Malaria in pregnancy poses severe risks including miscarriage, experts warn

A fever in early pregnancy might seem like nothing more than the body adjusting to its new state. A woman feels weak, loses her appetite, experiences nausea. These are the ordinary discomforts of the first trimester. But if that fever is malaria, the consequences can be catastrophic—miscarriage, severe anemia, a baby that fails to grow, or death in the womb.

Maternal health specialists across Nigeria are sounding an alarm about malaria's particular danger during pregnancy, especially in the opening weeks when a developing baby is most vulnerable. The disease strikes at a moment when a pregnant woman's immune system is naturally suppressed, leaving her less able to fight infection. Malaria parasites, once they establish themselves, can lodge directly in the placenta—the organ that feeds and oxygenates the growing fetus. When this happens, the supply of nutrients and oxygen diminishes. The baby may stop growing altogether. Birth weight plummets. Premature labor can begin. In the worst cases, the fetus dies.

Professor Aniekan Abasiattai, an obstetrician and gynecologist at the University of Uyo in Akwa Ibom State, explained that malaria is a well-documented trigger for miscarriage in the first thirteen weeks of pregnancy. The high fever alone can precipitate loss. Beyond that, malaria is among the leading causes of anemia in pregnant Nigerian women, and that anemia compounds the damage—weakening both mother and child. The parasites can accumulate in the placenta even when they do not show up in routine blood tests, creating a hidden threat that interferes with the basic exchange of life between mother and fetus.

The challenge is diagnosis. Malaria's symptoms—weakness, vomiting, loss of appetite, general malaise—overlap almost entirely with the early signs of pregnancy itself. A woman experiencing these symptoms might assume they are simply part of being pregnant and delay seeking care. She might self-medicate, or wait for the discomfort to pass. By the time she reaches a doctor, precious weeks may have elapsed. Dr. Stanley Egbogu, a consultant obstetrician and gynecologist, stressed that this confusion is dangerous. When malaria parasites lodge in the placenta, they obstruct blood flow. The fever itself can trigger miscarriage. The infection destroys red blood cells, deepening anemia. It can damage vital organs, including the kidneys.

The scale of the problem extends far beyond individual cases. According to the World Health Organization, malaria in pregnancy accounts for eleven percent of all newborn deaths globally and ten thousand maternal deaths each year. Nigeria ranks among the two countries with the highest exposure to malaria during pregnancy. The disease is endemic across much of sub-Saharan Africa, making prevention and early detection not merely medical advice but a matter of public health urgency.

Treatment is possible, but it requires precision. Not all antimalarial drugs are safe in the first trimester. The WHO's 2025 guidelines recommend artemether-lumefantrine for uncomplicated cases of Plasmodium falciparum malaria in early pregnancy, while quinine is another option. After the first trimester, preventive treatment with sulphadoxine-pyrimethamine can be given monthly as part of routine antenatal care. But none of this works if the infection is not caught. Abasiattai emphasized that the modern approach to malaria management has shifted decisively toward confirmation—testing for the parasite before treatment begins. This prevents unnecessary medication, which has contributed to drug resistance, while ensuring that women who truly have malaria receive the right drugs at the right time.

Prevention remains the strongest defense. The WHO recommends long-lasting insecticide-treated mosquito nets throughout pregnancy. Environmental sanitation—clearing brush and stagnant water where mosquitoes breed, installing window nets, maintaining mosquito-control measures around the home—reduces exposure. But these measures work only if women know to use them and have access to them. The experts urge pregnant women to seek immediate medical evaluation and testing if they develop fever, nausea, vomiting, weakness, or any general feeling of illness. A rapid diagnostic test takes minutes. A confirmed diagnosis opens the door to safe, effective treatment. Delay risks everything.