USE OF PROGUANIL IN PREGNANCY

Proguanil is an antimalarial, frequently prescribed with chloroquine or used in combination with atovaquone (as Malarone®) for malaria prophylaxis.

Malaria in pregnancy presents a high risk to both mother and fetus. Travel to areas where malaria is endemic should be avoided during pregnancy wherever possible. If travel to such areas is unavoidable, insect repellents, bed nets and appropriate clothing to prevent mosquito bites should be used. Pregnant women should also be advised to use the most effective malaria chemoprophylaxis for that area and the available pregnancy safety data discussed with the patient.

There are very limited data on proguanil use (as a single agent) in pregnancy. Most of the available studies report on use of proguanil in combination with chloroquine or atovaquone (Malarone®) and involve a low number of first trimester exposures. These data, although extremely limited, have not shown an increased risk of congenital malformation. However, proguanil is a folate antagonist and these data are not robust enough to disprove theoretical concerns that use before or during early pregnancy may increase the risk to the fetus of congenital malformations associated with folate deficiency. It is therefore recommended that pregnant women take high dose folic acid (5mg daily) in conjunction with proguanil.

The limited data investigating proguanil use specifically do not suggest an increased risk of spontaneous abortion, low infant birth weight or preterm delivery and a single study investigating Malarone® (proguanil-atovaquone) exposure found no adverse neurodevelopmental outcomes among a small number of prenatally exposed one year old infants. 

Exposure to proguanil at any stage of pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

Important: Please ensure that the selected antimalarial will provide appropriate prophylaxis for the area of travel. Up-to-date advice is available from a number of sources (e.g. BNF,[1] Fit For Travel,[2] NathNAC,[3] TRAVAX[4]).

For further advice on malaria prevention in pregnancy please refer to the relevant UKTIS document below.