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Malaria in the Pregnant Woman

  • Chapter
Malaria: Drugs, Disease and Post-genomic Biology

Part of the book series: Current Topics in Microbiology and Immunology ((CT MICROBIOLOGY,volume 295))

Abstract

Women become more susceptible to Plasmodium falciparum malaria during pregnancy, and the risk of disease and death is high for both the mother and her fetus. In low transmission areas, women of all parities are at risk for severe syndromes like cerebral malaria, and maternal and fetal mortality are high. In high transmission areas, where women are most susceptible during their first pregnancies, severe syndromes like cerebral malaria are uncommon, but severe maternal anemia and low birth weight are frequent sequelae and account for an enormous loss of life. P. falciparum-infected red cells sequester in the intervillous space of the placenta, where they adhere to chondroitin sulfate A but not to receptors like CD36 that commonly support adhesion of parasites infecting nonpregnant hosts. Poor pregnancy outcomes due to malaria are related to the macrophage-rich infiltrates and pro-inflammatory cytokines such as tumor necrosis factor-α that accumulate in the intervillous space. Women who acquire antibodies against chrondroitin sulfate A (CSA)-binding parasites are less likely to have placental malaria, and are more likely to deliver healthy babies. In areas of stable transmission, women acquire antibodies against CSA-binding parasites over successive pregnancies, explaining the high susceptibility to malaria during first pregnancy, and suggesting that a vaccine to prevent pregnancy malaria should target placental parasites. Prevention and treatment of malaria are essential components of antenatal care in endemic areas, but require special considerations during pregnancy. Recrudescence after drug treatment is more common during pregnancy, and the spread of drug-resistant parasites has eroded the usefulness of the few drugs known to be safe for the woman and her fetus. Determining the safety and effectiveness of newer antimalarials in pregnant women is an urgent priority. A vaccine that prevents pregnancy malaria due to P. falciparum could be delivered before first pregnancy, and would have an enormous impact on mother-child health in tropical areas.

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  1. Seattle Biomedical Research Institute, 307 Westlake Avenue, Seattle, WA, USA

    P. E. Duffy & M. Fried

  2. Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, USA

    P. E. Duffy

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  1. P. E. Duffy
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  1. Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, The Johns Hopkins University, 615 North Wolfe Street, E5628, Baltimore, MD, 21205, USA

    David J. Sullivan M.D.

  2. Department of Cellular and Molecular Medicine, Infectious Diseases Group, St. George’s Hospital Medical School, Cranmer Terrace, London, SW17 ORE, UK

    Sanjeev Krishna D. Phil, F.R.C.P., F. MED. Sci.

  3. Atlanta, Georgia

    R. W. Compans

  4. Birmingham, Alabama

    M. D. Cooper

  5. Kyoto

    T. Honjo

  6. Philadelphia, Pennsylvania

    H. Koprowski

  7. Basel

    F. Melchers

  8. La Jolla, California

    M. B. A. Oldstone

  9. Oslo

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  10. Bethesda, Maryland

    M. Potter

  11. La Jolla, California

    P. K. Vogt

  12. Munich

    H. Wagner

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Duffy, P.E., Fried, M. (2005). Malaria in the Pregnant Woman. In: Compans, R.W., et al. Malaria: Drugs, Disease and Post-genomic Biology. Current Topics in Microbiology and Immunology, vol 295. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-29088-5_7

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