Abstract
BackgroundMalaria and hypertensive disorders of pregnancy (HDoP) affect millions of pregnancies worldwide, particularly those of young, first-time mothers. Small case-control studies suggest a positive association between falciparum malaria and risk of pre-eclampsia but large prospective analyses are lacking.MethodsWe characterized the relationship between malaria in pregnancy and the development of HDoP in a large, prospectively followed cohort. Pregnant women living along the Thailand-Myanmar border, an area of low seasonal malaria transmission, were followed at antenatal clinics between 1986 and 2016. The relationships between falciparum and vivax malaria during pregnancy and the odds of gestational hypertension, pre-eclampsia, or eclampsia were examined using logistic regression amongst all women and then stratified by gravidity.ResultsThere were 23,262 singleton pregnancies in women who presented during the first trimester and were followed fortnightly. Falciparum malaria was associated with gestational hypertension amongst multigravidae (adjusted odds ratio (AOR) 2.59, 95%CI 1.59–4.23), whereas amongst primigravidae, it was associated with the combined outcome of pre-eclampsia/eclampsia (AOR 2.61, 95%CI 1.01–6.79). In contrast, there was no association between vivax malaria and HDoP.ConclusionsFalciparum but not vivax malaria during pregnancy is associated with hypertensive disorders of pregnancy.
Highlights
Malaria and hypertensive disorders of pregnancy (HDoP) affect millions of pregnancies worldwide, those of young, first-time mothers
As eclampsia is considered to be a feature of severe preeclampsia and there were relatively few eclampsia outcomes, we considered the composite outcome of pre-eclampsia or eclampsia
Association between falciparum malaria and hypertensive disorders of pregnancy by gestational age of falciparum malaria As abnormalities in spiral artery remodeling are associated with subsequent HDoP, we considered whether the effects described above varied by gestational age of the first detection of falciparum malaria
Summary
Malaria and hypertensive disorders of pregnancy (HDoP) affect millions of pregnancies worldwide, those of young, first-time mothers. The clinical presentation ranges from gestational hypertension to pre-eclampsia to life-threatening eclampsia [1]. It is unclear whether gestational hypertension and pre-eclampsia are separate entities or represent a spectrum of disease as they share some but not all risk factors and result in varying placental pathology, with findings consistent with placental ischemia associated with pre-eclampsia [5]. Accumulating evidence suggests that pre-eclampsia is the product of abnormal spiral artery development leading to placental hypoxia, triggering the release of fetal-derived molecules that increase maternal blood pressure and perfusion of the placenta but result in diffuse endothelial dysfunction in the mother [4]
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