Malaria during Pregnancy

• Published in: Cold Spring Harbor perspectives in medicine Vol. 7; no. 6; p. a025551
• Main Authors: Fried, Michal, Duffy, Patrick E
• Format: Journal Article
• Language: English
• Published: United States Cold Spring Harbor Laboratory Press 01.06.2017
• Subjects: Africa - epidemiology; Antimalarials - therapeutic use; Artemisinins - therapeutic use; Drug Combinations; Drug Resistance; Female; Humans; Malaria - drug therapy; Malaria - epidemiology; Malaria - immunology; Malaria - prevention & control; Malaria Vaccines - immunology; Mefloquine - therapeutic use; Placenta - parasitology; Plasmodium falciparum - drug effects; Plasmodium falciparum - immunology; Pregnancy; Pregnancy Complications, Parasitic - drug therapy; Pregnancy Complications, Parasitic - epidemiology; Pregnancy Complications, Parasitic - immunology; Pregnancy Complications, Parasitic - prevention & control; Pregnancy Outcome; Pyrimethamine - therapeutic use; Sulfadoxine - therapeutic use
• ISSN: 2157-1422; 2472-5412
• DOI: 10.1101/cshperspect.a025551

One hundred and twenty-five million women in malaria-endemic areas become pregnant each year (see Dellicour et al. e1000221 [2010]) and require protection from infection to avoid disease and death for themselves and their offspring. Chloroquine prophylaxis was once a safe approach to prevention but has been abandoned because of drug-resistant parasites, and intermittent presumptive treatment with sulfadoxine-pyrimethamine, which is currently used to protect pregnant women throughout Africa, is rapidly losing its benefits for the same reason. No other drugs have yet been shown to be safe, tolerable, and effective as prevention for pregnant women, although monthly dihydroartemisinin-piperaquine has shown promise for reducing poor pregnancy outcomes. Insecticide-treated nets provide some benefits, such as reducing placental malaria and low birth weight. However, this leaves a heavy burden of maternal, fetal, and infant morbidity and mortality that could be avoided. Women naturally acquire resistance to over successive pregnancies as they acquire antibodies against parasitized red cells that bind chondroitin sulfate A in the placenta, suggesting that a vaccine is feasible. Pregnant women are an important reservoir of parasites in the community, and women of reproductive age must be included in any elimination effort, but several features of malaria during pregnancy will require special consideration during the implementation of elimination programs.