Malaria During Pregnancy

Pregnancy is the time when you want to ensure your health stays at its peak, and there are no complications that could affect the baby. However, certain health conditions arise despite all the precautions taken, and malaria can be one of them. It is a life-threatening disease that is preventable and curable through sustained medication. In this post, we will discuss what malaria is, its causes, diagnosis, and its risk and treatment during pregnancy.

What Is Malaria?

Malaria is a lethal disease that is caused by a parasite which infects the female Anopheles mosquitoes. When these mosquitoes feed on humans by biting them, malaria spreads and is thus transmitted into human beings. These malarial parasites have been identified as follows:

• Plasmodium Malariae
• Plasmodium Ovale
• Plasmodium Vivax
• Plasmodium Falciparum

While Plasmodium Vivax and Plasmodium Falciparum are the most commonly found, it is the latter that is the deadliest. When a mosquito bites a person with malaria and sucks in blood, the malarial parasites travel from the infected person’s blood to the mosquito. The malarial parasite develops and multiplies within 10 to 14 days of its stay within the mosquito and can be easily passed into a healthy person’s body. The infected person takes 7 to 21 days to become sick, but in rare cases, it can take several months for the symptoms to appear.

If expecting mothers are not careful and don’t keep the mosquitoes away, there is a chance that they could get infected. Below, we shall discuss why pregnant women are at risk.

Malaria and Pregnancy

Here are a few basic facts about malaria during pregnancy that you should be aware of:

During pregnancy, your immunity is low, and this makes you a more likely target for malaria. It is necessary to be careful, especially during the second and third trimesters of pregnancy since immunity is at its lowest during these times. Pregnant women are also more likely to face frequent and serious attacks of malaria and have a higher risk of complications, too.

If the pregnant woman is already suffering from nutritional anaemia, the malaria-induced anaemia will increase its impact further, and also lead to complications that could be fatal for the mother. There are chances of the malarial parasites getting into the placenta and interfering with the oxygen transfer and smooth passage of nutrients from the mother to the foetus. This increases the risk of spontaneous abortion, stillbirth, or pre-term birth. In some cases, the woman may even give birth to a baby with low birth-weight.

Causes of Malaria During Pregnancy

Malaria during pregnancy is a major health risk for pregnant women. Various studies have shown that women who live in tropical and developing countries are more prone to malarial infection. Here are some more causes of Malaria during pregnancy.

• Immunity Loss: Due to the decrease of immunoglobulin synthesis during pregnancy, a woman’s immune system is at an all-time low, and this is one of the primary causes of contracting malaria during pregnancy.
• Placenta: The placenta is a new organ that grows inside women during pregnancy. The malarial infection can break through the immunity protection, and placenta-specific phenotypes are also allowed to multiply.
• Weather Conditions: Monsoon provides a fertile breeding ground for mosquitoes to grow, and it is generally during this season that the spread of malaria becomes rampant. Humidity, temperature and rainfall can also play a significant role in the spread of malaria.

Signs and Symptoms of Malaria

The symptoms of malaria, quite similar to those of influenza, are quite difficult to diagnose and make themselves visible more than seven to ten days after the first mosquito bite. Some common symptoms include the following:

• Headache
• High fever
• Muscle pain
• Nausea
• Vomiting
• Chills
• Sweats
• Diarrhoea

Pregnancy can alter these symptoms slightly, where the fever is extremely high or low, and the shivering and sweating may be missing. Since the symptoms are similar to that of the flu, a blood test is an assured way of confirming malaria and the type that has affected you. If you have chills and sweating, with high fever, then it is best to speak to your doctor at once to avoid further problems.

Risk Factors of Malaria in Pregnant Women

Malaria in pregnant women can be contracted if the infected person resides in an area that is unhygienic and dirty. If there are stagnant pools of water or water puddles that haven’t been attended to or cleaned for long, they allow mosquitoes to breed easily, increasing the risks of malaria in pregnancy.

Also, if the pregnant woman has to undergo any kind of blood transfusion or organ transplant, there is a possibility of infected blood passing the parasite to her. Malaria can also be transmitted from the mother to the infant.

Diagnosis of Malaria During Pregnancy

Malaria during pregnancy is difficult to diagnose since most women are asymptomatic. The peripheral blood samples are unable to detect its infection since the falciparum parasite is isolated in the placenta. The following tests are conducted after collecting blood samples from the patient:

• Blood Smear Test: It includes a microscopic screening of the blood sample taken from the patient; it is a standard test for malaria diagnosis.
• RDT (Rapid Diagnostic Test): This test detects the malaria antigens in the blood and is used where microscopy is not available.
• Histological Examination: Considered to be the most reliable and more accurate than others; this test for detecting pregnancy malaria involves the examination of tissue samples with the use of a microscope.

Malaria Treatment During Pregnancy

If a pregnant woman contracts malaria, it is necessary to provide quick medical attention to her. There are medications for the treatment of malaria during pregnancy which are safe and do not present any kind of side effect to the mother or the foetus.

