This could be due to the hormonal , immunological and hematological changes of pregnancy. Due to the hormonal and immunological changes, the parasitemia tends to be 10 times higher and as a result, all the complications of falciparum malaria are more common in pregnancy compared to the non-pregnant population. Some anti malarials are contra indicated in pregnancy and some may cause severe adverse effects. Therefore the treatment may become difficult, particularly in cases of severe P. falciparum malaria. Other problems Management of complications of malaria may be difficult due to the various physiological changes of pregnancy.
Careful attention has to be paid towards fluid management, temperature control, etc.
Also decisions regarding induction of labour may be difficult and complex. Foetal loss, IUGR, and premature labour are common. Pathology of malaria in pregnancy P. falciparum malaria can run a very turbulent course in pregnancy, particularly the first and second pregnancies. These complications are more common and severe in hyperendemic areas for falciparum malaria. Physiologic changes of pregnancy contribute to the aggravation of malarial infection.