Abstract
Preeclampsia (PE) is a placental disorder with different phenotypic presentations. In malaria-endemic regions, high incidence of PE is reported, with debilitating foeto-maternal effects, particularly among primigravid women. However, the relationship between placental pathology and Plasmodium falciparum infection in the placenta with PE is underexplored. Placentas from 134 pregnant women were examined after delivery for pathological lesions and placental malaria (PM). They comprised of 69 women without PE (non-PE group) and 65 women diagnosed with PE (PE group). The presence of placental pathology increased the risk of PE, with particular reference to syncytial knots. Placental malaria was 64 (48.1%) and 21 (15.8%) respectively for active and past infections and these proportions were significantly higher in the PE group compared to the non-PE group. Further multivariate analyses showed placental pathology (adjusted (aOR) 3.0, 95% CI = 1.2–7.5), active PM (aOR 6.7, 95% CI = 2.3–19.1), past PM (aOR 12.4, 95% CI = 3.0–51.0) and primigravidity (aOR 6.6, 95% CI 2.4–18.2) to be associated with PE. Our findings suggest that placental histological changes and PM are independent risk factors for PE particularly in primigravida. These findings might improve the management of PE in malaria-endemic regions.
Highlights
Preeclampsia (PE) is a placental disorder with different phenotypic presentations
Of the specific alterations associated with PE in this study, syncytial knots were identified as the main contributor to placental pathology in women diagnosed with PE
The overall association between placental pathology and PE as shown in this study suggests that these placental lesions may have a contributory effect to the PE syndrome
Summary
Preeclampsia (PE) is a placental disorder with different phenotypic presentations. In malaria-endemic regions, high incidence of PE is reported, with debilitating foeto-maternal effects, among primigravid women. Placentas from 134 pregnant women were examined after delivery for pathological lesions and placental malaria (PM). ✉e-mail: www.nature.com/scientificreports associated with placental histopathological lesions such as infarcts, increase in syncytial knots, fibrin deposits, atherosis of the arterial wall, accelerated villous maturation and calcifications[11,12,13,14,15,16]. These changes result from ischaemic and hypoxic mechanisms secondary to poor perfusion[17]. Variable effects on the clinical severity of PE and foetal outcomes have been shown to implicate several placental factors in the pathogenesis of PE14,16
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