause adverse effects on the fetus. Atovaquone-proguanil is not recommended for use by pregnant women to prevent malaria because of the lack of safety studies during pregnancy.
Treatment and Management

Malaria must be treated as a medical emergency in any pregnant traveler. A woman who has traveled to an area that has chloroquine-resistant strains of P. falciparum should be treated as if she has illness caused by chloroquine-resistant organisms. The management of malaria in a pregnant woman should include frequent blood glucose determinations and careful fluid monitoring (being careful not to give too much intravenous fluid).

Table 8-07. Half-lives of selected antimalarial drugs