Pregnancy and malaria: the perfect storm.

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Global Health

Background:

• Malaria in pregnancy significantly impacts maternal and infant health, particularly in Africa.
• Plasmodium falciparum and P. vivax infections present distinct challenges, including lasting neurocognitive effects on infants and relapsing infections.
• Early pregnancy malaria, especially in the first trimester, is increasingly recognized for its adverse outcomes.

Purpose of the Study:

• To review current understanding of malaria in pregnancy, focusing on recent findings and challenges.
• To evaluate the efficacy and limitations of current diagnostic and treatment strategies.
• To highlight the need for novel interventions for malaria prevention and treatment in pregnant women.

Main Methods:

• Review of recent scientific literature on malaria in pregnancy.
• Analysis of data on the impact of maternal malaria on infant neurocognitive development.
• Evaluation of intermittent preventive treatment in pregnancy (IPTp) regimens and drug resistance.

Main Results:

• Maternal malaria has lasting neurocognitive effects on infants.
• Artemisinin-based combination therapies are effective in later pregnancy but lack safety data for the first trimester.
• Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine improves outcomes but faces resistance; IPTp with dihydroartemisinin-piperaquine shows efficacy but not improved outcomes due to nonmalarial benefits of sulfadoxine-pyrimethamine.

Conclusions:

• Novel IPTp regimens are necessary.
• Interventions are required to protect against malaria acquired before and in early pregnancy.
• Further research is needed on the nonmalarial benefits of sulfadoxine-pyrimethamine in pregnancy.