Malaria and immunity during pregnancy and postpartum: a tale of two species

SUMMARYIt is well established that pregnant women are at an increased risk ofPlasmodium falciparuminfection when compared to non-pregnant individuals and limited epidemiological data suggestPlasmodium vivaxrisk also increases with pregnancy. The risk ofP. falciparumdeclines with successive pregnancies due to the acquisition of immunity to pregnancy-specificP. falciparumvariants. However, despite similar declines inP. vivaxrisk with successive pregnancies, there is a paucity of evidenceP. vivax-specific immunity. Cross-species immunity, as well as immunological and physiological changes that occur during pregnancy may influence the susceptibility to bothP. vivaxandP. falciparum. The period following delivery, the postpartum period, is relatively understudied and available epidemiological data suggests that it may also be a period of increased risk of infection toPlasmodiumspp. Here we review the literature and directly compare and contrast the epidemiology, clinical pathogenesis and immunological features ofP. vivaxandP. falciparumin pregnancy, with a particular focus on studies performed in areas co-endemic for both species. Furthermore, we review the intriguing epidemiology literature of bothP. falciparumandP. vivaxpostpartum and relate observations to the growing literature pertaining to malaria immunology in the postpartum period.