Did you know that malaria in pregnancy could cause a miscarriage?

4 min read

The World Health Organization(WHO) has set aside the 25th of April every year as WORLD MALARIA DAY to commemorate the effect of malaria on disease burden countries and high-risk populations such as pregnant women and infants. The theme for this year’s celebration is Zero Malaria – Draw the line against malaria.

Malaria is the most common infection in the tropics, including Ghana. It is spread through mosquito bites and is caused by plasmodium parasites. In Africa, malaria during pregnancy is one of the most common preventable causes of miscarriages and stillbirths. Pregnancy-associated malaria is also one of the causes of anaemia, which leads to pregnancy-related hospitalizations and deaths.

Malaria has 2 habitats – a place in an organism where Plasmodium parasites can live and reproduce successfully in the human Liver and the Red blood cells. In pregnant women, the placenta is an additional habitat. This organ is formed during pregnancy as a functioning & protective intermediary between maternal blood and fetal blood.

Why is pregnancy-associated malaria dangerous?

Malaria during pregnancy can lead to a high risk of miscarriages and stillbirths. This is due to the massive breakdown of red blood cells (RBCs) infected with Plasmodium parasites. These cells are the oxygen transporters needed for human survival, including the growing fetus. A major breakdown to these oxygen carrier units in pregnancy-associated malaria results in decreased oxygen supply to the developing fetus, resulting in retarded growth and development, and worse cases death.

 Glucose is a source of nutrient for the fetus is from the maternal liver. When a woman has malaria, the plasmodium parasites feed on the glycogen in the mother’s liver, reducing the number of nutrients available to her and developing fetus. This results in a decrease in fetal growth and development, as well as the possibility of stillbirth and spontaneous abortion (miscarriage).

The placenta is a rich site for oxygen and nutrients for the fetus. Of the 2 habitats, the placenta is the most suitable home for Plasmodium parasites because of its inherent property. The parasites move to the placenta during pregnancy-related malaria episodes because of their high nutrient content. This is known as placental malaria. It is a disturbing situation because mothers especially non-first-time pregnant women may never experience any symptoms of malaria that would cause them to visit the clinic for checkups and even if the mother is doing well, the disease could be affecting the developing fetus unknowingly.

The factors listed above denies the unborn baby the oxygen and nutrients needed resulting in such babies been born premature and with a low birth weight smaller than a normal baby, predisposing them to Neonatal Intensive Care Units (NICU) admissions, and infant mortality in the first 30 days of life.

Why should the public be aware of pregnancy-associated malaria?

Pregnancy-associated malaria is very preventable. 2019 WHO World Malaria Report revealed that malaria during pregnancy was responsible for 5–12 per cent of all low birth weight and 35 per cent of preventable low birth weight, as well as 75 000, to 200 000 child deaths per year. Although the data is worrying, this can be prevented if pregnant women sleep under insecticide-treated nets and take their malaria pills given at antenatal care visits.

Malaria is particularly dangerous to pregnant women because it reduces their immunity to the disease, making them more vulnerable to infections and increasing their risk of other illness such as serious anaemia, and in severe cases death. Anaemia in pregnancy is a risk factor for fetal demise.

Malaria is more likely to cause serious complications in first-time mothers than in other pregnancies. The first and second trimesters of pregnancy are crucial periods when pregnant women are most vulnerable to malaria. Preventive measures like sleeping under insecticide-treated nets and regular antenatal visits are strongly advised.

Symptoms and signs of pregnancy-associated malaria

Malaria in a pregnant woman may be symptomless however, symptomatic malaria shows signs which includes: fever, headache, bitter taste, loss of appetite, vomiting, breathlessness, joint pains, myalgia, jaundice, coke coloured urine, an unusual general feeling of unwellness and so. These are red flags that should prompt an expectant mother to go for antenatal care even if her scheduled date is not due. Regular antenatal visits will prevent symptomless malaria. This is because examination and routine lab tests are conducted to screen for malaria and other worrying conditions like an ailing fetus probably due to malaria and this can be detected early and the necessary attention is given. Please do not miss antenatal visits, they are life-saving.

How to prevent this

The Ministry of Health and the Ghana Health Service have two main approaches for malaria treatment that are used across the country. Pregnant women are given pills to take during antenatal visits; whether infected with the plasmodium parasites or not. This is referred to as intermittent preventive treatment (IPT). The Second is for every pregnant woman to sleep under an insecticide-treated net.  

It is time to weigh the benefit of sleeping under the net considering your unborn child and sleep comfort. The following are preventive add-ons:

• Residual room spraying
• Using a trap door
• Close doors and windows when it is dark
• Covering stored water
• Taking the full drug regimen when diagnosed with malaria even when you are feeling better
• Clearing of bushes and distilling choked and sluggishly flowing gutters

MICHAEL BAAH BINEY

Final year Medical Student

University for Development Studies

Member of curious minds Ghana and activ8

Fellow at African Youth Center for Health (AYCH)

mikebiney77@gmail.com