Abstract

Pregnancy-associated malaria (PAM) is a critical public health concern in endemic regions, particularly sub
Saharan Africa, where it significantly contributes to maternal and neonatal morbidity and mortality. 
Immunological and hormonal changes during pregnancy heighten women’s susceptibility, especially among 
primigravidae and those with HIV co-infection. PAM is primarily caused by Plasmodium falciparum, which 
sequesters in the placenta, impairing nutrient and oxygen transfer and leading to adverse outcomes such as 
maternal anaemia, miscarriage, stillbirth, preterm delivery, and low birth weight. Globally, more than 125 million 
pregnancies annually are at risk, with prevalence influenced by geographic distribution, socioeconomic conditions, 
and immunological factors. Diagnosis remains challenging due to placental sequestration and low peripheral 
parasitemia, with microscopy and rapid diagnostic tests often missing infections. Molecular techniques and 
placental histology improve detection but are not widely accessible. Preventive measures recommended by the 
World Health Organization include insecticide-treated nets (ITNs), indoor residual spraying (IRS), and 
intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine. These interventions have 
proven effective in reducing parasite prevalence, maternal anaemia, and adverse birth outcomes, but challenges 
persist with drug resistance, limited coverage, and sociocultural barriers. Effective management of PAM requires 
integrated strategies that combine improved diagnostics, equitable access to preventive interventions, and 
strengthened antenatal care. Addressing PAM holistically is essential to safeguard maternal and child health and 
accelerate global malaria elimination efforts.