Malaria in Pregnancy: The Hidden Toll on Mothers and Babies and Why UK Clinicians Are on Alert

**Lead**

Each year, hundreds of pregnant women in the United Kingdom are diagnosed with malaria after returning from tropical regions, and health experts warn that the consequences of infection during pregnancy can be devastating for both mother and child. Malaria in pregnancy is not simply a more uncomfortable version of the usual illness: it is a leading cause of severe maternal anaemia, stillbirth, preterm delivery and low birth weight across the globe. In the UK, where malaria is not endemic, cases are almost entirely travel-related, but obstetricians are increasingly concerned that delayed diagnosis and suboptimal prevention are putting pregnancies at unnecessary risk.

**Contexto**

The disease is caused by Plasmodium parasites, transmitted by the bite of infected female Anopheles mosquitoes. In pregnancy, the parasite has a particularly dangerous tendency to sequester in the placenta, where it can interfere with the transfer of oxygen and nutrients from mother to fetus. This placental accumulation is why pregnant women are more likely to develop severe disease than non-pregnant adults, and why the unborn child bears much of the burden. According to the World Health Organization, pregnant women are among the highest-risk groups for malaria, with large numbers of maternal deaths in sub-Saharan Africa attributable to the disease each year.

In the UK, the majority of cases in pregnancy are caused by Plasmodium falciparum, the deadliest form of the parasite, and are acquired in West and East Africa as well as South Asia. Public Health England, now the UK Health Security Agency, has historically reported annual totals of imported malaria in the low thousands, with a small but significant proportion occurring in pregnant women. Because UK obstetricians see the disease relatively infrequently, there is concern that warning signs such as fever, headache and fatigue may be mistaken for more common viral illnesses or pregnancy-related complaints, delaying the blood tests required to confirm the diagnosis.

The Royal College of Obstetricians and Gynaecologists has issued guidelines emphasising that malaria should be considered in any pregnant woman with a fever who has recently travelled to an endemic area. Guidelines also note that pregnancy is not a contraindication to treatment, and that withholding appropriate antimalarial drugs out of fear of fetal harm is far more dangerous than the treatment itself. For the mother, untreated severe malaria can progress to cerebral malaria, acute kidney injury and death. For the baby, placental insufficiency can lead to fetal distress, growth restriction and stillbirth, while maternal anaemia increases the risk of preterm labour and low birth weight.

**Analise**

The burden of malaria in pregnancy falls disproportionately on low-income countries, but the condition has clear relevance to UK clinical practice. Global travel has rebounded since the pandemic, and the rise of cheap long-haul flights means that more women of childbearing age are visiting areas of high transmission. At the same time, the emergence of partial drug resistance to artemisinin-based combination therapies in parts of South-East Asia and Africa has made effective treatment more complicated. For UK clinicians, this means the old formula of ‘travel history plus fever equals malaria test’ must be applied with even greater urgency.

Prevention remains the most powerful tool. The standard advice for pregnant women travelling to malaria-endemic regions is to avoid unnecessary travel, use insecticide-treated bed nets and protective clothing, and take chemoprophylaxis with a drug that is safe in pregnancy, such as mefloquine or chloroquine where the parasite remains susceptible. However, surveys suggest that adherence to malaria prevention among UK travellers is often poor, particularly among those visiting friends and relatives in their country of origin. These travellers may assume they have protective immunity, but that protection wanes after years of living in the UK, and pregnant women are even more vulnerable.

The policy implications are significant. Specialist antenatal clinics and travel health services have a role in identifying high-risk women before conception and during early pregnancy. In obstetric units, protocols should ensure that blood films and rapid diagnostic tests are performed urgently in any febrile woman with relevant travel history, alongside screening for anaemia and fetal wellbeing. The UK has the expertise to prevent nearly all malaria deaths in pregnancy; the challenge is ensuring that every pregnant traveller receives accurate advice and every suspected case is managed without delay.

**Fontes**

This article is based on scientific and clinical information from the World Health Organization, the UK Health Security Agency, and the Royal College of Obstetricians and Gynaecologists' guidelines on the prevention and treatment of malaria in pregnancy. Specific statistics were deliberately omitted to avoid inaccurate citation of rapidly changing surveillance data.