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Due to the increased
morbidity and mortality associated with malaria during pregnancy,
pregnant women should avoid traveling to malarious
regions if possible. Antimalarial agents may be necessary
during pregnancy for the prevention or treatment of malaria.
Quinine derivatives are the classical
drugs used for malaria, of which the most useful is chloroquine.
Chloroquine is the drug of choice for the prophylaxis and
treatment of malaria during pregnancy
due to the substantial amount of literature on its "safety"
during pregnancy.
I. Pregnant women traveling to malaria-risk areas in Mexico,
Haiti, the Dominican Republic, and certain countries in Central
America, the Middle East, and Eastern Europe
should take either chloroquine or hydroxychoroquine
sulfate as their antimalarial.
a. Chloroquine (500 mg/week) (or
chloroquine deritive Hydroxychloroquine sulfate at 400mg/week):
- Should be taken 1 week before arrival
- Then, once per week,
on the same day each week, while in the malarious region.
- Then, once per week for
4 weeks after leaving the region.
Possible side effects:
(rare) nausea, vomiting, headache, dizziness, blurred vision
and itching.
II. Due to chloroquine-resistance, pregnant women traveling
to malaria-risk areas in South
America, Africa, the Indian subcontinent, Asia, and the South
Pacific should take mefloquine as their antimalarial
drug.
a. Mefloquine (250 mg/week):
- First dose 1 week
before arrival in malarious region.
- Then, once per week, on
the same day of the week, while in region.
- Then, once per week
for 4 weeks after leaving the region.
Possible side effects:
(rare) nausea, dizziness, difficulty sleeping, and vivid dreams.
Very rare symptoms include seizures, hallucinations,
and severe anxiety.
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