Malaria prevention strategies.

Acute and severe consequences of pregnancy-associated malaria (PAM), such as materno-fetal death or cerebral malaria, seem limited to unstable malaria areas. In areas of stable endemicity, the main consequences are maternal anaemia and low birth weight (LBW) babies, particularly in primigravidae. Placental malaria seems more frequent and its consequences more severe in HIV-infected women. Since 1964, several chemoprophylaxis controlled trials have been undertaken, mainly in Tropical Africa where malaria is stable. Most showed an increase in mean birth weight in the prophylaxis group, especially among primigravidae. Similar findings were made with anaemia. Prophylaxis seems less effective in the case of HIV-malaria co-infection, which may require an increase in the number of doses. At present, intermittent treatment with sulfadoxine-pyrimethamine given twice or thrice during pregnancy in antenatal clinics seems the best policy for preventing PAM. Such effective prophylaxis should be integrated with other antenatal clinic services. Recently identified molecular receptors involved in cytoadherence of parasitized erythrocytes to placenta could yield new therapeutic or vaccine approaches, specifically targeted to pregnant women.