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

<jats:title>SUMMARY</jats:title><jats:p>It is well established that pregnant women are at an increased risk of <jats:italic>Plasmodium falciparum</jats:italic> infection when compared to non-pregnant individuals and limited epidemiological data suggest <jats:italic>Plasmodium vivax</jats:italic> risk also increases with pregnancy. The risk of <jats:italic>P. falciparum</jats:italic> declines with successive pregnancies due to the acquisition of immunity to pregnancy-specific <jats:italic>P. falciparum</jats:italic> variants. However, despite similar declines in <jats:italic>P. vivax</jats:italic> risk with successive pregnancies, there is a paucity of evidence <jats:italic>P. vivax</jats:italic>-specific immunity. Cross-species immunity, as well as immunological and physiological changes that occur during pregnancy may influence the susceptibility to both <jats:italic>P. vivax</jats:italic> and <jats:italic>P. falciparum</jats:italic>. 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 to <jats:italic>Plasmodium</jats:italic> spp. Here we review the literature and directly compare and contrast the epidemiology, clinical pathogenesis and immunological features of <jats:italic>P. vivax</jats:italic> and <jats:italic>P. falciparum</jats:italic> in pregnancy, with a particular focus on studies performed in areas co-endemic for both species. Furthermore, we review the intriguing epidemiology literature of both <jats:italic>P. falciparum</jats:italic> and <jats:italic>P. vivax</jats:italic> postpartum and relate observations to the growing literature pertaining to malaria immunology in the postpartum period.</jats:p>