Malaria Treatment in Pregnancy: Safe Drugs for Mothers & Babies
Author: Arome David, BSc, MPH, Fellow – Media EIS
Medical Reviewer: Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)
Highlights
- Malaria in pregnancy claims 10,000 mothers yearly, but timely use of safe antimalarials protects both mother and baby.
- All suspected malaria cases should be confirmed with a rapid test or microscopy before treatment.
- Not all antimalarial drugs are safe in every trimester, making correct treatment essential.
- Delayed treatment increases the risk of severe complications for mother and child.
- A triple shield of mosquito nets, preventive therapy with sulfadoxine-pyrimethamine, and antenatal care saves lives.
Introduction
Despite decades of advancement in the treatment of malaria in pregnancy, this preventable disease persists. Within the sub-Saharan Africa region, about 13.3 million pregnant women are affected by malaria, the highest globally [1]. The distribution varies across the African continent, with West and Central Africa bearing the highest burden[2].
Pregnancy lowers women’s immune response to diseases, and exposure to malaria increases their risk of developing severe illness, anaemia, stillbirth, and even death. An estimated 10,000 maternal deaths globally are attributed to malaria during pregnancy.
Pregnant women in highly endemic regions, especially in Africa, are susceptible to frequent malaria attacks. Malaria does not just threaten the life of the pregnant woman but also their unborn child. The protection of mothers and their babies is certain when the right medicines are administered at the right time.
The treatment of malaria during pregnancy involves using antimalarial drugs that are proven safe for both mother and unborn child, given at the correct stage of pregnancy and under the care of trained health professionals.
What is Malaria in Pregnancy?
Malaria in pregnancy occurs when a pregnant woman gets infected with malaria, usually the Plasmodium falciparum parasite, spread through the bite of an infected female Anopheles mosquito.
Over two hundred Plasmodium species exist; only five are known to infect humans, including:
● Plasmodium falciparum
● Plasmodium ovale
● Plasmodium malariae
● Plasmodium vivax
● Plasmodium knowlesi [3].
Plasmodium falciparum, the deadliest of all, accounts for a vast number of malaria deaths. Malaria knows no boundary, and there is no exemption for pregnant women, especially those living in high-risk malaria transmission regions, from contracting it.
How Does Malaria Affect the Mother and Baby?
Pregnancy increases your chances of getting malaria, especially in high-risk malaria-prone regions. During pregnancy, the ability of your body to fight malaria reduces beacuse of poor immune response, and this increases your vulnerability to malaria. This also exposes your baby to contracting malaria from you. It goes from a simple infection to severe complications that can harm you and your baby
Why is Treating Malaria in Pregnancy Important?
Proper attention should be given to the treatment of malaria during pregnancy. When you treat malaria during pregnancy, you protect both your life and your baby’s life.Risks to the mother:
- Developing severe illness
- Anaemia and other complications [4]
- Death
Risks to the baby: Untreated malaria does not spare the unborn child; It increases the risk of:
Low birth weight
A baby weighing less than 2.5 kg at birth is said to have a low birth weight.
Neonatal death
The death of a baby within the first 28 days of life. This is a result of complications during pregnancy, childbirth, or immediately after birth.
Miscarriage
This occurs due to the loss of a pregnancy before the age of viability (this can be 20, 24 weeks or 28 weeks, depending on the locality).
- Stillbirth
The death of a baby after 20, 24 weeks or 28 weeks of pregnancy but before or during delivery.
Preterm Delivery
When a baby is born before 37 completed weeks of pregnancy.
- Congenital Malaria
Diagnosis of Malaria in Pregnancy
All suspected malaria cases should have undergone a test to confirm the diagnosis. The diagnostic tests for malaria infection include:
Rapid Diagnostic Test (RDT)
RDT is a commonly used diagnostic kit for uncomplicated malaria. This test checks for proteins (antigens) released by the malaria parasite into the blood. If these are found, it shows you have malaria. The blood sample is usually taken with a small finger prick.
Microscopy
Microscopy remains the most reliable and gold standard diagnostic test for confirming malaria parasites. This test can be used for both mild and severe malaria. It uses two types of blood samples viewed under a microscope; the thick sample shows how many malaria parasites are in the blood, while the thin sample helps identify the type of parasite causing the infection [5].
Safe Malaria Treatment in Pregnancy
Treatment of malaria is important in pregnancy because of the complications, but not all the drugs are safe in every stage of pregnancy. Safe treatment is important for the health of the pregnant woman and the unborn child. Recommended safe treatment options for malaria in pregnancy by the World Health Organization are as follows:
Uncomplicated Malaria
1st Trimester
The World Health Organization (WHO) recommends artemether-lumefantrine as the first-line treatment for uncomplicated malaria during the first trimester of pregnancy [6]. This is given by mouth as a 3-day course
2nd and 3rd Trimester
The August 2025 updated WHO guidelines for malaria treatment recommend the use of artemether-lumefantrine, an artemisinin-based combination therapy (ACT), in the 2nd and 3rd trimesters for uncomplicated malaria in pregnancy.
