1. Malaria in pregnancy is a major cause of maternal morbidity and mortality worldwide and leads to poor birth outcomes. 2. Treatment consists of antimalarial therapy and supportive care. Treatment choice for malaria infection depends on clinical severity, epidemiologic resistance patterns, and available data about drug safety in pregnancy. In chloroquine-sensitive areas give for firstline therapy (Grade 2C). 3. For treatment of uncomplicated chloroquine-resistant malaria during the first trimester, give quinine combined with clindamycin (Grade 2C). In 2nd or 3rd trimesters, artemi sinin combination therapy or quinine plus clindamycin may be used. For severe chloroquine-resistant malaria, give intravenous artesunate suggested (Grade 2C). 4. Prevention involves chemoprophylaxis and mosquito avoidance. Pregnant travelers must be advised to defer travel to areas where risk of malaria is high until after delivery, if feasible. For pregnant women who cannot defer travel or reside in malarious regions, recommend chemoprophylaxis and mosquito avoidance (Grade1A). 5. For pregnant women who reside in areas of medium and high malaria transmission, we recommend three doses of IPTp with sulfadoxine pyrimethamine rather than two doses (Grade 1A). 6. Sulfadoxine pyrimethamine is given at each scheduled antenatal care visit in the second and third trimesters (at 24 to 26 weeks, at 32 weeks, and at 36 to 38 weeks).
Pregnant women with HIV who are not using cotrimoxazole prophylaxis should receive monthly doses. Optimal antimalarial agent, dose, and frequency for IPTp depend on regional transmission intensity, drug resistance patterns, and HIV prevalence. 7. Mosquito avoidance reduces likelihood infection. It is advisable to diminish exposure between dusk and dawn by remaining in screened areas whenever possible, cover exposed skin with clothing, and apply insect repellent.