The Malaria in Pregnancy (MiP) Library is a regularly updated, comprehensive bibliographic database of published and unpublished literature relating to malaria in pregnancy, including a trial registry of planned and ongoing trials. The MiP library is a product of the Malaria in Pregnancy Consortium and is available free of charge.

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 Article highlights from the update in January 2017

Article highlights from the update in April 2017


In April 2017, 204 new entries were added to the MiP library. New entries include peer reviewed journal articles, PhD and MSc theses, reports, and conference abstracts. Here we highlight a few articles that may be of particular interest:

Natureeba et al. 2017 reported on a double-blinded placebo-controlled trial comparing daily trimethoprim-sulfamethoxazole plus monthly dihydroartemisinin-piperaquine versus daily trimethoprim-sulfamethoxazole only to prevent malaria among HIV-infected women in East-Uganda. Among the 194 participants, no difference was seen in placental malaria by histology; among the potential reasons for this finding suggested was the impact of an indoor residual spraying program which was started at about the same time as the trial  (resulting in a very low malaria prevalence overall) and the differences in the pharmacokinetics of dihydroartemisinin-piperaquine in the presence of efavirenz as part of antiretroviral therapy, as described by Kajubi et al. 2017. 

Two trials reported on nutritional factors and malaria in pregnancy. A double-blind placebo-controlled trial with a factorial design among 2,500 human immunodeficiency virus–negative primigravid or secundigravid pregnant women evaluated the effect on placental malaria of 2,500 IU of vitamin A, 25 mg of zinc, or both as once-only supplement against no supplement in the first trimester of pregnancy (Darling et al. 2017). Those who received zinc had a lower risk of histopathology-positive placental malaria compared with those who did not receive zinc (risk ratio = 0.64, 95% confidence interval = 0.44, 0.91), but neither nutrient had an effect on polymerase chain reaction–positive malaria, small-for-gestational age, or prematurity. A trial in Malawi investigated the impact of small-quantity lipid-based nutrient supplement (SQ-LNS) on the occurrence of Plasmodium falciparum parasitaemia during pregnancy and trichomoniasis, vaginal candidiasis and urinary tract infection (UTI) after delivery (N=1391); participants received either daily supplementation with SQ-LNS, or multiple micronutrients (MMN) or iron & folic acid (IFA) from <20 weeks of gestation weeks (Nkhoma et al. 2017).   No differences were detected between the three arms in the prevalence of any of the infections. For those who want an update on malaria and iron or folate supplementation, there are two articles of interest: Verhoeff et al. (2017) reviewed the safety and benefits of interventions to increase folate status in malaria-endemic areas, and Mwangi et al. (2017) reviewed the safety and benefits of antenatal oral iron supplementation in low-income countries with a section on malaria-endemic settings.  For readers who want to go back-to-basics on malaria in pregnancy there is a review by Fried et al.

Goncalves et al. (2017) presented their viewpoint on why not including pregnant women in malaria elimination campaigns is a missed opportunity; pregnant women are potentially important for transmission and there is increasing evidence of safety of artemisinin-based combination therapies. 

Malaria during pregnancy has been implicated to affect immunity in the infant with consequences for transplacental antibody transfer and different responses to childhood vaccinations. In this update McKittrick et al. (2017) showed that infants born to mothers with prenatal malaria, hookworm, or S. haematobium infections were associated with a significantly reduced ratio of maternal:infant cord blood antibody concentration for certain Streptococccus pneumoniae serotypes compared to infants of uninfected mothers, but not for anti-diphtheria toxoid and anti-H. influenza type B. However, no effect of maternal malaria (or other maternal parasitic infections) on antibody concentrations in infants at one year of age after vaccinations was seen in a study in Uganda (Nash et al. 2017). A study in Tanzania showed that placental malaria resulted in increased maternal material ‘trafficking’ to the foetus, and this was associated with an increased risk of malaria infection but decreased risk of malaria disease in children (Harrington et al. 2017).


here is limited knowledge on co-morbidities of malaria and other infections during pregnancy. Anchang-Kimbi et al. (2017) reported on the risk of severe anaemia among pregnant women with both Plasmodium falciparum and Schistosoma haematobium.  The last infection was also an independent risk factor for low birth weight in a cohort study from Gabon controlling for malaria (Mombo-Ngoma et al. 2017). Chico et al. (2017) examined the effect of IPTp with sulphadoxine-pyrimethamine (SP) on malaria and sexually transmitted and reproductive tract infections and detected reduced adverse birth outcomes with increasing number of SP doses, among women with malaria at enrolment, among women with Neisseria gonorrhoeae and/or Chlamydia trachomatis and among women with neither malaria or sexually transmitted and reproductive tract infections, suggesting that the effect of IPTp-SP may be wider than just on malaria. Using mathematical modelling, Walker et al. (2017) calculated that not accounting for protection from the use of ITNs during pregnancy, expanding IPTp-SP to all women with ≥3 ANC visits in Africa could prevent an additional 215,000 LBW deliveries; they also pointed out that only 4% (1.4 million) of pregnancies occurred in settings with >10% prevalence of the sextuple haplotype associated with compromised SP effectiveness. 

With regards to malaria prevention, stock outs were reported as a major issue for ITNs as distributed through antenatal clinics (Theiss-Nyland et al. 2017) and for cotrimoxazole for HIV-infected pregnant women (Kamuhabwa et al. 2016). Permala et al. (2017) explored the use of weekly dihydroartemisinin-piperaquine (3 tablets weekly for adult) instead of monthly treatment for the prevention of malaria in pregnancy using pharmacokinetic modelling and suggested that weekly dosing may improve treatment outcome and reduce selection pressure.

In the search for the underlying pathophysiology of the effect of malaria in pregnancy on the developing foetus, Ome-Kaius et al. (2017) presented results of Doppler velocimetry studies of umbilical artery and middle cerebral artery flow during malaria in pregnancy and reported that both microscopic and sub-microscopic P. falciparum infections impair foetoplacental and intrafoetal flow, at least temporarily. Another study by Dimasuay et al. (2017) reported that inhibition of placental mTOR signalling (rapamycin signalling, a pathway known to regulate amino acid transport) may constitute a mechanistic link between placental malaria-associated intervillositis and decreased amino acid uptake, which may contribute to lower birthweight. A study into antibodies to malaria in areas with both P. vivax and P. falciparum showed that naturally acquired binding-inhibitory antibodies to anti-Pv ligand Duffy binding protein might confer protection against poor outcomes of P. vivax malaria in pregnancy, such as low birthweight (Requena et al. 2017). Bostrom et al. (2017) suggest that neutrophils may play a role in placental malaria and should be more closely examined as an etiological agent in the pathophysiology of disease. Gueneuc et al. (2017) review the usefulness of a biomarker to identify placental dysfunction in the context of malaria.