This sheet talks about using an antimalarial medication in a pregnancy or while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.

What is an antimalarial medication?

Antimalarials are medications that are taken to prevent malaria. There are a number of different medications that have been used to prevent malaria. These medications include: chloroquine, mefloquine, atovaquone, proguanil, chloroguanide, artesunate, doxycycline, pyrimethamine, hydroxychloroquine, primaquine, and others.

What is malaria?

Malaria is a blood-borne infectious disease found in many parts of the world. People typically become infected with malaria after being bitten by a mosquito that had been infected with a malaria-causing parasite. Less commonly, people can develop a malaria infection from blood transfusions, organ transplants, or the shared use of needles or syringes contaminated with infected blood. A pregnant woman may also pass malaria to her child before or during delivery. Malaria infection during pregnancy could cause severe illness in the mother as well as miscarriage, stillbirth or a complication like preterm delivery.

The Centers for Disease Control and Prevention (CDC) recommend that pregnant women not travel to areas where malaria is found; this is the best way to prevent a malaria infection. If travel cannot be avoided, it is recommended that pregnant women take steps to protect themselves from mosquito bites. Methods to help prevent malaria infection include using insect repellent (see the MotherToBaby information sheet on Insect Repellents at https://mothertobaby.org/fact-sheets/insect-repellents/pdf/ and the sheet on DEET at https://mothertobaby.org/fact-sheets/deet-nn-ethyl-m-toluamide-pregnancy/pdf/), sleeping in mosquito-free areas, wearing long sleeves and pants and, taking antimalarial medication before, during, and after travel, as directed by your healthcare provider.

You can read more about malaria in pregnancy on the malaria fact sheet at: https://mothertobaby.org/fact-sheets/malaria/pdf/.

Is antimalarial medication safe to take during pregnancy?

When considering the use of any medication during pregnancy, it is important to consider both the risks and benefits of taking the medication. It is commonly accepted that pregnancy complications associated with malaria infection pose a greater threat to the mother and developing baby than any risks associated with antimalarial medication used during pregnancy.

It is difficult to provide a general recommendation for which antimalarial medications are best suited for use in pregnancy as malaria parasites can be resistant to multiple drugs. The best medication for you will depend on the type of malaria parasite that is most common in the area to which you are traveling, as well as your personal health history. After discussing your travel plans with your healthcare provider, contact MotherToBaby with the name of the medication that you have been advised to take. A MotherToBaby specialist can then discuss the current pregnancy and breastfeeding research on your specific medication(s).

The Centers for Disease Control and Prevention (CDC) have created a webpage that provides information on recommendations for each malaria-endemic country, available at: https://www.cdc.gov/malaria/travelers/country_table/a.html

Do any antimalarial medications cause birth defects or pregnancy complications?

In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. No specific birth defects have been associated with malaria prevention medications. However, with some of the medications, there is not enough experience with use in pregnancy to know for sure.

Since there are many different medications that can be used as an antimalarial, please contact a MotherToBaby specialist with the name of the specific medication(s) that you are considering.

Can I breastfeed my baby while taking antimalarial medications?

Breastfeeding has many benefits for a growing baby, and any concerns you have regarding medication use while breastfeeding should be addressed with your healthcare provider and your baby’s pediatrician. Small amounts of antimalarial medications might enter the breast milk, but in most cases this exposure is not expected to result in adverse effects on the baby.

The CDC indicates that some medications are not safe when the breastfed infant weighs less than 11 pounds, or has a genetic condition called “G6PD Deficiency”. Here is the CDC fact sheet on taking antimalarial medications and breastfeeding: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/malaria.html.

The amount of medicine in the breast milk does not provide protection from malaria for the breastfeeding infant. Infants who will be traveling to regions where malaria is present should receive their own malaria prevention medication. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

What if the father of the baby uses antimalarial medication?

In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet on Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.

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