Placental Malaria
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THE PLACENTA, TROPICAL DISEASES, AND PREGNANCIES (D SCHWARTZ, SECTION EDITOR)
Placental Malaria Arthurine K. Zakama 1 & Nida Ozarslan 2 & Stephanie L. Gaw 1 Accepted: 10 September 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Placental malaria is the primary mechanism through which malaria in pregnancy causes adverse perinatal outcomes. This review summarizes recent work on the significance, pathogenesis, diagnosis, and prevention of placental malaria. Recent Findings Placental malaria, characterized by the accumulation of Plasmodium-infected red blood cells in the placental intervillous space, leads to adverse perinatal outcomes such as stillbirth, low birth weight, preterm birth, and small-forgestational-age neonates. Placental inflammatory responses may be primary drivers of these complications. Associated factors contributing to adverse outcomes include maternal gravidity, timing of perinatal infection, and parasite burden. Summary Placental malaria is an important cause of adverse birth outcomes in endemic regions. The main strategy to combat this is intermittent preventative treatment in pregnancy; however, increasing drug resistance threatens the efficacy of this approach. There are studies dissecting the inflammatory response to placental malaria, alternative preventative treatments, and in developing a vaccine for placental malaria. Keywords Placental malaria . Malaria in pregnancy . Pathogenesis of placental malaria . Prevention of placental malaria . Obstetrical outcomes of placental malaria . Plasmodium infection
Introduction Malaria in pregnancy is an important global health issue. The World Health Organization (WHO) reports that 11 million pregnancies in sub-Saharan Africa were at risk of malaria in 2018 alone [1]. During pregnancy, the burden of adverse obstetrical and neonatal outcomes occurs as a result of placental malaria, when the parasite-infected red blood cells sequester in the intervillous spaces of the placenta. In endemic regions, placental malaria may be present in up to 63% of pregnant women, irrespective of malaria infection symptomatology [2–4].
Arthurine K. Zakama and Nida Ozarslan contributed equally to this work. This article is part of the Topical Collection on The Placenta, Tropical Diseases, and Pregnancies * Stephanie L. Gaw [email protected] 1
2
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 513 Parnassus Ave, Box 0556, San Francisco, CA 94143, USA Marmara University School of Medicine, Istanbul, Turkey
The global burden of malaria infection is primarily in lowand middle-income countries. The World Health Organization (WHO) reported in 2018 there were 228 million cases; 93% of cases occurred in Africa, followed by Southeast Asia (3.4%) and the Eastern Mediterranean Region (2.1%) [5]. Of note, subSaharan Africa and India carried 85% of all cases [5]. While cases in 2018 were lower than 2010 (251 million cases), the incidence rate has been relatively
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