ABSTRACT

Malaria poses special risks to women during pregnancy, and preventing malaria is essential to ensure favorable pregnancy outcomes. Few tools are available to control malaria during pregnancy, and their utility is limited by several technical and operational difficulties. To prevent adverse outcomes, the World Health Organization recommends that suppressive doses of an effective antimalarial drug be given to women living in malaria endemic areas throughout pregnancy. The ideal chemoprophylactic drug is effective, safe, cheap, acceptable to pregnant women, and easy to deliver. Traditionally, that drug was chloroquine, but the emergence and rapid spread of chloroquine-resistant P. falciparum has complicated recommendations for prophylaxis. Many antimalarials are contraindicated in the first trimester, and studies are urgently needed to better define the safety of these drugs during pregnancy. The burden of pregnancy malaria is greatest in Africa, but high-level drug resistance and the risk of severe malaria mandate special considerations for prophylaxis of travelers and women in areas of unstable endemicity, such as Southeast Asia. Implementing effective control programmes requires a knowledge of malaria transmission patterns, parasite drug sensitivities, drug safety profiles and the efficacy of anti-vectorial measures, as well as the behavioral and socioeconomic constraints that could mitigate success.