Malaria prevention in the pregnant traveller: a review

Malaria is still a major threat to health in tropical regions. Particular attention should be directed to malaria prevention in infants and pregnant women as they are at high risk for plasmodial infection and complicated malaria. In this review, we summarize and discuss current evidence on malaria prevention in pregnant travellers. As neither anti-mosquito measures nor anti-malarial drugs have been proven to be unequivocally safe or toxic in pregnant women, the individual risk assessment should take into account the risk of transmission at the destination, the benefit of travelling despite being pregnant as well as the individual risk perception. All three factors may differ in various groups of travellers like tourist travellers, expatriate travellers as well as those visiting friends and relatives. For pregnant women, mefloquine appears to be the drug of choice for prophylaxis and stand by-therapy if no contraindications exist - despite recent renewed warnings related to prolonged side effects. In areas with high resistance against mefloquine or in women with contraindications to mefloquine, atovaquone-proguanil or artemether-lumefantrine should be considered as an option for stand-by emergency therapy. Nevertheless, evidence on the safety of anti-malarials especially during the first trimester is still insufficient.