Malaria during and after pregnancy contributes significantly to maternal mortality and adverse fetal outcomes. While effective and safe antimalarial treatments are essential, quinine — an older, less effective drug — has long been favoured due to the limited safety data available on newer drugs. This review summarises the results of human studies investigating the safety and efficacy of antimalarial drugs during pregnancy and lactation. Artemisinin derivatives are more effective and better tolerated than quinine, and do not increase the risk of miscarriage, stillbirth or congenital abnormalities at any stage of pregnancy. However, data on optimal dosing and safety during breastfeeding remain limited. The emergence of resistance to sulfadoxine-pyrimethamine also necessitates a re-evaluation of current preventive guidelines for pregnant women. Further research is needed to ensure the safe and effective treatment of malaria in pregnant and breastfeeding women.