New Guidelines for Preventing and Treating Malaria in Pregnancy

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By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

In 2016, the World Health Organization (WHO) released new antenatal care (ANC) guidelines with the aim of promoting evidence-based practices and improving women’s pregnancy experiences. Notably, the new WHO ANC guidelines include a recommended change from four visits to at least eight ANC contacts.

Addressing the issue of malaria in pregnancy (MiP) is a key component of providing high quality ANC, particularly in endemic areas. A group of experts representing a number of organizations recently published a brief containing guidelines for preventing and treating MiP in the context of the updated WHO ANC guidelines.

Key messages

1. All pregnant women living in areas at risk for malaria transmission should:

  • Sleep under an insecticide-treated net (ITN).
  • Seek prompt quality diagnosis when signs and symptoms of malaria are present and receive effective malaria case management with an appropriate drug at the correct dose.

2. Pregnant women living in moderate to high malaria transmission areas in Africa should also receive:

  • Intermittent preventive treatment in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) under directly observed therapy (DOT) starting as early as possible in the second trimester, with doses given at least one month apart until the time of delivery.
  • To enable pregnant women in endemic areas to start IPTp-SP at the beginning of the second trimester, policymakers should put in place supportive policies to ensure that women have an ANC contact at 13 weeks’ gestation.
    • IPTp-SP should be given to a pregnant woman at every ANC contact starting from 13 to 16 weeks, with each dose being given at least one month (four weeks) apart.
    • Pregnant women who have an ANC contact twice between 13 and 20 weeks, at least one month apart, should receive IPTp-SP by DOT at both contacts.
    • If a woman comes for her first second-trimester contact anytime between 13 and 20 weeks, she should receive IPTp-SP, and at every following contact, with doses one month apart.
    • Pregnant women can receive IPTp-SP safely starting as early as possible in their second trimester up until the end of pregnancy.
  • SP should not be administered to women living with HIV who are receiving co-trimoxazole.

3. Countries should only provide quality-assured SP for IPTp to ensure effective care for pregnant women.

4. Iron and folic acid requirements increase during pregnancy.

  • Administer 30 to 60 mg of elemental iron and 400 mcg (0.4 mg) of folic acid.

Access the full MiP guidelines in English, French and Portuguese.


Learn more about malaria in pregnancy.

Read a summary of the newest WHO ANC guidelines.

What are your thoughts about these MiP guidelines? We want to hear from you!