What happens when you get malaria during pregnancy?

**Lead**

Malaria during pregnancy is one of the most dangerous yet overlooked complications in global health. Each year, millions of pregnant women across sub-Saharan Africa and parts of Asia are infected with Plasmodium falciparum, the deadliest form of the parasite. The consequences are devastating: maternal anaemia, severe illness, stillbirth, low birth weight, and a heightened risk of infant death. This is not merely a problem for tropical countries. In an era of global travel, climate change, and shifting disease patterns, the UK’s medical establishment is increasingly aware that the effects of malaria in pregnancy must be understood not only by doctors in endemic regions but also by obstetricians, midwives, and policymakers in London, Manchester, and Birmingham.

**Context**

The biological mechanism behind severe outcomes in pregnancy is well established in medical literature. When a pregnant woman is bitten by an infected Anopheles mosquito, the malaria parasite travels to her liver and then invades red blood cells. What makes pregnancy different is the placenta. The parasite is able to sequester in the placental tissue, avoiding the maternal immune system and causing an inflammatory response that damages the organ. This can restrict the flow of oxygen and nutrients to the foetus, leading to intrauterine growth restriction and low birth weight. For the mother, the infection can cause severe anaemia because the parasite destroys red blood cells, leaving her exhausted, breathless, and vulnerable to complications during labour.

In the UK, malaria is not endemic. The mosquitoes that transmit the disease do not survive in the British climate, and indigenous transmission has been absent for decades. However, UK public health authorities record a significant number of imported cases every year, particularly among travellers, migrants, and people visiting friends and relatives in high-risk areas. A pregnant woman who has not grown up in a malaria-endemic region has no partial immunity, and is therefore at even greater risk. This is a particular concern for women of African or South Asian heritage living in Britain who travel to their country of origin during pregnancy, as well as for pregnant women who are newly arrived in the UK from affected regions.

According to the World Health Organization, malaria infection in pregnancy is estimated to cause a substantial proportion of maternal deaths in endemic countries. WHO recommends a three-pronged approach in high-burden areas: insecticide-treated bed nets, intermittent preventive treatment with sulfadoxine-pyrimethamine, and prompt case management. In 2019, the WHO African region alone accounted for the overwhelming majority of malaria cases and deaths worldwide, and pregnant women and children under five are consistently identified as the highest-risk groups. For the UK, the National Health Service produces clear guidance for clinicians: pregnant women travelling to malaria-risk countries should be advised to avoid travel if possible, and if travel cannot be avoided, they should practice strict mosquito avoidance and consider prophylaxis after careful risk assessment.

**Analysis**

The significance of malaria in pregnancy extends beyond the immediate clinical picture. On a global scale, the disease perpetuates cycles of poverty and inequality. A mother who survives severe malaria may still give birth to a baby who is underweight, with lifelong consequences for cognitive development and overall health. These babies are more likely to grow into children who struggle at school, which in turn affects economic productivity in their communities. For the UK, there is a strong humanitarian argument for continued investment in global health programmes. The UK has historically been one of the largest donors to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and British scientific institutions have contributed to the development and testing of malaria vaccines, including the RTS,S vaccine recommended by WHO in 2021 and the later R21 vaccine.

Domestically, the issue presents a clear challenge for primary care and obstetrics. Because malaria is rare in the UK, diagnostic delays can occur. A pregnant woman who returns from Nigeria or Ghana and develops a fever may initially be treated for a viral infection if her travel history is not immediately considered. This is why clinical training and public awareness matter. Midwives in London and other multicultural cities are encouraged to take a detailed travel history during antenatal appointments. Public Health England, now known as the UK Health Security Agency, has historically published annual travel health surveillance reports highlighting malaria cases in returning travellers, and frequently notes that a proportion of cases involve pregnant women who did not take appropriate prophylaxis.

The broader lesson is that diseases do not respect borders. As global connectivity continues to grow, UK health professionals must remain vigilant about the health of patients who arrive from or travel to tropical regions. The relationship between health systems in high-income countries and endemic countries is not merely charitable; it is mutual. Advances in vaccine research, insecticide technology, and diagnostic tools benefit everyone. When malaria-resistant mosquitoes emerge, or when climate change shifts the range of Anopheles mosquitoes towards southern Europe, the UK will depend on data and expertise developed in global partnerships. Investing in malaria control during pregnancy is therefore an investment in global health security.

For pregnant women making travel decisions, the advice from health authorities is unambiguous: if you are pregnant, avoid travelling to areas with high malaria transmission. If you must travel, seek pre-travel advice from your GP or a specialist clinic, take effective mosquito precautions such as long sleeves and DEET-based repellents, and complete any prescribed antimalarial medication exactly as directed. The risks of malaria to both mother and baby are simply too high to ignore.

**Fontes**

World Health Organization (WHO) – Malaria in Pregnant Women fact sheet and World Malaria Report.

UK Health Security Agency (UKHSA) – Travel Health Surveillance: malaria annual reports.

National Institute for Health and Care Excellence (NICE) – guidance on malaria prophylaxis in pregnancy.

NHS England – Clinical guidance on malaria in pregnancy and imported infections.