The placenta in malaria: mechanisms of infection, disease and foetal morbidity

There is still much to discover about the reasons for the increased suscept ibility of pregnant women to malaria or the pathogenesis of placental malar ia. More systematic and detailed examination of the placenta may help. In m any ways, the placenta can be seen as the flight recorder of the pregnancy; by examining it carefully it should be possible to tell much about how smo oth a 'flight' the mother and baby experienced. It is hoped that, by probin g the secrets of this 'squishy black box', the causes of adverse effects in pregnancy are elucidated, and the safe 'travel' of babies and their mother s in the future is ensured. In this review, the features of parasite accumu lation in the placenta, parasite adherence, and hormonal and inflammatory r esponses to placental malaria are discussed, focussing on infection with Pl asmodium falciparum. The results of recent research indicating an interacti on between HIV and malaria in pregnancy are summarized. Ten questions for b asic researchers are posed. The answers may help direct future efforts to c ontrol malaria in pregnancy.