Placental malaria is hypothesized to lead to placental insufficiency, which causes fetal growth restriction (FGR). In this review, recent discoveries regarding the mechanisms of pathogenesis by which malaria causes FGR are discussed in the wider context of placental function and fetal growth. Placental malaria and associated host responses can induce changes in placental structure and function, affecting pregnancy-associated growth-regulating hormones and predisposing the offspring to hypertension and vascular dysfunction. Risk factors associated with FGR are highlighted, and potential interventions and studies to uncover remaining mechanisms of pathogenesis are proposed. Together, these strategies aim to decrease the burden of FGR associated with malaria in pregnancy.