Malaria medications for pregnant women

August 28, 2013 8:33 AM

YANMD, YANAD, etc. I need to sort out the differing opinions on malaria medication for pregnant women.

I have to go to a malarial area in ten days. I will be 14 weeks pregnant. In my current country (South Africa), I have gotten a pretty slash-and-burn response to asking for malaria meds: basically I have been told that I cannot go and if I do I risk death in a fiery inferno. I am waiting for a response from my doctor in the US, but in the meantime, I was hoping for some help sorting out the myriad of conflicting information out there.

Assume I have to go. I prefer not to get into a debate about whether I should or should not go. What malaria medications can I take with a minimum of risk? Should I even take them? Is DEET and long pants and nets enough protection?

The area is northern Botswana and it is low-risk season, but a higher risk area. The US State Department cites very few cases of malaria among government employees that spend time in the bush and the delta.

posted by mrfuga0 to Travel & Transportation around Botswana (9 answers total)

I am not an expert, but this

DEET

means different things to different people. Are you talking about a product like Deep Woods OFF! with 25% DEET, or are you talking about what I use in the Everglades, which is a 98% DEET or when I can get it, 100% MAXI DEET?

Deep Woods OFF? No, I would not trust that in a malarial area. Hell No. 100% DEET, plus nets plus layers (I have watched mosquitoes bite me through jeans and long johns together.) Spray my clothes with DEET and I'd maybe consider it without antimalarial drugs. Maybe.

Long pants will not help you if your arms are exposed. Also, if the spaces between your pants bottoms and shoes are exposed/only covered by sock. You seriously want layers. And/or to be hanging around lots of people wearing much less than you are.

(I would also wpnder if "who spend time in the bush and the delta" might mean "people who got sick and tired of all the precautions and didn't like the freaky dreams that the antimalarial drugs gave them" BUT it might not mean that.)
posted by bilabial at 8:52 AM on August 28, 2013

I know you're waiting for your doctor's response on this, but have you looked around the CDC website for info on Botswana? IAAD but don't really do travel medicine - my understanding was that, of the antimalarials, mefloquine/Lariam is the only option for you in Botswana (due to chloroquine resistance in the area). Definitely all the preventative measures would be recommended as well (e.g. nets, long pants, DEET).
posted by flying kumquat at 9:46 AM on August 28, 2013

My only knowledge in this area is that I am referring to a trustworthy source.

According to MotherRisk (which is run by the Hospital for Sick Children in Toronto), mefloquine is safe in all trimesters. At the above link, two papers on mefloquine in the first trimester are cited, but neither is a large randomized controlled trial.
posted by snorkmaiden at 10:01 AM on August 28, 2013

Response by poster: I'm down to taking either Doxy or Mefloquine, or potentially taking nothing. Botswana is in low risk season now, but it's a higher risk area in general.
posted by mrfuga0 at 10:25 AM on August 28, 2013

Mefloquine has many adverse side affects that one should know, per this recent article in NYTimes. Per this CDC advisory page, Chloroquine can be used in all trimesters of pregnancy, though I cannot speak to the resistance concerns. Safe travels and good luck.
posted by zachxman at 11:18 AM on August 28, 2013

because there are different types of resistance worldwide, the cdc has a country by country breakdown that might offer some advice
posted by OHenryPacey at 11:29 AM on August 28, 2013

also as dentist i have to mention that doxy will almost certainly result in dark banding in your child's teeth and is contraindicated for this reason
posted by OHenryPacey at 11:33 AM on August 28, 2013 [2 favorites]

My understanding: Actual quinine is less prone to drug resistance than the synthetic derivatives. My opinion/experience: Herbal extracts (like quinine) are easier on the body than synthetic drugs. They work more subtly, thus are less of a blunt instrument.

Is actual quinine an option?
posted by Michele in California at 4:57 PM on August 28, 2013

I am 32 weeks pregnant and living in a malaria zone. Malarone (atovaquone/proguanil) is another possibility, although it's more expensive than mefloquine. Some countries (US) list it as contraindicated for pregnant women. Others (UK) don't. I get bad side effects from mefloquine that I don't get from malarone. Everyone thinks doxy is bad for pregnant women.

Whatever you decide, the number one preventer of malaria deaths worldwide is sleeping under an impregnanted mosquito net. If you don't have one, buy one to take with you.
posted by asnowballschance at 8:55 AM on August 29, 2013