There are no recent studies on this question. 
What is known for is certain is: 
· All fevers cause the secretion of prostaglandins, which may provoke uterine contractions (LEAL M. - Les prostaglandines, aspects actuels, aperçu médico-légal. Medical thesis n°39, Bordeaux 1979, 119p.); 
· All malaria attacks may provoke uterine contractions because of the accompanying fever; 
·  Quinine constricts smooth muscle fibers, sufficiently to have an action on a labour that has already started, but certainly not enough to provoke a childbirth;  
· Through its action on smooth muscular fiber, quinine has for a long time been wrongly considered as an abortive. 
Quinine remains the best treatment for malaria in pregnant women. 

For more information on the question of antimalarial drugs and pregnancy: Newman RD, Parise ME, Slutsker L, Nahlen B, Steketee RW - Safety, efficacy and determinants of effectiveness of antimalarial drugs during pregnancy: implications for prevention programmes in Pasmodium falciparum-endemic sub-Saharan Africa. Trop. Med. Int. Health 2003 ; 8: 488-506. 
(answer prepared with the assistance of Prs D. Gendrel, P. Ambroise-Thomas, M. Kombyla, D. Richard-Lenoble, M.Danis, J. Delmont and Drs B. Marchou and A. Berrebi)

In the case of a simple malaria crisis, two approaches are possible: 

1.         In a public health system: the recommendations of the National Program against Malaria should be applied, that is to say – for the Ivory Coast- chloroquine (CQ) initially and the combination sulfadoxine-pyrimethamine (SP) subsequently. 
But, in a recent publication, M-C. Henry et al. have shown that in the province of Zouan Hounien, the therapeutic failure rate was 43% with CQ and 6% with the SP combination. It is probable that the Ivory Coast government will soon modify its recommendations, but it is not yet the case. The authors propose amodiaquine as an alternative.  

2.         In the private sector, the practitioner is free to prescribe what he so chooses. There can be seen a marked trend in the    prescription of artemisinin derivatives. This phenomenon may be explained in a number of ways:  

·         quinine is reserved for severe forms of malaria   

·         the artemisinin derivatives are quickly efficacious: a malarial crisis is controlled   within less than 24 hours  

·         the artemisinin derivatives are very well tolerated    

·         certain artemisinin derivatives, such as artesunate, are prescribed orally  

the other antimalarial drugs are less well known to practitioners or have the reputation of being difficult to handle: mefloquine, halofantrine, atovaquone-proguanil combination, etc. 

Blackwater fever (BWF) is a severe syndrome characterized by the association of an intravascular hemolysis, hemoglobinuria and acute renal failure. BWF had almost disappeared since the 1950s, when chloroquine replaced quinine as the prophylaxis and the initial treatment for malaria.   But it has re-appeared over the past ten years or so, especially among Europeans who have spent a number of years in Africa without taking a prophylaxis, but who just before the BWF, had treated a malarial attack, true or assumed, with an amino-alcohol: quinine, halofantrine or mefloquine.
The pathogenesis of BWF is not very well known. An immunological mechanism is often discussed: there would be a gradual disappearance of red blood cells sensitized by an amino-alcohol. However, no formal proof of this mechanism has been provided. 
The treatment of BWF covers two essential points:  

1.         the patient should be taken into a resuscitation service, with the possibility of dialysis treatment: in this environment, the rate of mortality is less than 3%. 

2.         in the treatment   of the malarial attack which has justified the prescription of an amino-alcohol: care should be taken to avoid the cross reactions between quinine, halofantrine and mefloquine with, in preference, the prescription of the sulfadoxine-pyrimethamine combination, artemisinin derivatives or the atovaquone-proguanil combination.  

For more information see: BRUNEEL F., GACHOT B., WOLFF M. et al. - Resurgence of blackwater fever in long-term European expatriates in Africa: report of 21 cases and review. Clin .Infecs .Diseas. 2001 ; 32: 1133-40.

Dr Francis J. LOUIS
World Health Organization 
CDS/CPE/ZFK
BP 155 Yaounde, Cameroun
thanks to Pr Martin Danis, Drs Bruno Marchou and Christophe Rogier.