Pregnancy and Malaria Quiz

A 24-year-old primigravida at 28 weeks has a hemoglobin (Hb) of 9.5 g/dL. Ferritin is 15 µg/L, MCV is 75 fL. She is from a region with high malaria prevalence. What is the most appropriate management plan?

• Begin high-dose oral iron and folate, no malaria prophylaxis needed

• Switch to parenteral iron immediately and treat for possible hemolytic anemia

• Oral iron + folate + malaria prophylaxis + evaluate for hookworm infestation

• Wait until third trimester to treat since Hb above 9 g/dL

Which of the following statements best explains why physiologic anemia occurs during pregnancy?

• Red cell mass decreases while plasma volume remains constant

• Plasma volume increases proportionally more than red cell mass

• There is increased destruction of red blood cells due to immune changes

• Fetuses consume maternal hemoglobin directly

A pregnant woman has persistent severe anemia (Hb 6.5 g/dL) in third trimester despite oral iron therapy. What factor should you investigate first?

• Iron absorption issues (e.g., dietary inhibitors)

• Hemoglobinopathies (e.g., thalassemia)

• Chronic blood loss

• Compliance & side effects of oral iron

Which of the following is a major risk of malaria in pregnancy for the fetus?

• Macrosomia

• Intrauterine growth restriction (IUGR)

• Post-term delivery

• Polyhydramnios

A pregnant woman in her second trimester presents with fever and confirms Plasmodium falciparum parasitemia. Which of the following is the best treatment choice?

• Chloroquine only

• Quinine + clindamycin

• Artemisinin-based combination therapy (ACT) if local guidelines permit in second trimester

• No treatment until third trimester due to drug safety

What is an effective preventive strategy against malaria in pregnancy in endemic areas?

• Single dose of sulfadoxine-pyrimethamine at booking only

• Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine in the second and third trimesters

• Use of insecticide spray only in the household

• Prophylactic daily chloroquine plus iron supplements

A 35-year-old woman with BMI 32, previous macrosomic baby, presents at 24 weeks. Which screening strategy is most evidence-based?

• One-step 2-hour 75 g OGTT for all pregnant women at 24-28 weeks

• Only screen women with risk factors at 28 weeks using 50 g glucose challenge

• Universal screening in first trimester

• No screening unless symptoms appear

Why is tight glycemic control in GDM important for neonatal outcomes?

• To prevent maternal ketoacidosis only

• To reduce risk of macrosomia, birth trauma, neonatal hypoglycemia

• To allow gestational weight loss

• Because GDM always causes congenital malformations

A pregnant patient with GDM is managed with diet and moderate exercise, but her 2-hour OGTT is still elevated. Next best step:

• Add metformin

• Start insulin therapy

• Continue diet and wait till 36 weeks

• Recommend bariatric surgery

Which of the following maternal complications is most likely to be worsened by GDM?

• Placenta previa

• Preeclampsia

• Post-partum hemorrhage only

• Ectopic pregnancy