Current update on malaria in pregnancy: a systematic review
Awoke Minwuyelet, Delenasaw Yewhalaw, Melkamu Siferih, Getnet Atenafu
Abstract
BACKGROUND: Malaria during pregnancy poses significant risks to both the mother and the developing fetus. For pregnant women, the infection can result in severe illness and even death. Parasite sequestration in the placenta can cause maternal anemia and increase the risk of mortality both during and after childbirth. Malaria is also a major contributor to stillbirths and preterm births. Infected placental tissue can impede fetal growth, resulting in low birth weight, which is linked to delayed growth and cognitive development in the child. Furthermore, malaria during pregnancy remains a major contributor to perinatal, neonatal, and infant mortality. OBJECTIVES: To review the epidemiological patterns of malaria in pregnancy and its impact on maternal and neonatal health, and to analyze the availability and effectiveness of drug treatment options. METHODS: Relevant articles published only in English were searched using electronic databases such as PubMed, Web of Science, Scopus, and Pro-Quest. Keywords including "'malaria in pregnancy", "placental malaria", "congenital malaria", "treatment options", and "nutrition intervention and intermittent preventive treatment" were used in combination. Of the total of 4,486 articles identified, 139 articles were ultimately included. Whereas, others were excluded due to duplication, irrelevant abstract, title, and quality assessment. RESULTS: From 139 included studies, 47 focused on epidemiology of malaria in pregnancy, 58 on its impact and 16 on treatment options and 18 on nutrition intervention and intermittent treatment. Plasmodium falciparum is the leading cause of complications in pregnant women and is primarily found in Africa, while P.vivax is recognized as an emerging global threat, and causing serious consequences. Other species, such as P.knowlesi, P.ovale, and P.malariae are less common. Malaria prevalence in pregnancy can reach 60% in sub-Saharan Africa and 36% globally, with placental malaria affecting up to 28% of cases. The disease causes serious complications such as maternal anemia, premature birth, and low birth weight, severe anemia and increased maternal and infant mortality. Prevention strategies like intermittent preventive treatment (IPTp), insecticide-treated nets (ITNs) and Indoor residual spray (IRS) are essential. Early diagnosis and treatment can reverse adverse effects on placental and congenital function. Artesunate is recommended for severe malaria in all trimesters. Even resistance to chloroquine reported in some areas, it is the drug of choice for uncomplicated P.vivax infections. CONCLUSIONS: Malaria during pregnancy significantly impacts maternal and fetal health, leading to anemia, growth restriction, preterm birth, and neonatal death. Infants born to mothers with malaria are more likely to contract the disease. Further research and improved treatment strategies are needed to address this issue effectively.