Towards protective immune responses against malaria in pregnant women

Plasmodium falciparum infection was estimated to affect around 11 million pregnancies in 2018 in 38 countries in sub-Saharan Africa.1 Malaria-associated maternal anaemia is a major driver of low birthweight in newborn babies and WHO have estimated that malaria infections in pregnancy have resulted i...

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Bibliographic Details
Published in:The Lancet infectious diseases 2020-05, Vol.20 (5), p.517-519
Main Author: Daubenberger, Claudia A
Format: Article
Language:English
Subjects:
Anemia
Antibodies
Antimalarial agents
Babies
Birth weight
Cognitive ability
Cotrimoxazole
Erythrocytes
HIV
Human immunodeficiency virus
Immune response
Immunization
Immunosuppressive agents
Infections
Infectious diseases
Insecticides
Malaria
Monoclonal antibodies
Pregnancy
Prophylaxis
Proteins
Pyrimethamine
Sulfadoxine
Target recognition
Vaccines
Vector-borne diseases
Womens health
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Summary:Plasmodium falciparum infection was estimated to affect around 11 million pregnancies in 2018 in 38 countries in sub-Saharan Africa.1 Malaria-associated maternal anaemia is a major driver of low birthweight in newborn babies and WHO have estimated that malaria infections in pregnancy have resulted in an estimated 872 000 babies born with low birthweight in 2018.1 Low birthweight results in a higher risk of death, stunting, and poor cognitive development later in life.2 WHO recommends a combination of insecticide-treated nets and the use of intermittent preventive treatment in pregnancy with malaria drugs sulfadoxine-pyrimethamine in women who are HIV-negative3 or daily co-trimoxazole prophylaxis in women who are HIV-positive3 as part of routine antenatal care in sub-Saharan African countries. About 25% of P falciparum isolates have more than one var2csa gene copy expressed.7 It is desirable to develop a vaccine that induces long lasting, highly cross-reactive antibodies binding to VAR2CSA expressed by most P falciparum field isolates to cover the whole pregnancy period. The addition of vaccines covering VAR2CSA clades 3 and 4 might improve protection further.7 Development of next generation vaccines guided by human monoclonal antibodies isolated from women who are multigravid, successfully blocking interaction between infected erythrocytes and CSA might result in identification of novel, conserved target structures providing improved protection.8,9 Barriers for next steps in immunisation against malaria infections in pregnancy remain.
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(20)30002-5