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Parasitology. 2015 Jul;142(8):999-1015. doi: 10.1017/S0031182015000074. Epub 2015 Mar 3.

Malaria and immunity during pregnancy and postpartum: a tale of two species.

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Macfarlane Burnet Institute of Medical Research,85 Commercial Road,Melbourne,Victoria 3004,Australia.
Centre for Epidemiology and Biostatistics,Melbourne School of Population and Global Health,The University of Melbourne,Melbourne,Victoria,Australia.


It is well established that pregnant women are at an increased risk of Plasmodium falciparum infection when compared to non-pregnant individuals and limited epidemiological data suggest Plasmodium vivax risk also increases with pregnancy. The risk of P. falciparum declines with successive pregnancies due to the acquisition of immunity to pregnancy-specific P. falciparum variants. However, despite similar declines in P. vivax risk with successive pregnancies, there is a paucity of evidence P. vivax-specific immunity. Cross-species immunity, as well as immunological and physiological changes that occur during pregnancy may influence the susceptibility to both P. vivax and P. falciparum. The period following delivery, the postpartum period, is relatively understudied and available epidemiological data suggests that it may also be a period of increased risk of infection to Plasmodium spp. Here we review the literature and directly compare and contrast the epidemiology, clinical pathogenesis and immunological features of P. vivax and P. falciparum in pregnancy, with a particular focus on studies performed in areas co-endemic for both species. Furthermore, we review the intriguing epidemiology literature of both P. falciparum and P. vivax postpartum and relate observations to the growing literature pertaining to malaria immunology in the postpartum period.


Plasmodium vivax; epidemiology; falciparum; immunity; malaria; postpartum; pregnancy

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