Malaria during Pregnancy: Incidence, Manifestations, Therapy, and Prevention

Abstract

Malaria remains one of the most complex health problems facing humanity and pregnant women are highly vulnerable with substantial risks for the mother, her foetus and the neonate. Plasmodium falciparum is responsible for most of the complications of malaria in pregnancy and maternal anaemia is the most common and potentially lethal consequence of P. falciparum malaria. Central to the pathogenesis of P. falciparum infection in pregnancy is the accumulation of infected erythrocytes in the placenta (placental malaria). Adverse perinatal outcomes associated with placental malaria include congenital malaria, perinatal mortality, preterm delivery, intrauterine growth retardation, low birth weight, reduced neonatal anthropometric parameters, and foetal anaemia. The recommended strategies for controlling malaria in pregnancy include both preventive and curative measures. Sulfadoxine-pyrimethamine (SP) has been extensively used as intermittent preventive chemotherapy in pregnancy, however high rates of resistance to SP reduced its use as therapy for malaria. Artemisin combination therapy (ACT) as well as clindamycin / quinine combinations are important therapeutic schemes used in pregnancy. A major tool currently used for malaria prevention in pregnancy is insecticide-treated net (ITN). Increased international funding and greater political commitment, have led to some level of reduction in malaria burden in pregnancy.