YALE JOURNAL OF BIOLOGY AND MEDICINE 80 (2007), pp. 95-103 Copyright © 2007. REVIEW Impact of Placental Plasmodium falciparum Malaria on Pregnancy and Perinatal Outcome in Sub-Saharan Africa II: Effects of Placental Malaria on Perinatal Outcome; Malaria and HIV Chigozie J. Uneke Faculty of Clinical Medicine, Ebonyi State University, Nigeria Placental malaria is recognized as a common complication of malaria in pregnancy in areas of stable transmission, and, as a consequence, serious health problems arise for the mother and especially her baby [1]. Although malaria in pregnancy is a major factor associated with adverse perinatal outcome, the link between malaria and perinatal morbidity/mortality is less clear in areas with stable endemic malaria where pregnant women have acquired immunity [2]. Histological examination of the placenta is a predictor of fetal morbidity, as well as being the most sensitive detector of maternal infection [3]. Adverse perinatal outcome has been described as an important indicator of poor quality of obstetric care and social development [4]. A variety of adverse perinatal outcomes associ- ated with placental malaria have been described, including low birth weight, preterm delivery, intrauterine growth retardation, fetal anemia, congenital malaria, and fetal mortality. The most common clinical features in 80 percent of perinatal cases are fever, anemia, and splenomegaly [5]. Other signs and symptoms include hepatomegaly, jaundice, regurgitation, loose stools, poor feeding, and, occasionally, drowsiness, restlessness, and cyanosis also can be seen [5,6]. A review of studies that investigated these poor fetal outcomes associated with placental malaria in sub-Saharan Africa is presented here. ADVERSE OUTCOMES OF PLACENTAL MALARIA Congenital malaria Malaria during pregnancy may result in fetal exposure to malaria if parasites are transmitted across the placenta and could re- sult in congenital malaria. Transplacental transmission of P. falciparum has been well described, and the reported frequency of this event in babies born in malaria-exposed pregnancies has ranged from 0 percent to more than 25 percent [7-11]. Thus, placental malaria is known to be a major determinant To whom all correspondence should be addressed: Chigozie J. Uneke, Department of Med- ical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University, PMB 053 Abakaliki, Nigeria. Tele: 234-08038928597; Fax: 234-043221093; E-mail: unekecj@ yahoo.com. †Abbreviations: LBW, low birth weight; PTD, preterm delivery; IUGR, intrauterine growth re- tardation; MTCT, mother-to-child transmission. 95