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fever and headache. Atypical manifestations of malaria are particularly more common in the second half of pregnancy. Generalized immunosuppression, reduction in gammaglobulin synthesis, inhibition of the reticulo-endothelial system, and decreased levels of anti-malarial antibodies during pregnancy are thought to cause an increased susceptibility to infection. Factors that increase the risk for more severe malarial infection include non-immunity and primigravidy (Nosten et al, 1991).
Placental Changes
When a pregnant women is infected with malaria, there is a chance that the placenta will become infected as well. The placenta is actually the preferred site of sequestration and development of the malaria parasite. Intervillous spaces become filled with parasites and macrophages, and thus interfere with oxygen and nutrient transport to the fetus. Infected primigrada have approximately a 30-40% risk for placental infection, whereas multigravidae have an approximate 15-20% risk. The difference in risk is possibly due to formation of anti-adhesion antibodies during previous pregnancies (www.geocities.com/HotSprings/resort/5403/preganncy.htm).
Fetal Risks
Malaria during pregnancy poses significant risks to the fetus. Studies have shown that maternal infection is significantly correlated with low birth weight (Nyirjesy et al, 1993). Pregnancy loss, premature birth, stillbirth, placental insufficiency, and intrauterine growth retardation have all been observed in developing fetuses of non-immune infected mothers. Complications during pregnancy that can adversely affect the fetus include maternal high grade fever, placental insufficiency, hypoglycemia and anemia (Ibhanesebhor, 1995). Although rare, transplacental spread of malaria parasites can lead to congenital malaria in the new born (Nyirjesy et al, 1993).
Congenital Malaria
Congenital malaria occurs in up to 7.4% of non-immune mothers, and results most often in patients with P. falciparum infection. The predominant clinical features include fever, respiratory distress, pallor, anemia, hepatomegaly, jaundice and diarrhea (Covell, 1950).
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