Serological reactivity to the ring-infected erythrocyte surface antigen and circumsporozoite protein in gravid and nulligravid women infected with Plasmodium falciparum.

To investigate potential mechanisms for pregnancy-associated alterations in the immune response to malaria, we tested plasma samples from Plasmodium falciparum-infected nulligravida (42), primigravida (23) and multigravida (38) Kenyan women for reactivity to the ring-infected erythrocyte surface antigen (RESA) by a modified indirect fluorescent antibody assay and to synthetic peptides derived from amino acid sequences of RESA and the circumsporozoite (CS) protein of P. falciparum by an enzyme-linked immunosorbent assay. Reactivity to RESA showed the lowest titres in primigravid women, intermediate titres in nulligravid women and the highest titres in multigravid women (loge mean antibody = 3.28, 4.64, and 5.28, respectively, P less than 0.03), but was not associated with initial parasite density or response to chloroquine treatment. No relationship in antibody reactivity to the 3 synthetic peptides of the RESA molecule was observed by gravidity (0, 1, or greater than or equal to 2), age, initial parasite density or response to treatment. Levels of antibody to the synthetic peptides of the CS protein increased with age and were higher in gravid than in nulligravid women in the 15-19 year age group. The increased malaria prevalence and parasite density and the decreased response to antimalarial treatment in pregnant women is not explained by lower levels of antibody to RESA or CS protein during pregnancy.