Mutabingwa, Theonest K.2020-03-092020-03-092006Muehlenbachs, 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).doi:10.1371/ journal.pmed.0030446http://hdl.handle.net/123456789/314Background: 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.enHypertensionPlacental malariaMaternal–fetalArticle