Pregnancy

Patients who are pregnant should be advised that they have an increased risk of contracting malaria and if infected the condition is likely to be more severe. This can lead to an increased risk of maternal death, spontaneous abortion, low birth weight baby or premature labour.

Certain vaccines and antimalarial drugs are contra-indicated in pregnancy. Travel to areas where malaria is endemic during pregnancy should be discouraged wherever possible. It is advisable to refer patients who are pregnant or planning a pregnancy to their GP prior to travel.

Wherever possible conception whilst in a malaria zone should be avoided due to the increased risk of contracting malaria and also the effects of chemoprophylaxis medication on the foetus. Patients who are planning to become pregnant whilst abroad or soon after their return should be advised that there are recommended time intervals between completing antimalarial medication and becoming pregnant, these intervals differ for each of the regimes:

• Mefloquine - 3 months
• Doxycycline - 1 week
• Atovaquone/proguanil - 2 weeks

Breastfeeding

Patients who are breastfeeding should be advised that whilst antimalarials are secreted in breast milk the amount is not sufficient to provide protection for the infant who will require their own prophylactic regime.

Chloroquine and proguanil are the preferred antimalarials during breastfeeding, however these drugs may not provide sufficient protection in high risk areas. Doxycycline must not be used by breastfeeding mothers whereas mefloquine and atovaquone/proguanil can be used if there is no alternative.

Breastfeeding mothers should be advised to increase their fluid intake whilst abroad as dehydration can affect milk production.