KIU Publications

Malaria in pregnancy remained a dominant, preventable driver of maternal anemia, placental inflammation, fetal growth restriction, and preterm birth in Sub-Saharan Africa despite insecticide-treated nets and intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp SP). Persistent transmission, imperfect antenatal coverage, and drug resistance sustain residual risk. This review evaluated the biochemical and immunologic rationale, emerging clinical evidence, and implementation pathway for monoclonal antibody (mAb) prophylaxis to prevent P. falciparum infection and pregnancy-associated malaria in Sub Saharan Africa. A narrative synthesis was developed from peer-reviewed mechanistic literature, major clinical trial reports, and global guidance documents on malaria in pregnancy and antibody-based prevention to write this article. Long-acting anti-sporozoite mAbs targeting circumsporozoite protein, including CIS43LS and L9LS, showed high levels of protection in controlled human malaria infection and field trials, with extended half-life enabling seasonal protection after a single administration. However, pregnancy-specific evidence remained limited, requiring careful bridging of pharmacokinetics, placental IgG transfer biology, and maternal-fetal safety. A pregnancy-centered target product profile must prioritize simplicity of delivery, compatibility with antenatal care schedules, surveillance for rare adverse outcomes, and equity in access. mAb prophylaxis was a credible, biologically rational complement to IPTp SP, not a replacement, and may be strategically deployed for women at highest risk or in settings with high residual transmission while pregnancy-specific trials mature.