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Malaria and pregnancy.

The recent spate of reports' confirming the extension to parts of east Africa of chloroquine resistant strains of Plasmodium falciparum, which have been present for some time in other parts of the tropical world,2 3 has caused much concern. Travel for business or pleasure has now become commonplace: in 1981 some 19 million Britons spent their holidays abroad, and many of them went to various exotic areas.4 No wonder, then, that the news of changing trends in prevention of malaria by hitherto reliable drugs has caused some disquiet. In particular, many women want answers to three important questions. Does pregnancv aggravate malaria and vice versa ? Can the available drugs always protect from malaria infection ? Does the prevention of infection by antimalarial drugs have an adverse effect on the pregnancy or on the unborn child? Much has been written on these three topics and some aspects remain uncertain, but a consensus of expert opinion may be given. Malaria in general, and especially an infection with Pfalciparum, is more hazardous during pregnancy. Pregnancy appears to interfere with the immune processes in malaria,5-7 a disease which itself alters immune reactivity.8 In highly endemic malarious areas, where semi-immune adults usually have substantial acquired resistance to local strains of plasmodia, the prevalence of clinical malaria is higher and its severity greater in pregnant women, especially during the second trimester, with the greatest risk in primiparas.5 7 10 The mechanism of this phenomenon is complex, with evidence of both suppression of antibody formation and depression of cell mediated immunity.8 Malaria may cause abortion and premature labour; in tropical areas many pregnant women suffer from severe anaemia due to the infection itself and to the effects of deficiency of iron and folic acid.1' 12 The results of recent studies indicate that the anaemia of malaria is due to some extent to the immune destruction of sensitised red cells and a depression of erythropoiesis.13 Acute malaria in a pregnant woman requires speedy and complete treatment by the most effective drugs available, with full supporting medication.1