Other ACT combinations include:
- artesunate-amodiaquine (AS+AQ)
- artesunate-mefloquine (ASMQ)
- dihydroartemisinin-piperaquine (DHAP)
- artesunate + sulfadoxine-pyrimethamine (AS+SP)
- artesunate-pyronaridine (ASPY) (2022)
Complicated Malaria (Severe Malaria)
1st Trimester
The WHO also recommends the use of artesunate in severe or complicated malaria in all trimesters of pregnancy. It is confirmed to be safe for pregnant women. This is given into the veins (intravenous).
In the absence of artesunate, artemether (given into the muscles) can be used in preference to quinine for severe malaria treatment in pregnancy.
2nd and 3rd Trimester
The recommended drugs are:
- Artesunate
- Artemether
Preventing Malaria in Pregnancy
Preventing malaria in pregnancy helps the woman and the unborn child stay free from malaria-associated complications. The WHO recommends the combination of three interventions for the prevention and treatment of malaria in pregnancy in high-risk settings.
These interventions include:
Intermittent preventive treatment in pregnancy (IPTp)
IPTp offers double protection for pregnant women and the unborn. The WHO recommends that pregnant women in high malaria risk regions receive at least three doses of sulfadoxine–pyrimethamine (SP), administered monthly. The WHO also recommends a minimum of eight scheduled antenatal clinic visits, with administration of SP at each visit. SP is safe for use during pregnancy and effective in women of reproductive age.
Insecticide-Treated Net (ITN)
ITN protects pregnant women against mosquito bites. It is a widely used and recommended prevention strategy in malaria-prone regions like sub-Saharan Africa. ITN not only repels, it also kills and reduces mosquito exposure. The nets can be obtained at the antenatal clinic, hospital, and other private and public health outlets.
Effective Case Management of Malaria Illness
Prompt malaria treatment is recommended in pregnancy. Early detection and access to safe treatment are key to ensuring the mother and unborn child stay healthy. As part of the routine antenatal care, pregnant women are also expected to receive iron and folic acid for the prevention and treatment of anaemia. The WHO recommends a daily oral intake of iron, 30 - 60mg and folic acid, 400mg to prevent anaemia. [7].
When to See a Doctor
You should see a doctor immediately if you notice any early warning symptoms, like:
- Persistent fever
- Severe headache
- Loss of appetite
- Vomiting
- Convulsions
- Difficulty breathing
- Weakness
Delay in seeking medical attention increases the risk to the mother and the unborn child of severe malaria complications.
The World Health Organisation emphasises that all suspected malaria in pregnancy should be diagnosed and treated promptly by trained healthcare professionals in line with the WHO malaria in pregnancy guidelines.
Conclusion
Getting safe treatment during pregnancy is not just about curing malaria but protecting the mothers and the unborn children. With the right drugs and health-seeking behaviour in pregnancy, the mothers and their babies can stay safe and healthy.
References
1. Li J, Docile HJ, Fisher D, Pronyuk K, Zhao L. Current Status of Malaria Control and Elimination in Africa: Epidemiology, Diagnosis, Treatment, Progress and Challenges. Journal of Epidemiology and Global Health. 2024 Apr 24;14:561–79. Available from: https://link.springer.com/article/10.1007/s44197-024-00228-2
2. World Health Organization. World Malaria Report: 20 years of global progress and challenges. Geneva: World Health Organization; 2020. https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2020
3. Sato S. Correction to: Plasmodium—a brief introduction to the parasites causing human malaria and their basic biology. Journal of Physiological Anthropology. 2021 Jan 29;40(1). Available from: https://jphysiolanthropol.biomedcentral.com/articles/10.1186/s40101-020-00251-9
4. Minwuyelet A, Yewhalaw D, Siferih M, Atenafu G. Current update on malaria in pregnancy: a systematic review. Trop Dis Travel Med Vaccines. 2025 May 22;11(1):14. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12096600/
5. Fitri LE, Widaningrum T, Endharti AT, Prabowo MH, Winaris N, Nugraha RYB. Malaria diagnostic update: From conventional to advanced methods. Journal of Clinical Laboratory Analysis. 2022 Mar 4;36(4). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8993657/
6. World Health Organization. Guidelines for the treatment of malaria. World Health Organization, 2025. Available from: https://www.who.int/publications/i/item/guidelines-for-malaria
7. Moor VD, Tinne Mesens, Soetkin Soulliaert, van, Simen Vergote, Verheecke M, et al. Iron deficiency anaemia (IDA) in pregnancy: screening and management. European Journal of Obstetrics & Gynaecology and Reproductive Biology X. 2025 May 1;100402–2. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12205318/
Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Published September 29, 2025
