An analysis of malaria in pregnancy in Africa.

TLDR

Malaria infection is more frequent and severe in first‑pregnancy women and follows a pattern similar to that seen in infants and children. The article reviews epidemiological evidence and discusses practical implications of malaria in pregnancy in Africa. It summarizes data on malaria prevalence, immunity loss, and recovery dynamics across gestation in African populations. In western Kenya, peak infection rates of 85.7 % in primigravidae and 51.7 % in multigravidae occur at 13–16 weeks, with similar recoveries in later trimesters, an 11‑fold drop in recovery during early pregnancy, and a late‑pregnancy immune rebound that restores prepregnancy status near delivery, a pattern that repeats in successive pregnancies.

Abstract

This article summarizes information and specific evidence regarding the epidemiology of malaria in pregnancy in Africa. Malaria infection is more frequent and severe in primigravidae both during pregnancy and at the time of delivery. A study of pregnant women living under holoendemic conditions in western Kenya showed that the peak prevalence of infection in primigravidae (85.7%) and multigravidae (51.7%) occurred at 13-16 weeks gestation. There were a similar number of recoveries in both groups during the 2nd and 3rd trimesters. The loss of immunity in early pregnancy was equivalent to an 11-fold decrease in the rate of recovery from infection. The recovery seen in late pregnancy suggests that the women mount a satisfactory immune response to malaria infection, reacquiring their prepregnancy immune status at about the time of delivery. The pattern of infection in pregnancy is comparable to that observed in infants and children. What the child achieves over several years, the mother reachieves in 9 months; the pattern is repeated in successive pregnancies. The practical implications of this pattern of malaria in pregnancy are discussed.