Dr. Clara Menendez and her colleagues evaluated malaria infection in 1819 Mozambican women who delivered babies during a 10-year period beginning in 2003. Malaria became less common during the decade of the study; during the first two years of the study, 11% had microscopic evidence of malaria at the time of delivery; during the final two years of the study, only 2% were smear-positive at the time of delivery. Antimalarial IgG levels similarly decreased over the decade of the study.
In women who did have malaria, however, parasite densities were nine-fold higher in the blood during the final two years of the study than during the initial two years; parasite densities of infected placentas similarly increased 10-fold during the study years. Infected women had more malaria-associated anemia in recent years than in the earlier years of the study when malaria was more common. During the later years of the study, malaria-infected women had babies who weighed an average of 130 grams less than did babies of malaria-infected women earlier in the study.
COMMENTARY
There are significant efforts to overcome malaria in Africa. Women in the current study, for instance, benefitted from the use of insecticide-treated bednets and intermittent preventive anti-malarial treatment. It is exciting to see that efforts to “roll back malaria” are succeeding in some areas with marked decreases in the prevalence of malaria infection.
However, during these years when malaria is less common but not yet eradicated, pregnant women have less anti-malarial immunity and risk having more severe outcomes of malarial infection — increased parasite density, more anemia, lower birthweight babies. Even after birth, babies continue to suffer adverse effects of their mothers’ gestational malaria.1 It is good news that malaria is less common, but the ongoing bad news is that women who do get malaria during pregnancy now might face even worse outcomes than before.
These data remind us to continue vigilant care of all people, especially pregnant women, in areas where malaria is still transmitted. The improving public health situation leaves people more susceptible to adverse outcomes when they do become infected. Thus, especially in this era of declining malaria prevalence, we must be extremely careful to provide appropriate preventive interventions (bednets, preventive chemotherapy). Similar data from Malawi support targeting women during the beginning weeks of pregnancy.2 In addition, rapid diagnostic testing of symptomatic individuals and effective early treatment of infected patients are also important.
REFERENCES
- Hartman TK, et al. The impact of maternal malaria on newborns. Ann Trop Paediatr 2010;30:271-282.
- Boudová S, et al. The prevalence of malaria at first antenatal visit in Blantyre, Malawi declined following a universal bed net campaign. Malar J 2015;14:422.
With waning natural immunity against malaria, women face increased adverse consequences of malaria infection during pregnancy. As malaria is being conquered, good clinical care of vulnerable individuals is still essential.
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