Health
Poorly treated malaria in pregnancy can hinder babies’ growth — Gynaecologists
Poorly treated malaria during pregnancy can inflame the placenta, reduce the flow of oxygen and nutrients to the unborn baby, and increase the risk of growth restriction, premature birth, and even stillbirth, maternal health experts have warned.
The specialists also cautioned that pregnancy lowers a woman’s natural immunity, making her more susceptible to severe malaria and its complications.
They stressed that early diagnosis, prompt treatment, and preventive medication remain critical to protecting both mother and child.
According to the World Health Organisation, malaria infection during pregnancy is a major public health problem, with substantial risks for the mother, her foetus, and the neonate.
In 2018, 11 million pregnant women were infected with malaria in areas of moderate and high disease transmission in sub-Saharan Africa, and as a result, nearly 900, 000 children were born with low birth weight, according to WHO estimates.
The United Nations Children’s Fund says Nigeria has the highest burden of malaria and accounts for 27 per cent of the global malaria burden and 31 per cent of deaths.
The 2023 World Malaria Report reports about 200,000 deaths from malaria.
Children under the age of five and pregnant women are mostly affected by malaria.
In 2021, a 22 per cent malaria prevalence rate was recorded in children aged six to 59 months.
According to the Federal Ministry of Health, malaria is associated with 11 per cent of maternal deaths and 70.5 per cent of morbidity in pregnancy in Nigeria.
Speaking exclusively with PUNCH Healthwise, a Professor of Obstetrics and Gynaecology at the University of Uyo, Akwa Ibom State, Aniekan Abasiattai, said malaria poses significant risks to both the expectant mother and the developing foetus if it is not properly diagnosed and treated.
He explained that pregnancy naturally weakens a woman’s immunity against malaria, increasing both the frequency of infection and the severity of the disease.
Abasiattai said, “Malaria has effects on both the mother and the baby during pregnancy. To avoid these deleterious effects, malaria must be diagnosed early and treated properly.
“If malaria is not properly diagnosed and treated, both the mother and the baby stand the risk of developing the adverse effects of malaria during pregnancy.”
He added that pregnant women lose part of the immunity they have developed against malaria over time, making them more vulnerable to the infection than women who are not pregnant.
Explaining how malaria affects unborn babies, the professor said the parasites can hide in the placenta even when they are not easily detected in the mother’s bloodstream, interfering with the transfer of oxygen and nutrients needed for normal foetal development.
“In malaria-endemic environments like ours, the malaria parasites may not even be visible in the peripheral blood, but they can sequester in the placenta and reduce the exchange of nutrients and oxygen to the foetus. As a result, the baby’s growth is restricted. It can even lead to the death of the foetus,” Abasiattai said.
According to him, placental malaria can trigger several pregnancy complications, including foetal growth restriction, intrauterine fetal death, preterm labour and premature delivery.
“Malaria is also one of the most common causes of anaemia during pregnancy. As you know, what the malaria parasites do is destroy red blood cells. They cause haemolysis—not only of the red blood cells containing the parasites but also, through other mechanisms, of red blood cells that are not infected. Over time, this leads to anaemia.
“That anaemia itself can have serious consequences for the foetus because it reduces oxygen delivery and nutrient exchange. Consequently, the baby may develop growth restriction, low birth weight, and other complications. So, the long-term effects on the foetus include restricted growth, low birth weight, preterm delivery, and, in severe cases, foetal death,” he said.
The don also noted that, although uncommon, babies can contract malaria from their mothers before birth through a condition known as congenital malaria.
Abasiattai explained that while mothers pass protective substances to their babies during pregnancy, the malaria parasite can still cross the placenta in some cases, making early diagnosis essential when newborns present with fever.
Also speaking, a Consultant Obstetrician and Gynaecologist at the Federal Medical Centre, Abeokuta, Ogun State, Dr Olanrewaju Jimoh, said malaria should never be dismissed as “ordinary malaria”, particularly during pregnancy.
He said the disease could affect both the mother and the baby in several ways if left untreated or poorly managed.
“When a pregnant woman develops malaria, the malaria parasites—particularly Plasmodium falciparum—accumulate within the placenta. Once the parasites invade the placenta, they trigger what we call inflammation of the placenta,” Jimoh said.
The gynaecologist added that malaria parasites can sometimes cross the placental barrier and infect the baby before birth, resulting in congenital malaria.
He warned that affected newborns face an increased risk of jaundice and other serious health problems soon after delivery.
“Although congenital malaria is not very common, when it occurs, it can present with temperature abnormalities, difficulty controlling blood sugar levels, jaundice, and respiratory distress. The baby may not be able to breathe well and may require oxygen and other intensive care measures.
“Sometimes, because of overwhelming sepsis and these other complications, some babies may still die and not survive. Those are the major issues,” Jimoh said.
Some studies, he added, have also suggested that children born with congenital malaria may later experience developmental challenges, although more long-term follow-up is needed to fully understand these outcomes.
Beyond its effects on the fetus, Jimoh warned that malaria can have devastating consequences for pregnant women.
Because pregnancy naturally suppresses immunity, he said expectant mothers are more likely to develop severe malaria than non-pregnant adults, exposing them to complications such as severe anaemia, cerebral malaria, hypoglycaemia, pulmonary oedema, kidney injury, miscarriage and, in severe cases, death.
According to the consultant, many of these complications are preventable through consistent antenatal care and the use of Intermittent Preventive Treatment in pregnancy.
He advised pregnant women to receive sulfadoxine-pyrimethamine at scheduled intervals during antenatal visits to reduce the risk of malaria and its complications.
Jimoh noted that the WHO recommends that every pregnant woman receive at least three doses of the preventive medication during pregnancy, although some women may require additional doses depending on their circumstances.
He said the intervention has proved highly effective in preventing placental malaria, congenital malaria, and other adverse pregnancy outcomes linked to the disease.
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