Which malaria drug is safe for a pregnant woman?

Key takeaways

• Pregnant women are at a higher risk of getting severe malaria. It is the leading cause of complications and death in pregnant women.
• The most severe and life-threatening form of malaria is caused by Plasmodium falciparum, which is common in most African countries.
• Malaria drugs that are safe for pregnant women include quinine, chloroquine, artesunate, and mefloquine.

Malaria is an infectious and life-threatening disease common in tropical regions. However, it is also a preventable and curable disease.

The plasmodium parasites cause malaria. Several plasmodium parasites are responsible for causing malaria, but the most common one in Africa is Plasmodium falciparum. Other types of plasmodium parasites that cause malaria in humans include Plasmodium ovale, Plasmodium vivax, and Plasmodium malariae. 

The female Anopheles mosquito usually transmits the Plasmodium falciparum parasite. You get malaria when a mosquito carrying this parasite bites you. However, malaria can be prevented by using treated mosquito nets or taking certain medicines. 

Malaria is rare in some places, like the United States, but common in tropical regions like Africa. According to WHO, Africa has a disproportionately high share of the global malaria burden, with 95% of all malaria cases coming from this region in 2021. 

Also, malaria is more common in children, pregnant women, and people living with HIV/AIDS. In 2018,  11 million pregnant women were exposed to malaria infections.

Are all malaria drugs safe for pregnant people?

No. Not all malaria drugs are safe for pregnant women.

Pregnant people are at a higher risk of contracting malaria and are expected to take malaria drugs during their pregnancy. However, there are certain malaria drugs that pregnant people should avoid.

Malaria drugs that are safe for a pregnant people

There are different types of malaria drugs available in the market today. However, some of these malaria drugs are not suitable for pregnant women.

Here are malaria drugs that are safe for pregnant women:

1. Sulfadoxine-pyrimethamine

Malaria in pregnant women can quickly become severe; hence, healthcare professionals emphasize the need for pregnant women to take preventive measures to avoid contracting malaria.

Sulfadoxine-pyrimethamine is the primary drug used in Nigeria to prevent malaria in pregnant women. All pregnant women are usually given a curative dose of sulfadoxine-pyrimethamine, whether infected with plasmodium or not. This is in line with the recommended interventions by the CDC for preventing malaria in pregnant women. 

Sulfadoxine-pyrimethamine is usually given early in the second trimester of pregnancy and also in the third trimester.

2. Quinine

Quinine is a malaria drug that is safe for pregnant women. The oral form of quinine treats uncomplicated malaria in pregnant women during the first trimester and is usually given for seven days.

On the other hand, intravenous quinine is used to treat pregnant women with severe malaria in the first trimester of pregnancy.  

3. Chloroquine

Chloroquine is another malaria drug considered safe in pregnant women in their first trimester. A study in Denmark showed that chloroquine did not increase the risk of significant congenital disabilities or preterm births. 

However, chloroquine is not effective in treating chloroquine-resistant malaria. Chloroquine-resistant malaria occurs when the Plasmodium falciparum parasite becomes resistant to treatment using chloroquine.

4. Artemether-Lumefantrine

Artemether-lumefantrine is an artemisinin-based combination therapy commonly used to treat uncomplicated malaria in pregnant women in their second or third trimester.

Before now, doctors typically avoided giving pregnant people Artemether-lumefantrine because animal studies showed it can lead to teratogenicity and pregnancy loss. However, a recent study suggests using artemether-lumefantrine as the preferred treatment for uncomplicated malaria in the first trimester.

Also, the updated WHO Guidelines for malaria now recommend artemether-lumefantrine for treating uncomplicated malaria in all trimesters of pregnancy.

Artemether-lumefantrine is also highly effective for treating chloroquine-resistant malaria. 

5. Artesunate

Artesunate is another antimalarial drug that is safe for pregnant women. It treats complicated malaria in all trimesters and is usually administered intravenously.

Intravenous artesunate is gradually replacing IV quinine for treating severe malaria in first-trimester pregnancy as it is more effective.

6. Mefloquine

Mefloquine is a malaria drug recently recommended for use in pregnant women. It is now used to treat or prevent malaria in all trimesters of pregnancy.

However, mefloquine has increased risks of side effects like vomiting, fatigue, and dizziness and is not commonly used as there are better alternatives.

7. Amodiaquine

Amodiaquine is considered safe and effective for treating malaria in pregnant women. It is used when the malaria parasite is resistant to chloroquine. However, there are limited studies on its safety, so it is usually used when the benefits of its use outweigh any risk.

8. Proguanil

Proguanil is another malarial drug used to prevent malaria that is also considered safe in the first trimester of pregnancy. However, proguanil may increase the risk of folate deficiency; hence, patients are advised to take folic acid while using proguanil. Also, proguanil is usually combined with atovaquone and given only when no other alternatives exist.

Complications of malaria in pregnancy

Malaria is one of the leading causes of complications and death in pregnant women. Pregnant women are at a higher risk of contracting malaria due to their lowered immunity than nonpregnant women. 

Complications of malaria in pregnancy include: 

• Miscarriage
• Stillbirth
• Premature birth
• Maternal anemia

Why you should see a doctor before taking any malaria medication during pregnancy

Treating malaria during pregnancy can be tricky. Instead of buying any malaria drug in the market, it is best to see a doctor first. A doctor will prescribe the best antimalarial drug based on your unique needs.

Also, seeing a doctor will prevent you from taking malaria drugs that might harm you or your child.