• During the first trimester, quinine and clindamycin can be administered to the patient if it is a mild form of malaria. Chloroquine is also an effective medicine for uncomplicated pregnancy malaria.
• The safest and the most effective treatment for malaria during the second and third trimesters is ACT or Artemisinin Combination Therapy.

The above-mentioned antimalarial treatments in pregnancy are safe but should be administered to the patient under medical guidance only. The medication will depend upon the type of malaria contracted, the age of the pregnant woman, the stage of pregnancy, and the severity of symptoms. These medicines are generally administered in the form of tablets or capsules and sometimes intravenously, too, especially if the patient is at an advanced stage.

Although treatable, malaria during pregnancy could lead to complication. Let’s take a look at them.

Complications of Malaria During Pregnancy

Malaria can be classified into a complex or an uncomplicated infection. Complex malaria is a serious condition that has the potential to give rise to cerebral malaria, anaemia, ARDS (Acute Respiratory Distress Syndrome) and could even lead to organ damage. Uncomplicated infection of malaria displays symptoms like fever, headache and chills followed by sweating that happens every two days and lasts for eight to ten hours.

The condition could affect the mother and the child in the womb depending on how severe it is. Read on to know it could affect the mother.

Maternal Complications

Expecting mothers face the following complications if they suffer from malaria during pregnancy:

• Anaemia: When the malarial parasite infects the pregnant woman’s blood, it causes haemolysis or rupture of red blood cells, which creates an additional need for blood supply. This causes anaemia which could lead to haemorrhage and maternal mortality in certain cases.
• Renal Failure: Unobserved dehydration during malaria can lead to renal failure, and the patient will have to be put under fluid management and diuretics as a part of its treatment. In certain cases, dialysis may also be required.
• Hypoglycaemia: This condition occurs when the blood sugar level reduces drastically and falls below 60 mg/dl. The increased action of the falciparum parasites causes this condition which then leads to the enhanced use of glucose and low glucose production. This complication is asymptomatic and needs constant monitoring.
• Immuno-Suppression: Your body undergoes many hormonal changes during pregnancy which impact the immune system in a big way. Your body produces the immunosuppressive hormone called cortisol, which reduces immunity. When cortisol levels rise, the resistance to malaria also decreases, and it can lead to many complications like cerebral malaria, pulmonary oedema, hypoglycaemia and hyperpyrexia.
• Acute Pulmonary Oedema: Known as the severest form of anaemia, it occurs during the second or third trimester. The falciparum infection causes fluid leakage into the lungs, a condition created by the formation of a membrane in the alveoli.

Foetal Complications

When the mother is detected with malaria, the foetus could face a few complications which are listed below:

• IUGR or Low Birth-Weight: The growth of a new organ in the form of the placenta allows the malarial parasites to enter the mother’s immune system and prevent oxygen and nutrient supply to the growing foetus. This leads to infants with low birth-weight and IUGR-Intrauterine growth retardation. There are low chances of survival for infants who are born with bodyweight less than 2.5 kg (5.5 lbs).
• Preterm Delivery: It is the placenta where the malarial parasites strike and multiply, and it is through this infected passage that antibodies and cytokines are carried, triggering an active response and thus leading to early labour.
• Vertical Transmission: The risk of malarial infection can easily pass on from the mother to the baby. If malaria is detected on time, and the mother receives proper medication, then the foetus remains safe, too. That is the reason most doctors advise blood screening of the baby after birth to ensure he has not been infected.

Side Effects of Malaria on Pregnancy and Foetus

Malaria in pregnancy increases the risk of neonatal death, low birth-weight babies, miscarriage and stillbirth. Also, the baby itself could be born with malaria, which could prove to be fatal.

How to Prevent Malaria in Pregnant Women

Since mosquitoes are the main cause of this disease, it is necessary to keep them at bay when you are pregnant. It is necessary to identify potential mosquito-breeding spots around your home and get them cleaned. Any stagnant water that hasn’t been used for a long time should be emptied, especially during monsoon. All containers like vases, flowerpots and fishbowls should be cleaned and filled with fresh water.

Try to wear light-coloured clothes, since mosquitoes are generally attracted to dark colours. Wearing full-length garments and long sleeves, especially during the night, is highly recommended. The use of mosquito repellents and nets can also be an effective way of keeping mosquitoes at bay during pregnancy and preventing malarial infections.

If you plan to use chemical-based mosquito repellents, make sure you apply it as per the instructions given. Applying more will not give better protection; in fact, it can expose you to higher chemical levels. It is best to apply a thin layer over your skin and spread it evenly for maximum protection.

World over, major steps are being taken to reduce the occurrence of malaria, and the mortality rate can be seen falling due to these efforts. Scientific advancements have helped prevention of malaria to a large extent. However, we are still unable to defeat it completely, which is why it is imperative to be on your guard and see the doctor at once in case you suspect any symptoms of the condition.