Malaria precautions while pregnant or breast feeding

Malaria and pregnancy

If you are pregnant and planning to travel to a malaria-risk area, it would be best to postpone your travel plans. Malaria infection in pregnant women may be severe and can increase the risk of miscarriage, premature birth, and stillbirth.

If you must travel in these areas, you should talk to your doctor beforehand and they will prescribe an antimalarial medicine for you to take.

You should also try to prevent mosquito bites to reduce the risk of contracting malaria.

Which medicine should I take?

Chloroquine, a type of antimalarial drug, is generally considered safe to take during pregnancy. In some malaria-risk areas, chloroquine may be less effective due to resistance to this medicine, and mefloquine may be used as an alternative.

Your doctor will prescribe an antimalarial that is best suited to the area of the world in which you are travelling and any other medical conditions you may have. You need to take antimalarials on schedule and be careful not to miss any doses.

Antimalarials and breast feeding

If you are breast feeding and taking chloroquine, a very small amount of the antimalarial drug will be passed into your breast milk. This very small amount of drug will be transferred to your baby, but this has been shown not to be harmful, in general.

However, this small amount of antimalarial does not protect the baby from malaria, so infants need to be given their own antimalarial medicines.

Recommended dosages for babies and children are usually listed on the medications and will vary with the age and weight of the child. Your doctor will advise you.

All antimalarial medicines should be taken on schedule, with no missed doses.

Over-dosage of antimalarials can be fatal and these medicines should be stored in childproof containers out of the reach of children.

Prevention

It is always best to take precautions to prevent being bitten by mosquitoes in high-risk areas.

  • Before leaving, visit your doctor to see about any necessary vaccinations and to get a prescription for an antimalarial medicine. It is recommended that you take these antimalarial medications at least one week before you travel and continue them for 1-4 weeks after you return — according to the type of medicine and your doctor's instructions.
  • The most active time for the malaria mosquito is from dusk till dawn and you should try to avoid going outside during this time, if possible.
  • Wear long-sleeved shirts and long pants in light colours when going outside after dusk.
  • Use mosquito repellents, taking care not to exceed the recommended dose. Do not apply these repellents on the hands of children who may wipe their hands on their eyes or put their hands in their mouths. When using repellents with DEET (N,N-diethyl m-toluamide), you should always follow the label directions. It should only be used outdoors and should be washed off when coming indoors. Try to apply DEET mainly to your clothing, and (in small amounts) to exposed skin when necessary. Do not inhale or swallow the repellent, or allow it to get in the eyes. The repellent should also not be applied to wounds or broken skin. There are some reports of safety concerns regarding the use of DEET during pregnancy.
  • Sleep under a mosquito bed net that has been treated with permethrin insecticide if you are not staying in a screened or air-conditioned room.
  • Use insect sprays containing pyrethrum in your living and sleeping areas. Lighting a ‘mosquito coil’ can also be effective.

It is still possible to get malaria even after using all the prevention measures, so if you experience any of the symptoms of malaria (fever and flu-like illness, including chills, muscle aches and tiredness), seek medical attention as soon as possible.

Are pregnant women at increased risk of contracting malaria?

Several studies in Africa have shown that pregnant women are significantly more attractive to mosquitoes than their non-pregnant counterparts. This puts them at higher risk of diseases such as malaria that are transmitted by mosquito bites. Because of this increased susceptibility, the World Health Organization recommends that in areas where malaria is present, pregnant women should be vigilant in using protective measures against mosquito bites, such as insect repellants and insecticide-treated mosquito nets. They should ensure, however, that they do not exceed the recommended dosage of insect repellants.

There are several theories why pregnant women are more likely to be bitten by mosquitoes. One is that their increased blood flow to the skin results in the release of odours that attract mosquitoes. Another is that they have to get out of bed more often to visit the toilet and so have a greater chance of being exposed to mosquitoes during the night.

Pregnancy also appears to reduce a woman’s immunity to malaria. This makes pregnant women more susceptible to malaria infection compared with women who aren’t pregnant.

Malaria infection during pregnancy can have serious effects in both the mother and her unborn baby. In addition, many of the medicines taken to prevent malaria are not suitable during pregnancy. For these reasons, the best advice for pregnant women planning a holiday is to choose a destination where malaria is not a problem.

Last Reviewed: 20 February 2013
myDr. Adapted from original material sourced from MediMedia.

References

1. Malaria (revised June 2010). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed Jun 2013).
2. Centers for Disease Control and Prevention (CDC). Travelers’ Health - 2012 Yellow Book. Chapter 3: Infectious diseases related to travel – Malaria (updated 8 Nov 2011). http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/malaria (accessed Jun 2013).
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