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Congenital Malaria - Causes, Symptoms, Diagnosis, and Treatment

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Congenital malaria is often rare, and by the term itself, we could understand that malaria is transmitted from the mother to the child. To know more about it, read the article below.

Medically reviewed by

Dr. Madhuvanthi Rajendran

Published At March 23, 2022
Reviewed AtJuly 17, 2023


Congenital malaria is one of the rare forms of malaria, and it could be fatal. The mortality rate is high if the newborns born to nonimmune women are affected by the Plasmodium falciparum parasite. But semi-immune women (immigrant families or those who acquired infection during travel) transmit malaria less likely. Their children exhibit less severe symptoms, usually weeks after delivery. In asymptomatic women, the absence of fever or prophylactic measures taken for malaria during pregnancy does not prevent congenital malaria from happening in a newborn. It can occur in newborns due to any of the below-mentioned causes.

What Causes Congenital Malaria?

During pregnancy, there is increased susceptibility to Plasmodium falciparum and vivax, but the susceptibility to Plasmodium malariae and ovale remains unchanged, and all four human malarial parasites are known to cause congenital malaria.

Erythrocytic-stage of malarial parasites cause congenital malaria, and they are transmitted from mother to child. The pre-erythrocytic stage of malarial parasites (sporozoite) and the hepatocytes that develop during the first week of infection are not known to cross the placenta or cause congenital malaria. The treatment in case of congenital malaria is given to newborns to eradicate blood-stage parasites and not liver-stage parasites.

Sometimes, a mother’s history can also be misleading for clinicians to assess an infant with congenital malaria because malarial parasites can also be seen in asymptomatic individuals. Congenital malaria can also occur in newborns whose mothers reported having malaria prophylaxis during travel or residence in endemic areas. In addition, the transmission may also occur across the placental barrier during labor or can also result when the newborn contacts the infected maternal blood during parturition. Thus, it is totally uncertain how the mode of parasite transmission occurs from mother to newborn.

What Are the Symptoms of Congenital Malaria?

Though congenital malaria is defined as the presence of malaria in a newborn baby, the parasites will start to increase significantly within the first 24 hours to 7 days. Hence the symptoms will begin to appear usually between the 10th day and the 30th day after the child is born. The most common set of symptoms that are observed in 80 % of the cases are:

  • Anemia (lack of healthy red blood cells).

  • Fever.

  • Splenomegaly (enlargement of the spleen).

  • Jaundice.

  • Regurgitation (bringing up swallowed food or digested food).

  • Loose stools.

  • Poor feeding.

  • Restlessness.

  • Drowsiness.

  • Cyanosis (bluish discoloration of the child's skin).

Also, in some cases, it is possible for the child to have:

  • Hepatomegaly (enlargement of the liver).

  • Certain distress during respiration.

  • Passing watery stools.

How Is Congenital Malaria Diagnosed?

Congenital malaria might often be fatal. Hence proper diagnosis is required to help save the newborn's life. Though congenital malaria is very rare, it is still considered a life-threatening condition. While diagnosing a child who is having fever and thrombocytopenia (decreased blood platelet count), the doctor will inquire about the previous medical conditions related to any exposure to malaria with the mother, as it is one of the major factors that contribute to this condition in a child.

If the doctor suspects that the child has congenital malaria, then the laboratory findings help in confirming the suspicion. The blood is drawn from the child to make use of the Giemsa-stained blood smear test, and it makes use of both thick and thin blood smears. This blood smear test will help in identifying the presence of the parasite in the red blood cell using the microscope, but more than one blood smear is needed to diagnose congenital malaria because of the low parasite density, so the chances of detecting the parasite on a single smear are low.

The other test that helps in diagnosing the presence of parasites is the cord blood test, which utilizes the blood cells from the cord instead of the peripheral blood of the infant. This test avoids the extraction of blood from the newborn, but it does not help arrive at a definitive diagnosis because of the fact that the cord blood might be infected with the contaminated maternal blood.

On a separate note, HIV (human immunodeficiency virus) increases the risks of congenital malaria. If the doctor has some suspicions of the newborn having malarial parasites, then the doctor will ask the patient for a proper HIV assessment and suggest adequate preventive measures based on the newborn's indication.

How Is Congenital Malaria Treated?

There has been very little study and research about the pharmacokinetics and pharmacodynamics of the parasites. Hence there is no standard treatment procedure for congenital malaria. The treatment guidelines rely on the previous case reports and extrapolation methods from previously affected children. Treating malaria in the newborn also depends on:

  • Parasite species.

  • The region from where the infection is acquired.

  • The severity of the disease.

Early treatment is essential, but the pediatric preparations of the medicines are not available. The suggested adult medications require dissolving to make them consumable for the baby. In major cases, the perfect go-to medicine for:

  • The presence of a chloroquine-sensitive strain of Plasmodium falciparum or Plasmodium vivax is Chloroquine.

  • Uncomplicated chloroquine-resistant Plasmodium falciparum is Quinine sulfate plus Clindamycin.

The dosage is based on the child's weight, and it is important to monitor the glucose level as these drugs might lead to hypoglycemia.

