World Malaria Day 2022: How Does Malaria Affect Pregnancy?

World Malaria Day 2022: Malaria Signs in Pregnancy, Diagnosis, Cure, Treatment And All You Need to Know

Malaria in Pregnancy: The World Health Organisation describes malaria as a parasitic infection transmitted by mosquitoes. It is one of the most devastating infectious diseases, killing more than one million people annually. After tuberculosis, malaria is the second leading cause of mortality from infectious diseases. Malaria is a parasitic disease caused by the protozoon of the genus Plasmodium. Four species of the genus Plasmodium; Plasmodium vivax, P. Ovale, P. Falciparum, P. Malaria. First two pieces are prevalent in India. Parts of India where malaria is endemic include northeastern states, Bihar, Orissa, Andhra Pradesh, Karnataka coastal region, and Chhattisgarh.

Malaria in Pregnancy

Pregnancy is an immunosuppressive stage; this makes them more susceptible to malaria-causing parasites than the general population. They are more likely to become infected, have a recurrence, or develop severe complications that may lead to death. Dr. B. Ramesh, Founder, and Urology Laboratory Laparoscopic Surgeon, Altius Hospital, Bengaluru has explained below how dangerous malaria can be for pregnant women.

How does Malaria affect pregnancy??

According to the Centers for Disease Control and Prevention, pregnant women lose some protection from malaria infection due to changes in their immune systems and the existence of a new organ (the placenta) with new locations for parasites to adhere. This altered immune response in pregnancy makes them more vulnerable to its consequences. It can harm both mother and baby.

Signs Of Malaria In Pregnant Women

Pregnant women who contract malaria may experience these symptoms:

• Fever with chills
• Rigor
• Headache
• Pain in muscles
• Pain in joints
• Feeling of discomfort
• Nausea
• Vomiting
• Abdominal pain
• Dehydration
• Anemia

If a pregnant woman notices these symptoms, she must consult her doctor immediately to avoid complications

What are Effects of Malaria on Pregnancy?

A woman pregnant for the first time are at maximal risk, as there is increase in immunity status with rising parity. And passive transfer of IgG antibodies across placenta helps protect the fetus and new born for the first 3-6 months during infancy.

What is an Uncomplicated Malaria?

Uncomplicated malaria is defined as: Symptomatic infection with malaria parasitemia without signs of severity and/or evidence of vital organ dysfunction.

What is Complicated or Severe Malaria?

Complicated or severe malaria is defined as symptomatic malaria in a patient with P. falciparum with one or more of the following life-threatening complications:

• Cerebral malaria (unrousable coma not attributable to other causes).
• Generalised convulsions (> 2 episodes within 24 hours)
• Severe normocytic Anaemia (Ht<15% or Hb < 5 g/dl) – The malaria parasite is capable of rupturing and destroying the red blood cells. When this happens in a pregnant woman, it could result in severe anaemia, such that she won’t have any capacity to cope with haemorrhage (bleeding) during childbirth, making the pregnant woman more likely to die during delivery
• Hypoglycaemia (blood glucose <40 mg/dl )
• Metabolic acidosis with respiratory distress (arterial pH < 7.35 or bicarbonate < 15 mmol/l)
• Fluid and electrolyte disturbances –
• Acute renal failure (urine <400 ml/24 h in adults; 12 ml/kg/24 h in children)
• Acute pulmonary oedema and adult respiratory distress syndrome
• Abnormal bleeding
• Jaundice
• Haemoglobinuria
• Circulatory collapse, shock,
• Septicaema (algid malaria)
• Hyperparasitaemia (>10% in non-immune; >20% in semi-immune

How to Make a Diagnosis?

• Light microscopy
• Rapid diagnostic tests (RDTs).

Common methods for parasitological diagnosis of malaria. Microscopy is the gold standard for diagnosis of malaria for Parasite density, Species diagnosis and Monitoring response to treatment.

What is the treatment of Malaria in Pregnancy?

The antimalarials considered safe in the first trimester of pregnancy are quinine, chloroquine, proguanil, pyrimethamine and sulfadoxine–pyrimethamine. Of these, quinine remains the most effective and can be used in all trimesters of pregnancy including the first trimester. There is increasing experience with artemisinin derivatives in the second and third trimesters and there have been no adverse effects on the mother or fetus. Therefore, artemisinin derivatives can be used to treat uncomplicated falciparum malaria in the second and third trimesters of pregnancy, but should not be the first choice in the first trimester.