Antimalarial drugs in pregnancy

Abstract

The purpose of this article is to describe the clinical pharmacology of antimalarial drugs in pregnancy. It is not meant to be an overview of the management of malaria in pregnancy, but a few clinical observations will be made by way of introduction. Malaria during pregnancy carries great risks both for mother and baby, particularly when women have come from non endemic areas and are therefore not immune. Maternal complications can include hypoglycaemia, adult respiratory distress syndrome, disseminated intravascular coagulation and renal failure. Fetal outcome is compromised by pre-term labour and spontaneous abortion which are believed to result from extensive malarial involvement of the placenta. The standard advice given to pregnant women intending to travel to areas where malaria is endemic is: ‘don't’. However, they often do travel, in which case prophylaxis is necessary. This generally takes two forms: non pharmacological and pharmacological. The former includes fairly obvious recommendations such as wearing long sleeved shirts and trousers and sleeping under netting which has an appropriately small mesh size and which is treated with insect repellent. Mosquito coils may also be helpful. Insect repellents are widely used by travellers to endemic areas but the more effective preparations contain N,N-diethyl-m-toluamide (Deet). This agent is absorbed through the skin and its safety in pregnancy has not been established. Each of the drugs used in the prophylaxis or treatment of malaria will now be considered.