A tale of two lives, vivax malaria in pregnancy in Indonesia's Heartland: A case series

Background: East Nusa Tenggara, an endemic region for malaria with the third-highest prevalence in Indonesia, increases the susceptibility of pregnant women to infection and related complications. Case: Two new cases of vivax malaria in pregnancy were identified in the first semester of 2024, both experiencing complications during pregnancy and the puerperium period. Both patients were nulliparous women from rural backgrounds, presented with evening fever, chills, heavy sweating, headache, myalgia, and arthralgia. The first case involved a singleton pregnancy in the third trimester, complicated by anemia and thrombocytopenia, which led to a malaria relapse a month post-delivery. The second case involved multiple pregnancies in the second trimester, presenting with thrombocytopenia, premature labor, and low birth weight post-treatment. Both patients received a three-day course of dihydroartemisinin-piperaquine (DHP), resulting in negative follow-up blood smears on days 3 and 7. Discussion: Plasmodium infects erythrocytes, sequesters in the placenta, and induces placental insufficiency, thereby contributing to maternal anemia, low birth weight, premature delivery, and infant mortality. DHP exhibits high efficacy and tolerability in pregnant women during the second and third trimesters, as evidenced by negative results in blood smears on days 3 and 7 post-treatment. However, the absence of a 14-day primaquine regimen leads to relapse in the first case. Conclusion: Early detection and treatment of malaria during pregnancy are essential in endemic regions to reduce maternal and neonatal complications.