appear to be buried in the quaternary structure. data has indicated that these domains interact, forming a binding site that is specific for low-sulfated csa found in the placenta. the binding of antibodies to one of these domains would prevent adhesion of parasitic ie in the placenta. moreover, studies have shown that women acquire immunity to pam through antibody recognition of the var2csa domain, also known as vsapam, after exposure during their first pregnancy. by measuring circulating levels of igg antibodies that presumably target var2sca, the study demonstrated that subsequent pregnancies confer progressively greater protection to pam. thus, pfemp1 proteins such as the var2csa domain could prove attractive as potential candidates for vaccine targets. additional genetic testing relating to pregnancy-associated malaria is currently being researched which involves looking at glucose-6-phosphate dehydrogenase (g6pd) which is an enzyme that is responsible for keeping red blood cells protected from being destroyed too soon by things such as foods and medications. the gene for this enzyme is found on the x chromosome which means that women in particular can have g6pd function that is normal, intermediate (which often shows up on lab tests as normal), and deficient. this gene is important in determining if certain antimalarial drugs such as primaquine and tafenoquine can be used since these antimalarial drugs are more likely to cause red blood cell hemolysis in women with a g6pd deficiency and worsen any anemia that comes from the malaria infection. although these drugs would most likely be used after delivery for treatment of pregnancy-associated malaria, this genetic testing can help avoid inducing anemia in women more prone to red blood cell breakdown. a vaccine to prevent a pregnancy-associated malaria called pamvac is currently undergoing clinical trials. pamvac is based on a recombinant form of the var2csa domain and has been shown to be well-tolerated when injected in malaria-naive volunteers while also successfully inducing the production of antibodies against var2csa. although the vaccine was injected in healthy participants who did not have malaria, the study provided insight into the vaccine's safety before administration into the target population – women with pam. a second vaccine candidate against pregnancy-associated malaria called primvac is also currently undergoing clinical trials in healthy adult women as a 3 dose course. this vaccine is based on the dbl1x-2x domain of var2csa which is able to bind to csa in the placenta. in preclinical studies, primvac injected in rats led to the production of antibodies against var2csa on infected erythrocytes and also resulted in reduction of their binding to csa. the vaccine was also shown to be well-tolerated in rats without any notable adverse reactions.