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Abstract
It is well established that pregnant women are at an increased risk of Plasmodium falciparum infection when compared to non-pregnant individuals and limited epidemiological data suggest Plasmodium vivax risk also increases with pregnancy. The risk of P. falciparum declines with successive pregnancies due to the acquisition of immunity to pregnancy-specific P. falciparum variants. However, despite similar declines in P. vivax risk with successive pregnancies, there is a paucity of evidence P. vivax-specific immunity. Cross-species immunity, as well as immunological and physiological changes that occur during pregnancy may influence the susceptibility to both P. vivax and P. falciparum. The period following delivery, the postpartum period, is relatively understudied and available epidemiological data suggests that it may also be a period of increased risk of infection to Plasmodium spp. Here we review the literature and directly compare and contrast the epidemiology, clinical pathogenesis and immunological features of P. vivax and P. falciparum in pregnancy, with a particular focus on studies performed in areas co-endemic for both species. Furthermore, we review the intriguing epidemiology literature of both P. falciparum and P. vivax postpartum and relate observations to the growing literature pertaining to malaria immunology in the postpartum period.
Highlights
Malaria is a mosquito-borne infectious disease caused by the parasite Plasmodium, of which six species can infect humans; Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale curtisi, Plasmodium ovale wallikeri, Plasmodium malariae and Plasmodium knowlesi
Numerous studies have demonstrated that pregnant women are at increased risk of P. falciparum infection and experience higher parasite densities and rates of clinical malaria when compared to non-pregnant women
India, Colombia and Indonesia have tended to find a greater reduction in birth weight and greater increase in the risk of preterm delivery amongst pregnant women with P. falciparum infections compared to P. vivax infections in pregnancy (Nair and Nair, 1993; Nosten et al 1999; Singh et al 1999; McGready et al 2004; Poespoprodjo et al 2008; Tobon-Castano et al 2011) (Table 3)
Summary
Malaria is a mosquito-borne infectious disease caused by the parasite Plasmodium, of which six species can infect humans; Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale curtisi, Plasmodium ovale wallikeri, Plasmodium malariae and Plasmodium knowlesi. In this review we highlight the similarities and differences of P. vivax and P. falciparum infection during pregnancy and the postpartum period with respect to epidemiology, clinical pathogenesis and immunology.
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