Malaria in pregnancy may cause miscarriage, say gynaecologists

Leading maternal health specialists have warned that malaria, especially in the first trimester of pregnancy, can cause miscarriage, anaemia, impaired foetal growth and other complications that threaten the health of mother and baby if not quickly diagnosed and treated.

The specialists said malaria parasites could affect the placenta, reducing the supply of oxygen and nutrients to the developing baby, thereby increasing the risk of restricted growth, low birth weight, premature delivery and, in severe cases, foetal death.

The gynaecologists further said that pregnant women, especially in the first trimester, are more vulnerable to malaria because pregnancy reduces their immunity, making them susceptible to the disease.

In exclusive interviews with PUNCH Healthwise, the specialists urged expectant mothers experiencing fever, vomiting, weakness, loss of appetite or general ill health that could be mistaken for early pregnancy symptoms to seek medical evaluation and testing rather than assuming or self-medicating.

The experts further stressed that malaria can be prevented and treated during pregnancy, including in the first trimester, but said prevention, prompt diagnosis and the use of appropriate antimalarial drugs are essential to reduce complications.

They recommended that pregnant women sleep under insecticide-treated mosquito nets, ensure proper environmental sanitation to prevent breeding of mosquitoes and seek urgent medical evaluation and treatment when symptoms develop.

According to the World Health Organisation, malaria in pregnancy is a major public health problem for women in sub-Saharan Africa, responsible for 11 per cent of all newborn deaths and 10,000 maternal deaths globally.

The WHO reports that Nigeria is one of the two countries with the highest exposure to malaria infection during pregnancy.

The United Nations health body recommends long-lasting insecticide-treated nets throughout pregnancy and intermittent preventive treatment with sulphadoxine-pyrimethamine from the second trimester in malaria-endemic African countries.

Also, WHO’s 2025 malaria guidelines recommend artemether-lumefantrine for uncomplicated Plasmodium falciparum malaria during the first trimester.

Speaking with PUNCH Healthwise, Professor of Obstetrics and Gynaecology at the University of Uyo, Akwa Ibom State, Aniekan Abasiattai, said malaria is a well-established cause of miscarriage during the first 13 weeks of pregnancy.

He explained that infections that cause high fever could trigger miscarriage, with malaria being one of the most common causes of anaemia among pregnant women in Nigeria.

The seasoned gynaecologist said anaemia associated with malaria could have adverse effects on both the mother and the unborn baby, while the infection could also interfere with placental development and function.

Abasiattai noted that malaria parasites may accumulate in the placenta even when they are not detected in the peripheral blood, affecting the exchange of oxygen and nutrients between the mother and the foetus.

He said this could prevent the baby from growing properly, cause low birth weight or, in severe cases, result in the death of the unborn child.

“Baby stops growing or refuses to grow properly, or even dies because it reduces the exchange of nutrients and oxygen to the baby,” the maternal health specialist said.

Abasiattai added that babies could sometimes be born with congenital malaria, although he noted that this was relatively uncommon in the local setting because newborns could receive some immunity from their mothers.

The professor said malaria symptoms could be difficult to distinguish from those of early pregnancy because both could involve vomiting, weakness, loss of appetite and general feelings of being unwell.

“Because the symptoms of malaria, even in pregnancy and even in the first trimester, are non-specific and may mimic several other infections, it is advised that once a pregnant woman has symptoms- that feeling of weakness, vomiting, not being able to eat, and so on- the person should visit her doctor,” he said.

He warned against treating every fever or illness in pregnancy as malaria without proper testing, explaining that the approach to malaria management had shifted towards confirming the presence of the parasite before treatment.

Abasiattai advised pregnant women who developed symptoms suggestive of malaria to visit their doctors for proper evaluation, including a malaria parasite test, before receiving treatment.

He explained that confirming the infection was important to prevent unnecessary treatment, which had contributed to drug resistance.

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The gynaecologist said pregnant women were particularly vulnerable to malaria because they could lose some of the immunity developed through previous exposure to the infection.

He noted that the risk of more frequent and severe malaria attacks was especially significant in malaria-endemic areas and that the vulnerability could occur throughout pregnancy, particularly during the second and third trimesters and in first pregnancies.

Abasiattai recommended sleeping under insecticide-treated mosquito nets during the first trimester, alongside environmental measures to reduce mosquito breeding and prevent mosquitoes from entering homes.

He said preventive treatment with a combination of antimalarial drugs was also recommended after the first trimester, with doses administered monthly under the prescribed antenatal care programme.

He urged pregnant women to clear bushes and stagnant water around their homes, use appropriate window nets and ensure that mosquito-control measures were observed.

He added that confirmed malaria cases should be treated with appropriate medication during pregnancy to reduce the risk of complications for both mother and baby.

Also, a Consultant Obstetrician and Gynaecologist, Dr Stanley Egbogu, warned that malaria could cause serious complications for both pregnant women and their unborn babies.

Egbogu said complications affecting the baby included miscarriage, restricted growth in the womb, low birth weight, premature labour and, in severe cases, foetal death.

He explained that when malaria parasites lodged in the placenta, they could interfere with blood flow, reducing the supply of oxygen and nutrients required for the baby’s development.

“The high fever that happens during malaria in pregnancy can lead to that abortion. Another thing that can happen is that the malaria parasite can lodge in the placenta. When it lodges in the placenta, it prevents blood flow,” Egbogu said.

He said the severity of the infection determined the extent of the complications, adding that inadequate blood and oxygen supply could affect growth and increase the likelihood of premature delivery.

Turning to the mother, Egbogu said pregnant women were more susceptible to malaria because pregnancy weakened their immune response, allowing the parasites to multiply and increasing the risk of severe illness.

He explained that malaria parasites destroyed red blood cells, which could cause anaemia, while the infection could also produce high fever and affect vital organs, including the kidneys.

The gynaecologist advised pregnant women who developed fever, nausea, vomiting, itching, weakness or general malaise to undergo a rapid diagnostic test for malaria instead of assuming the symptoms were simply part of pregnancy.

He said a positive test should be followed by treatment with medication appropriate for the stage and severity of the infection.

Egbogu stressed that not all antimalarial drugs were suitable for use during the first three months of pregnancy and advised expectant mothers to seek medical guidance before taking medication.

He said malaria could be safely treated during early pregnancy when appropriate drugs were used, identifying quinine as a treatment option for the first trimester in the guidance provided.

He added that uncomplicated cases could be treated with oral medication, while complicated cases might require injectable treatment under medical supervision.

Egbogu also emphasised prevention, including the use of insecticide-treated mosquito nets and prescribed preventive medication during pregnancy, urging women to seek prompt testing and treatment whenever malaria was suspected.