Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 210, Issue 9, Pages 1444-1455Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiu264
Keywords
Plasmodium falciparum; pregnancy; acquisition; antibody; longer-lasting; Malawi; Papua New Guinea
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Funding
- National Health and Medical Research Council of Australia [1024441, 1047715]
- Victorian state government
- Australian Research Council
- Malaria in Pregnancy Consortium from the Bill and Melinda Gates Foundation
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Background. As malaria control is intensified, pregnant women may be less exposed to malaria, thus affecting the acquisition of protective antibody. Methods. Plasma samples were collected from Malawian and Papua New Guinean (PNG) pregnant women enrolled over 7-year periods, during which malaria prevalence fell by over two thirds. Immunoglobulin G (IgG) levels to schizont extract, merozoite antigens, and VAR2CSA-DBL5. were measured by enzyme-linked immunosorbent assay (ELISA). Levels of IgG to variant surface antigens of infected erythrocytes (IEs) and merozoites and levels of opsonizing IgG to IEs were measured by flow cytometry. Results. In both settings, levels of antibodies in pregnant women to recombinant antigens and to intact IEs but not of opsonizing antibodies decreased over time. After adjustment for coverage with insecticide-treated bed nets (ITNs), these differences disappeared in the Malawian cohort, whereas in the PNG cohort, time was independently associated with a decrease in several antibody responses measured by ELISA. Conclusions. The impact of falling parasite prevalence on anti-Plasmodium falciparum serological indicators in pregnant women varies by setting. Increased ITN coverage may affect development of antibodies to recombinant antigens, but levels of opsonizing IgG remained stable over time. Opsonizing IgG against placental-binding IEs may persist, thus offering longer-lasting protection against malaria during pregnancy.
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