Can Child Be Affected by Mother’s Malaria

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QUESTION
If the baby’s mother has malaria, can it affect the child?

ANSWER

If the mother is pregnant when she gets malaria, particularly if it is her first pregnancy and particularly if she has never had malaria before, the effects on both the mother and child can be very serious. For the mother, this is because her immune system changes when she gets pregnant. This leaves her more vulnerable to the effects of malaria, including anaemia.

The most dangerous type of malaria, P. falciparum, also seems very able to infect cells in the placenta, leading to a higher intensity infection, and also reducing oxygen delivery to the baby. This, combined with the mother’s illness and anaemia, can lead to low birth weight, anaemia and other complications in the child once it is born. Malaria can also pass through the placenta, or be transferred to the baby through blood during childbirth, resulting in “congenital malaria”; that is, malaria which has been passed from mother to infant. Since newborns have inexperienced immune systems, malaria in the first days or weeks of life, and especially if the child is already low birth weight, can be very dangerous.

As such, a lot of effort has gone to finding ways to prevent malaria in pregnancy and to treat women who do get malaria while pregnant to prevent negative effects both to her and her unborn child. These efforts mainly involve the distribution of long-lasting insecticide treated bednets, and in some places also include the administration of intermittent preventive therapy, where women are given periodic doses of anti-malarials during pregnancy to protect against the disease.

Malaria and Pregnancy

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QUESTION

Can your baby become immune if you’re pregnant and you have malaria?

ANSWER

Some of the protective antibodies that the mother produces when she has malaria can pass to her baby via the placenta. There is also evidence for immune system “priming” in foetuses when their mothers have been infected my malaria during pregnancy. However, these potentially protective effects are usually far outweighed by the negative effects of malaria during pregnancy.

Due to changes to the mother’s immune system and also perhaps due to the creation and physiology of the placenta, pregnant women are very vulnerable to malaria. For reasons which are not fully understood, women experiencing their first pregnancy (primagravidae) are most susceptible to malaria and their foetuses are most likely to have severe effects. These effects vary depending on the immune status of the mother and whether she is from an endemic or low transmission malaria environment, but typical results include low birth weight, anaemia and spontaneous abortion—abortion rates due to malaria can vary between 15-70%.

There is also the risk (up to 33% in some studies) that malaria will pass directly from the mother to the baby, either through the placenta or in blood during childbirth—this is called “congenital malaria,” and can manifest as early as 1 day after delivery but a late as months after. The symptoms are similar to that of adult malaria, with fever, anaemia, lethargy, etc.

Given these negative effects, it is very important to protect pregnant women against malaria, and bednet distribution schemes in many places target these women. In high transmission settings, women may also be offered intermittent preventive therapy (IPT) which consists of at least two doses of anti-malarial medication, usually once during the second and once during the third trimester.

Teen Has Anaemia, Mom Had Malaria

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QUESTION

I am concerned that my 22 yr old daughter has anaemia (tired & sleepy), possibly caused by Malaria (Katima Mulilo, Namibia), which I contracted just before returning to Cape Town.

I fell pregnant at that time. I was treated at the local hospital before returning home. Could it have affected the unborn fetus? My daughter has a low red blood count.

ANSWER

Congenital malaria occurs when a foetus is infected with malaria from the mother, either through transmission across the placenta or during childbirth. It can cause serious complications for the foetus, including spontaneous abortion, low birth weight and anaemia.

However, I don’t think there is any evidence that anaemia persists later into life—usually congenital malaria only affects newborns a few weeks after birth.

One of our maternal/child health experts says that she knows of one study (mentioned in the Tanzania Journal of Health Research) which suggests that immune priming due to congenital malaria could result in longer term effects in infancy and childhood—however, anaemia is not mentioned specifically and the article emphasises that more study is required to confirm this hypothesis.

Our advisory expert also says that anaemia is common in teenage and pubescent girls, and it is important to confirm the anaemia with a haemaglobin blood test, and get advice regarding improving her diet and perhaps taking iron supplements if indeed she is anaemic.