Risk of malaria in infants can be influenced by prenatal factors. In this study, the potential for placental parasitemia at delivery in predicting susceptibility of infants to Plasmodium falciparum (Pf) infections was evaluated. Seventy-two newborns of mothers who were placental malaria negative (PM−) and of mothers who were PM+ with below (PM+ Lo) and above (PM + Hi) median placental parasitemia, were actively monitored during their first year of life. Median time to first PCR-detected Pf infection was shorter in PM + Lo infants (2.8 months) than in both PM− infants (4.0 months, p = 0.002) and PM + Hi infants (4.1 months, p = 0.01).

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Total number of new infections was also highest in the PM + Lo group. Only 24% of infants experienced clinical malaria episodes but these episodes occurred earlier in PM + Lo infants than in PM + Hi infants (p = 0.05). The adjusted hazard ratio (95% CI) of having Pf infection was 3.9 (1.8–8.4) and 1.5 (0.7–3.4) for infants in the PM + Lo and PM + Hi groups, respectively. Collectively, low placental parasitemia was associated with increased susceptibility to malaria during infancy. Therefore, malaria in pregnancy preventive regimens, such as sulfadoxine-pyremethamine, that reduce but do not eliminate placental Pf in areas of drug resistance may increase the risk of malaria in infants. When pregnant women become infected with the mosquito-borne parasite Plasmodium falciparum (Pf), parasitized erythrocytes adhere to placental villi and accumulate in the intervillous spaces (IVS), causing a condition referred to as placental malaria (PM).

In addition to eliciting adverse pregnancy outcomes, PM has been identified as a risk factor for early childhood morbidity and mortality. In general, infants born to PM-positive (PM+) mothers have a shorter time to first Pf infection, and first clinical episode of malaria,, a higher incidence of Pf infections early in life, lower hemoglobin levels, and higher risk of dying compared to infants of PM-negative (PM−) mothers. However, the risk of malaria is not homogeneous among infants of PM+ mothers, since some PM+ infants have similar risk outcomes as PM− infants,.

There is therefore a need to identify specific prenatal factors associated with increased susceptibility to malaria in infants whose mothers had PM. Factors thought to be important in modifying the susceptibility of infants to malaria include maternal gravidity and the timing of occurrence of malaria during pregnancy. For example, infants born to multigravid Tanzanian women had their first microscopically detected infection 12 weeks earlier than infants of primigravid women.