Table 7.

Epidemiological observations of P. falciparum and P. vivax during pregnancy and postpartum and proposed mechanisms

Proposed species-transcending mechanisms	References	Proposed species-specific mechanisms	References
Increased parasitaemia/risk of infection during pregnancy – greater increase in P. falciparum than P. vivax
Imunomodulation in pregnancy alters susceptibility	Roberts et al. (1996)	Plasmodium falciparum – placental sequestration	McGregor (1984)
Altered hormonal profiles during pregnancy	Bouyou-Akotet et al. (2005)	Plasmodium vivax – placental sequestration, though evidence is minimal	(Carvalho et al. 2010; Chotivanich et al. 2012)
Altered attractiveness to mosquitoes	Lindsay et al. (2000)	Plasmodium vivax – altered immunity/hormones in pregnancy alters risk of relapse	Roberts et al. (1996)
Reduced risk of infection with increasing gravidity
Acquisition of overall immunity acquired with age	Doolan et al. (2009)	Plasmodium falciparum – humoral immunity to PfVAR2CSA acquired with gravidity	Fried et al. (1998)
Altered hormonal profiles with gravidity	Bouyou-Akotet et al. (2005)	Plasmodium vivax – altered immunity/hormones with gravidity alters risk of relapse	Riley et al. (1989) Roberts et al. (1996)
Altered immunomodulation with gravidity	Riley et al. (1989)
Altered iron deficiency with gravidity	Ouedraogo et al. (2012)
Infection with both species leads to adverse birth outcomes, more severe in P. falciparum than P. vivax
Systemic immune response to infection contributes to foetal growth restriction.	Umbers et al. (2011)	Plasmodium falciparum – sequestration at the placenta, leads to local pathology and immune response at the placenta	Umbers et al. (2011)
Anaemia	Friedman et al. (2009)
Altered risk postpartum
Behavioural changes postpartum alter level of exposure to vectors	Boel et al. (2013)	P. falciparum – increased susceptibility during pregnancy leads to increased immunity postpartum	This review
Hormonal/immunological profile in transition from pregnancy to ‘normal’	Diagne et al. (2000)