(Date of issue: January 2015. Version: 2)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
What is it?
Malaria is a serious illness that is carried by certain types of mosquito and spread to humans by their bites. Due to the normal bodily changes that occur during pregnancy, pregnant women are more likely to develop malaria than non-pregnant women if bitten by an infected mosquito. Malaria infection in pregnancy can be very dangerous, and even fatal, to both mother and baby. Pregnant women and women planning a pregnancy, are therefore advised wherever possible, to avoid travelling to areas where there is a high risk of catching malaria.
How can I reduce the risk of malaria?
If travel to a high risk malaria area cannot be avoided, you should do the following to reduce your risk of being bitten by mosquitoes and of developing malaria:
• Take an antimalarial medicine (see below)
• Use insect repellents (see below)
• Stay inside between dawn and dusk, when mosquitoes are most active
• Cover up exposed skin with clothing (e.g. wear long sleeves and full length trousers)
• Sleep with mosquito nets over the bed
All of these measures should be used together to minimise the risk of malaria infection.
What are they?
Insect repellents contain chemicals to keep biting insects away and should be applied to clothes, exposed skin, and mosquito nets.
Is it safe to use insect repellents during pregnancy?
It is currently recommended that all people (including pregnant women) who are travelling to areas where there is a risk of malaria use an insect repellent called DEET. This is because DEET is considered to be the most effective insect repellent. A very small number of studies have examined DEET use during pregnancy. Although these studies do not suggest that use of DEET in pregnancy is harmful, more research about possible effects on a developing baby is required. However, the risk of harm to you and your baby from malaria is likely to be far greater than any risk from using DEET in pregnancy.
Until more scientific evidence is available it is advisable to only use DEET when needed and to follow the manufacturer’s instructions regarding the application of DEET. It is also recommended that insect repellents are washed off once you are no longer at risk of being bitten.
For more details on use of insect repellents during pregnancy please see the insect repellents bumps leaflet.
What are they?
Antimalarial medicines are taken by mouth and can help to prevent malaria from developing if you are bitten by a mosquito that is carrying the infection. There are a number of different antimalarial medicines including chloroquine, mefloquine, proguanil, Malarone® (atovaquone-proguanil combination), and doxycycline. The antimalarial medicine that you need to take will depend upon your travel destination. In some areas, certain antimalarials are ineffective because the malaria parasite has developed resistance to them. You may need to start taking an antimalarial medicine a few weeks before you travel. Your doctor is the best person to help you decide what is right for you and your baby.
Is it safe to take antimalarial medicines in pregnancy?
You should not avoid taking antimalarials just because you are pregnant. It is, however, important to inform your doctor or the prescriber of your antimalarial if you are, or could be, pregnant as this may influence what you are advised to take. For example, doxycycline, if taken after the first trimester, can cause a baby’s milk teeth to be permanently stained and discoloured and would therefore only be prescribed to pregnant women if no other effective antimalarial medicine is available or considered suitable.
For some antimalarial medicines, only small numbers of pregnant women have been studied and more research about possible effects on a developing baby is therefore required. However, the risk of harm to you and your baby from malaria is likely to be far greater than any potential risk from taking an antimalarial medicine in pregnancy. Please see our bumps leaflets on chloroquine, mefloquine, proguanil, and Malarone® for details of what is known about use in pregnancy of each of these antimalarial medicines.
No antimalarial medicine is 100% effective, therefore it is very important that you also reduce the chance of being bitten by using insect repellents, mosquito nets, and covering as much skin as possible with clothing, particularly between dawn and dusk as described above.
Will I or my baby need extra monitoring during pregnancy?
As part of their routine antenatal care, most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.
Using insect repellents and antimalarial medicines during pregnancy is not expected to cause any problems that would require extra monitoring of your baby. However, if you have been infected with malaria during your pregnancy, closer monitoring will be necessary.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.