Parasitic infections in pregnancy: malaria, hookworms and ascariasis — MSF Essential obstetric and newborn care

What this guideline says

GMJ summary

This MSF guideline addresses the management of parasitic infections during pregnancy, with particular focus on malaria and helminth infections. Malaria in pregnancy is associated with low birth weight, increased anaemia risk, and in low transmission areas, increased risk of severe malaria and death. The guideline provides detailed treatment protocols for uncomplicated and severe malaria across all trimesters.

For uncomplicated falciparum malaria, artemisinin-based combination therapies (ACTs) are recommended for 3 days in all trimesters, with specific dosing tables provided for artemether/lumefantrine, artesunate/amodiaquine, artesunate/mefloquine, and dihydroartemisinin/piperaquine. Quinine remains an alternative, particularly when combined with clindamycin in South-East Asia and Amazon regions. Severe malaria requires parenteral artesunate or artemether, with specific dosing schedules and monitoring requirements.

For helminth infections, the guideline recommends albendazole 400 mg as a single dose for both ancylostomiasis (hookworms) and ascariasis, but explicitly prohibits administration during the first trimester. Associated anaemia from hookworm infection requires concurrent treatment.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. Uncomplicated falciparum malaria: artemisinin-based combination therapy (ACT) for 3 days in all trimesters; artemether/lumefantrine 4 tablets twice daily for 3 days (20/120 mg formulation) is one recommended option
2. Severe malaria: artesunate IV/IM 2.4 mg/kg at H0, H12, H24, then once daily; or artemether IM 3.2 mg/kg loading dose then 1.6 mg/kg daily
3. Quinine alternative for uncomplicated malaria: 10 mg/kg PO 3 times daily for 7 days; in South-East Asia and Amazon, combine with clindamycin 10 mg/kg twice daily for 5 days
4. P. vivax, P. malariae, P. ovale, P. knowlesi: chloroquine 10 mg base/kg on days 1–2, then 5 mg base/kg on day 3, irrespective of pregnancy trimester
5. Hookworms and ascariasis: albendazole 400 mg single dose, but do not administer during first trimester—wait until second trimester
6. AS/SP combination is contraindicated in HIV-infected women taking co-trimoxazole prophylaxis
7. IV quinine for severe malaria: loading dose 20 mg/kg over 4 hours, then maintenance 10 mg/kg every 8 hours; omit loading dose if oral quinine or mefloquine given in previous 24 hours
8. After at least 24 hours of parenteral treatment for severe malaria and when oral intake tolerated, complete with 3-day ACT course

Dosage of artemisinin-based combination therapies (ACT) for uncomplicated malaria in pregnancy

Table extracted from the guideline

Source: Médecins Sans Frontières, Parasitic infections in pregnancy: malaria, hookworms and ascariasis — MSF Essential obstetric and newborn care. Reproduced in summary form.

From the guideline

Verbatim

“Malaria in pregnancy is associated with low birth weight, increased risk of anaemia and, in low transmission areas, an increased risk of severe malaria and death.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

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