Malaria in Pregnancy: Complications

Malaria (especially Plasmodium falciparum) is far more severe in pregnant women due to placental sequestration of parasitized red cells and relative immunosuppression of pregnancy. It behaves like "severe malaria" even with lower parasite loads, producing a well-recognized set of complications, including hematologic, metabolic, and coagulation abnormalities.

Analysis of Each Option

• Thrombocytopenia (1) — Correct. Thrombocytopenia is one of the most consistent laboratory findings in malaria, including in pregnancy, resulting from splenic sequestration/destruction of platelets and bone marrow suppression. It is so common that it is considered a useful diagnostic clue in endemic areas.
• Metabolic alkalosis (2) — Incorrect. Severe malaria in pregnancy is classically associated with metabolic acidosis (from anaerobic glycolysis, lactic acid accumulation, renal impairment, and hypovolemia), not alkalosis. Metabolic acidosis is in fact one of the WHO-defined criteria of severe/complicated malaria, so alkalosis has no place in this list.
• Hypoglycemia (3) — Correct. Hypoglycemia is a well-known and dangerous complication of malaria in pregnancy, caused by increased glucose consumption by the parasite, hyperinsulinemia (worsened by quinine therapy), and depleted hepatic glycogen reserves. It can occur even without quinine treatment and contributes significantly to maternal and fetal morbidity.
• Disseminated intravascular coagulation (4) — Correct. DIC is a recognized complication of severe/complicated malaria, particularly in pregnancy, arising from endothelial activation, cytokine release, and consumption of clotting factors. It is listed among the criteria/complications of severe malaria and is more frequent in the pregnant population due to placental involvement.

Conclusion

The correct complications of malaria in pregnancy from this list are Thrombocytopenia, Hypoglycemia, and Disseminated intravascular coagulation — corresponding to combination 1, 3 and 4. Metabolic alkalosis is not a recognized feature; severe malaria instead produces metabolic acidosis, making option "1, 3 and 4" the correct answer.