Lives at risk: Malaria in pregnancy

Malaria is a threat both to the pregnant mothers and to their babies. Each year there are many newborn deaths as a result of malaria in pregnancy.

Pregnant women are particularly vulnerable to malaria as pregnancy reduces a woman's immunity to malaria, making her more susceptible to malaria infection and increasing the risk of illness, severe anaemia and death. For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight - a leading cause of child mortality. The problem has long been neglected.

Protecting the pregnant women
Based on available evidence, three-pronged approach to the prevention and management of malaria during pregnancy are recommended:

1. Insecticide-treated nets (ITNs)

2. Intermittent preventive treatment

3. Effective case management of malarial illness.

Sleeping under ITNs remains an important strategy for protecting pregnant women and their newborns from malaria-carrying mosquitoes. In addition, in areas of high and moderate transmission of Plasmodium falciparum malaria, intermittent treatment with an antimalarial drug is a cost-effective means of preventing malaria in pregnancy. The current recommendation is to give at least two doses of a safe and effective antimalarial (currently, sulphadoxine-pyrimethamine) to all pregnant women living in these areas.

In areas of low or unstable malaria transmission, pregnant women have low immunity to malaria and a two- to threefold higher risk of severe malarial illness than non-pregnant women. In these areas, use of ITNs and prompt case management of pregnant women with fever and malarial illness are the main strategies for malaria prevention and treatment.

Delivering malaria interventions through antenatal care
Antenatal clinics are a major opportunity to prevent and treat malaria. The aim is to deliver this package - especially intermittent preventive treatment - to pregnant women as part of their routine antenatal care, using and strengthening the existing antenatal care infrastructure. This strategy is now an integral part of WHO's “Making Pregnancy Safer” initiative, which aims to strengthen antenatal services and provide preventive measures, treatment, care and counseling to improve all aspects of health in pregnant women and their newborns.

Overcoming challenges
To achieve the goal of malaria intervention for making pregnancy safer, several challenges must be overcome:

*Delivery of malaria interventions through antenatal clinics needs to be widespread. However, large-scale programmes are now being developed.

*Major issues of concern still have to be addressed. These include drug resistance and the safe and appropriate use of different antimalarial drugs during pregnancy. As resistance to antimalarial drugs increases, the challenges of treatment and prevention of malaria among pregnant women become greater. There is a need for research to develop prevention strategies for women residing in areas of low or unstable transmission, and in areas where the Plasmodium vivax type of malaria is a problem in pregnancy.

*Pregnant women who do not attend antenatal clinics or who attend only for the first visit or too late during pregnancy need to be reached. New strategies will be required to encourage these women to attend antenatal care early and consistently.

The availability of insecticide-treated nets, effective intermittent preventive treatment and a means of delivery through antenatal clinics, provides a unique opportunity that must be taken to protect the pregnant women each year, and their babies.