Malaria in a pregnant woman increases the risk of maternal death, neonatal death, miscarriage, and stillbirth. Medical help should be sought immediately if malaria is suspected, and treatment with an effective antimalarial drug must always be given. In areas of chloroquine resistance, prophylaxis with chloroquine plus proguanil is recommended during the first three months of pregnancy. Cumulative evidence from woman inadvertently given mefloquine chemoprophylaxis during pregnancy and from clinical trials has not showed embryotoxic or teratogenic effects. Mefloquine may therefore be given during the second and the third trimesters.
Data concerning use during the first trimester are limited.
Other drugs are either dangerous to the fetus or insufficiently investigated to be prescribed for prophylaxis in pregnancy. In non-pregnant women of childbearing potential, mefloquine or doxycycline can be given, but pregnancy should be avoided for three months after completing prophylaxis in the case of mefloquine, and for one week in the case of doxycycline. However, in the case of unplanned pregnancy, malaria chemoprophylaxis is not considered an indication for pregnancy termination. Children are at special risk since they can rapidly become seriously ill with malaria. Fever in a child returning from a malarious area should be considered to be due to malaria until proved otherwise.