Reducing the burden of malaria in pregnancy by preventive strategies.

Malaria is one of the most common and preventable causes of adverse birth outcomes. In Africa, important progress has been made in the past decade with the introduction of a preventive strategy for malaria in pregnancy consisting of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets, yet their coverage is still unacceptably low and malaria continues to demand a huge toll on pregnant women and their newborn babies. Increasing the frequency of dosing of IPTp with sulfadoxine-pyrimethamine might provide temporary respite, but increasing resistance to sulfadoxine-pyrimethamine makes research into safe, efficacious, and affordable alternatives for IPTp one of the highest priorities for the control of malaria in pregnancy. A number of promising alternatives are, or will soon be, available that need to be evaluated as IPTp after their safety and pharmacokinetics in pregnancy have first been assessed in parasitaemic women. Little is known about appropriate control strategies in Asia and Latin America for Plasmodium falciparum and Plasmodium vivax malaria in pregnancy, which in most countries rely on responsive case management approaches. The role of case management based on proactive screening for malaria infection of women attending antenatal care or preventive approaches with insecticide-treated nets or IPTp are urgently needed. To achieve these objectives, multicentre and multidisciplinary approaches are required across the range of malaria transmission settings that include assessment of immunological effect of successful preventions, the perceptions and acceptability of different preventive approaches, and their cost-effectiveness.