A pregnant woman should be evaluated for malaria if:
(1) she has lived in or traveled to a region endemic for malaria
(1a) Most mothers with malaria are immigrants (foreign born).
(1b) Women who have become infected during travel had an exposure within the past year.
(2) she has febrile episodes
(3) parasites are detected during histologic examination of the placenta
(4) she has a past history of malaria
The evaluation should consist of blood film examination, PCR or other test as available.
About 80% of cases involve Plasmodium vivax.
Primaquine is contraindicated during pregnancy. It can cross the placenta and cause hemolytic anemia in an infant with glucose 6-phosphate dehydrogenase deficiency.
The neonate may:
(1) be small for gestational age
(2) be at risk for increased perinatal and infant mortality
(3) have fever, anemia, thrombocytopenia, splenomegaly or other findings
A neonate born to a mother who has malaria:
(1) should be evaluated for malaria even if the mother has been treated
(2) does not need to receive primaquine phosphate if the infection is with Plasmodium vivax (only the blood stages are present in congenital infections)
