Hypertension and maternal–fetal conflict during placental malaria
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Date
2006
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Publisher
PLoS medicine
Abstract
Background:
Malaria and hypertension are major causes of maternal mortality in tropical countries,especially during first pregnancies, but evidence for a relationship between these syndromes iscontradictory.
Methods and Findings:
In a cross-sectional survey of Tanzanian parturients, the rate of hypertension was similar inplacental malaria (PM)-positive (11/85 = 13%) and PM-negative (73/602 = 12%) individuals.However, we found that PM was associated with hypertension in first-time mothers aged 18–20 ybut not other mothers. Hypertension was also associated with histologic features of chronicmalaria, which is common in first-time mothers. Levels of soluble vascular endothelial growthfactor receptor 1 (sVEGFR1), a preeclampsia biomarker, were elevated in first-time mothers witheither PM, hypertension, or both, but levels were not elevated in other mothers with theseconditions. In first-time mothers with PM, the inflammatory mediator vascular endothelial growthfactor (VEGF) was localized to maternal macrophages in the placenta, while sVEGFR1, its solubleinhibitor, was localized to the fetal trophoblast.
Conclusions:
The data suggest that maternal–fetal conflict involving the VEGF pathway occurs during PM,and that sVEGFR1 may be involved in the relationship between chronic PM and hypertension infirst-time mothers. Because placental inflammation causes poor fetal outcomes, wehypothesize that fetal mechanisms that promote sVEGFR1 expression may be under selectivepressure during first pregnancies in malaria-endemic areas.
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Keywords
Hypertension, Placental malaria, Maternal–fetal
Citation
Muehlenbachs, A., Mutabingwa, T.K., Edmonds, S., Fried, M. and Duffy, P.E., 2006. Hypertension and maternal–fetal conflict during placental malaria. PLoS medicine, 3(11).