Quinine

(Date of issue: September 2013. 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?

Quinine is sometimes taken in combination with another medicine to treat a person who is infected with malaria. Quinine is also occasionally used to treat leg cramps.

Malaria and pregnancy
Malaria is a serious illness that is spread by mosquito bites and can result in death. Malaria infection in pregnancy can be dangerous to the health of both mother and baby. Pregnant women are therefore advised to avoid travelling to areas where there is a risk of catching malaria.

If you are pregnant or planning a pregnancy and cannot avoid travelling to a high risk malaria area, ask your doctor for advice as soon as possible as you will need to take another antimalarial medicine (not quinine) for a few weeks before you travel to prevent malaria infection.

No antimalarial medicine is 100% effective. It is therefore 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. Please read our bumps leaflet on insect repellents for more information on which products are advised for use in pregnancy. 

Is it safe to take quinine in pregnancy?

You should not avoid taking quinine because you are pregnant. The risk of harm to you and your baby from malaria is likely to be far greater than any possible risk from taking quinine. There is no convincing scientific evidence that quinine is harmful to an unborn baby. However, if you are using quinine to treat leg cramps it is likely that your doctor may recommend that you stop treatment until after your baby is born.

Can taking quinine in pregnancy cause a miscarriage?

Information collected from two studies does not suggest that women who take quinine during pregnancy are at increased risk of having a miscarriage. In the past, quinine was used as a ‘folk remedy’ to induce miscarriage, although it is now thought to be ineffective for this purpose.

Can taking quinine in pregnancy cause my baby to be born with birth defects?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

No evidence of a link between taking quinine in early pregnancy and having a baby with a birth defect was provided by any of the three studies carried out so far, that investigated a total of around 1,000 women.

Can taking quinine in pregnancy cause preterm birth or my baby to be small at birth (low birth weight)?

Quinine use in pregnancy has not been shown to cause a baby to be born early (before 37 weeks of pregnancy) or to have a low birth weight (<2500g). Six studies have investigated these pregnancy outcomes and all have agreed that there are no links.  

Can taking quinine in pregnancy cause stillbirth?

There is no scientific evidence from seven studies that taking quinine during pregnancy increases the chance of stillbirth. 

Has taking quinine in pregnancy been linked to learning or behavioural problems in the child?

A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour. There is no known link between taking quinine in pregnancy and specific learning or behavioural problems such as attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder in the child. There are, however, no scientific studies that have specifically investigated a link with these problems.

Five studies have shown no difference in eyesight, hearing and developmental milestones of babies who were exposed to quinine while in the womb compared to babies not exposed in the womb. However, in these studies, the babies were examined at a maximum of one year of age, so we do not know if any differences became apparent as the children got older.

Will 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.

Taking quinine 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 it is likely that your doctor will wish to monitor your pregnancy more closely. 

A side effect of treatment with quinine can be lowered blood sugar. Your doctor may therefore wish to closely monitor your blood sugar levels if you are treated with quinine during pregnancy.

Are there any risks to my baby if the father has taken quinine?

We would not expect any increased risk to your baby if its father took quinine before or around the time your baby was conceived.

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

General information 

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.

   

www.medicinesinpregnancy.org

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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