Abstract
The in vitro environment has a profound effect on offspring neurodevelopment. Insults to the foetus during pregnancy can disrupt neurodevelopmental processes culminating in neurochemical and behavioural abnormalities. A growing body of evidence supports a role for maternal infection in precipitating neuropsychiatric disease in offspring. Since ~60% of pregnancies globally are at risk of malaria infection annually, we hypothesize that in utero exposure to malaria in pregnancy (MIP) may be a neglected risk factor for mental illness. We propose that the host response to infection makes an important contribution to this risk. MIP may mediate neuropathology via immune activation and inflammation in the placenta and consequent dysregulation of processes critical to fetal neurodevelopment including cerebral angiogenesis, neurogenesis, synaptic pruning, and neurochemical regulation.
Highlights
Neuropsychiatric disease is an enormous contributor to the global financial and social burden of health
Given the high prevalence of malaria in these regions, we propose that the disproportionate burden of mental illness in low and middle income countries may be associated with malaria in pregnancy (MIP) and hypothesize that prenatal malaria exposure is a modifiable risk factor for neuropsychiatric disorders later in life (Figure 1)
125 million pregnant women are at risk of MIP each year and over 85 million of these occur in areas with stable Plasmodium falciparum transmission [5]
Summary
Neuropsychiatric disease is an enormous contributor to the global financial and social burden of health. Low and middle income countries, including most sub-Saharan African countries, have a disproportionately high burden of mental illness, which has often been attributed to a number of social determinants and a lack of effective treatments and health care professionals, such as psychiatrists [4]. While these social factors likely contribute, maternal infection may represent an important and underappreciated risk factor. Even for those babies that survive the neonatal period, numerous epidemiological and animal studies have linked LBW with long-term neurodevelopmental deficits and adult disease (Figure 2)
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