Treatment of P. vivax or P. ovale Malaria in a Woman Who Is Pregnant or Breastfeeding

Clinical Scenario

This protocol covers the management of P. vivax or P. ovale malaria specifically in women who are pregnant or breastfeeding. Both states introduce important constraints on which agents can be used and when, making this a distinct clinical situation requiring a carefully sequenced approach.

Pregnancy & Breastfeeding Considerations

Certain agents standard for relapse prevention in P. vivax and P. ovale infections are contraindicated during pregnancy and during breastfeeding of infants under one month of age. Relapse prevention must therefore be deferred until after delivery and the completion of breastfeeding, with drug selection at that point guided by the patient's G6PD status.

Approach (partial overview)

The strategy involves suppressive weekly chemoprophylaxis continued throughout the pregnancy and breastfeeding period. Once those periods are complete, relapse prevention is addressed as a separate step — the agent chosen depends on G6PD assessment.

Full regimen, sequencing, and drug details are available via the link below.

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References

In women who are pregnant or breastfeeding, weekly chemoprophylaxis with chloroquine can be given until delivery and breastfeeding are completed, then, on the basis of G6PD status, primaquine can be given to prevent future relapse.

Primaquine is contraindicated in pregnancy and women breastfeeding infants aged < 1 month.

As an alternative, chloroquine prophylaxis could be given to suppress relapses after acute vivax malaria during pregnancy.

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