title: Improved pregnancy outcomes in women exposed to malaria with high antibody levels against Plasmodium falciparum.
abstract: BACKGROUND
  Antibodies against VAR2CSA, the Plasmodium falciparum variant surface antigen that binds placental chondroitin sulfate A, have been suggested to mediate protection against malaria in pregnancy but also to be markers of infection. Here, we aimed to identify clinically relevant antibody responses, taking into consideration variations in parasite exposure and human immunodeficiency virus type 1 (HIV) infection status.
  
  
  METHODS
  Levels of immunoglobulin G (IgG) against placental and pediatric isolates, VAR2CSA (DBL2X, DBL3X, DBL5ε, and DBL6ε domains), and other blood-stage antigens (DBLγ, DBLα, MSP119, AMA1, and EBA175) were measured in plasma specimens from 293 pregnant Mozambican women at delivery. Associations between antibody responses, factors influencing malaria exposure, HIV infection status, and pregnancy outcomes were assessed.
  
  
  RESULTS
  Maternal antibodies were affected by placental infection, parity, season, and neighborhood of residence. HIV infection modified these associations and attenuated the parity-dependent increase in IgG level. High levels of antibody against AMA1, DBL3X, DBL6ε, placental isolates, and pediatric isolates were associated with increased weight and gestational age of newborns (P ≤ .036) among women with malaria episodes during pregnancy.
  
  
  CONCLUSIONS
  Antiparasite IgGs in women at delivery are affected by HIV infection, as well as by variations in the exposure to P. falciparum. Heterogeneity of malaria transmission needs to be considered to identify IgGs against VAR2CSA and other parasite antigens associated with improved pregnancy outcomes.
authors: Barcelona Center for International Health Research, Hospital Clínic-Universitat de Barcelona, Spain. agmayor@clinic.ub.es
authors: Alfredo
authors: A
authors: Mayor
authors: Urwashi
authors: U
authors: Kumar
authors: Azucena
authors: A
authors: Bardají
authors: Pankaj
authors: P
authors: Gupta
authors: Alfons
authors: A
authors: Jiménez
authors: Amel
authors: A
authors: Hamad
authors: Betuel
authors: B
authors: Sigaúque
authors: Bijender
authors: B
authors: Singh
authors: Llorenç
authors: L
authors: Quintó
authors: Sanjeev
authors: S
authors: Kumar
authors: Puneet K
authors: PK
authors: Gupta
authors: Virander S
authors: VS
authors: Chauhan
authors: Carlota
authors: C
authors: Dobaño
authors: Pedro L
authors: PL
authors: Alonso
authors: Clara
authors: C
authors: Menéndez
authors: Chetan E
authors: CE
authors: Chitnis
mesh_terms: D000293:Adolescent; D000328:Adult; D000913:Antibodies, Protozoan / Q000097:blood*; D000953:Antigens, Protozoan / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016778:Malaria, Falciparum / Q000276:immunology*; D010963:Plasmodium falciparum / Q000276:immunology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology*; D011256:Pregnancy Outcome; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D007074:Immunoglobulin G