Impact of Malaria in Pregnancy as Latin America Approaches Elimination

In Latin America, four million pregnancies are at risk of malaria annually, but malaria in pregnancy is largely overlooked. As countries progress toward malaria elimination, targeting reservoirs of transmission is a priority. Pregnant women are an important risk group because they harbor asymptomatic infections and dormant liver stages of Plasmodium vivax that cause relapses. Of significant concern is the discovery that most infections in pregnant women fail to be detected by routine diagnostics. We review here recent findings on malaria in pregnancy within Latin America. We focus on the Amazon basin and Northwest Colombia, areas that harbor the greatest burden of malaria, and propose that more sensitive diagnostics and active surveillance at antenatal clinics will be necessary to eliminate malaria from these final frontiers.

TrendsPlacental damage may be one of the hallmarks of malaria in pregnancy (MiP), whereas the clinical spectrum of birth outcomes is broad.As the incidence of patent MiP declines, an increasing proportion of infections are sub-microscopic and asymptomatic; these are considered to be reservoirs of infection.More sensitive molecular diagnostics are needed at the point-of-care to detect sub-microscopic infections in pregnancy. RDTs lack the sensitivity and specificity to detect low-level infections and are not widely used in Latin America.There are disparities in access to antenatal services, particularly in indigenous communities in the Amazon basin.