In severe cases of congenital malaria, where there are associated complications of seizures, breathing difficulties, hyperparasitemia, or severe anemia, intravenous Quinidine gluconate in combination with Clindamycin should also be prescribed. Also, if the child is highly anemic, transfusion might be required to help manage the condition.


Congenital malaria is extremely rare and might become fatal for the child if not assessed properly during the early stages. The presence of fever during pregnancy is one of the most presenting symptoms that the baby might become affected by the parasite. Hence it is always essential to discuss your health condition with the doctor throughout the pregnancy period so that it would be safe and healthy for the baby as well.

Frequently Asked Questions


Do Infants Acquire Malaria From Their Parents?

Infants rarely acquire malaria from mothers, referred to as congenital malaria. It occurs as follows:
- The parasites like Plasmodium falciparum and Plasmodium vivax cause malaria in pregnant women and are transmitted to babies in the womb.
- It also occurs in babies whose mothers had a history of taking vaccines and medications for malaria or lived in endemic areas.
- It is also transmitted during labor, as the babies contact the infected mother's blood.


How Is Malaria Treated?

Malaria is a severe condition, and parasites are transmitted to humans by an infected mosquito. It is treated according to the age of the patient, symptom severity, and type of parasite that caused malaria. It includes:
- Artemisinin-based combination therapy (ACT) is mainly preferred due to its high efficacy and tolerance. Two or more drugs are combined to treat malaria. For example, medications like Artesunate and Mefloquine are combined.
- Chloroquine phosphate is also used in treating different parasites. But, it is not widely preferred due to the resistance of parasites to such drugs.
- Other drugs like Quinine and Doxycycline are also suggested.


What Is the Treatment of Malaria in Infants?

Malaria is transmitted from mother to infant via the placenta or during birth. Therefore, immediate treatment is essential, and it includes:
- Chloroquine is the most preferred drug against Plasmodium falciparum and Plasmodium vivax.
- The parasites resistant to Chloroquine are treated with Quinine sulfate and Clindamycin.
- Fluids containing Glucose are suggested for babies as the anti-malarial drugs lower blood glucose levels.
- Antiemetic drugs like Domperidone are also suggested to control vomiting and further dehydration (loss of body fluids) in babies.


How Are Congenital Abnormalities Explained?

Congenital abnormalities are structural and functional body defects that occur when the baby is in the mother's womb and are present at birth. The cause is unknown but is associated with maternal conditions. A few common congenital abnormalities are listed below:
- Heart defects are more common and are associated with diabetes and smoking habits in mothers. It affects the heart's walls, valves, or septum, and the normal blood flow is disturbed.
- Neural tube defects: Neural tube forms in early pregnancy and later develops in the spinal cord and brain. Any disturbance in neural tube development causes various brain and spinal cord abnormalities.
- Orofacial cleft: A more common congenital disability occurs due to improper development of the mouth and lips.
- Microcephaly refers to the abnormally small-sized head compared to babies of the same age and gender.


What Is a Congenital Malformation?

Congenital malformation or congenital disabilities are structural or functional disorders during intrauterine life (inside the womb) or at birth. Few malformations are detected later during the developmental stages of infants. Genetic, socio-economic, and environmental factors predispose the formation of congenital malformations or abnormalities. Certain anomalies like cleft lip and palate are treated by surgical method. However, other abnormalities like neural tube defects and heart defects impact life severely.


How Is Malaria Transmitted?

Malaria is an infectious disease caused by Plasmodium species. The main modes of malaria transmission are:
- Mosquito bite: The female Anopheles mosquito infected with malarial parasite transmit the infection to human.
- Congenital malaria: Infected mothers also transmit malaria to the growing fetus before or during birth.
- Blood transfusion from the infected individual also transmits malaria.
- Needlestick injury: Unaware injury by contaminated needles may transmit infectious parasites.


What Disturbs the Transmission Cycle of Malaria?

The malaria transmission cycle occurs when the mosquito gets infected by biting the affected person, and it transmits malaria to a non-infected person through a bite. The parasites enter the bloodstream to reach the liver. After maturation, it attacks the red blood cells. The transmission cycle of malaria is disturbed by:
- Body's immunity to attack the parasite.
- Climatic conditions also influence the incidence of malaria occurrence.
- The temperature needed for the development of parasites is 25 to 27°C, below which the growth is limited.
- The capacity of the Anopheles mosquito to transmit malaria depends on its varying species.
- The incidence of malaria transmission is low in urbanized areas.


How to Prevent a Congenital Abnormality?

Congenital abnormalities are congenital disabilities that occur due to environmental and genetic factors. It is prevented to a certain extent by eliminating the risk factors as follows:
- By avoiding alcohol and tobacco use during pregnancy.
- Intake of nutritious foods.
- Intake of supplements rich in vitamins, minerals, and folic acid.
- Avoid places that are endemic or show a high risk for infections.
- Proper weight management is also essential.
- Avoid exposure to pesticides and harmful chemicals.
- Regular screening to identify any diseases.
Dr. Madhuvanthi Rajendran
Dr. Madhuvanthi Rajendran



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