Publication Q&A: Impact of Maternal Malaria on Hypertensive Disorders of Pregnancy
May 2021 – Whitney Harrington, MD, PhD shares insights into their latest findings on the impact of maternal malaria on hypertensive disorders of pregnancy (HDoP) from a recent publication in BMC Medicine.
Falciparum but not vivax malaria increases the risk of hypertensive disorders of pregnancy in women followed prospectively from the first trimester
Whitney E. Harrington, Kerryn A. Moore, Aung Myat Min, Mary Ellen Gilder, Nay Win Tun, Moo Kho Paw, Jacher Wiladphaingern, Stephane Proux, Kesinee Chotivanich, Marcus J. Rijken, Nicholas J. White, François Nosten & Rose McGready
Published April 27, 2021
What is the current focus of your lab/research?
Our lab focuses on the impact of maternal infections such as malaria and HIV on fetal and infant immune development. Most of our work is focused on maternal microchimerism, or rare maternal cells, which traffic into the fetus and infant and become long-term resident populations in the offspring. This paper focuses on the impact of maternal malaria on hypertensive disorders of pregnancy (HDoP), which are a leading cause of prematurity, stillbirth, and maternal mortality world-wide, utilizing data collected over 30 years by our collaborators Rose McGready and Francois Noşten at Shoklo Malaria Research Unit.
What are the significant findings in this paper?
In a cohort of more than 20,000 pregnancies prospectively followed from the first trimester at Shoklo Malaria Research Unit, we found that peripheral falciparum malaria infection more than doubled the risk of HDoP. In addition, we found evidence of effect modification by gravidity, where amongst mothers in their first pregnancy, falciparum infection was associated with pre-eclampsia / eclampsia, the most severe form of HDoP. In contrast, among mothers in their second or later pregnancy, falciparum malaria was associated with the milder form of HDoP know as gestational hypertension. Finally, we found that the impact of falciparum malaria was modified by the gestational age of first infection, with the greatest risk conferred by infections that occur in the first half of pregnancy. This finding is notable because prior work has shown that falciparum malaria can sequester in the placenta and alter placental development, and pre-eclampsia is thought to principally reflect abnormal spiral artery remodeling resulting in chronic placental hypoxia. In contrast, vivax malaria, also a systemic infection, was not associated with HDoP, which may reflect differences in ability of the two parasite species to sequester in the placenta.
What are the next steps and long-term goals for this research?
This paper emphasizes the detrimental impact of falciparum malaria on the health of the mother and her fetus and infant, in addition to other poor outcomes previously described (miscarriage, stillbirth, growth restriction, prematurity). It further emphasizes the need to protect women from falciparum malaria early in the pregnancy, at a time when most interventions to prevent malaria have not yet been implemented (e.g. intermittent treatment, which begins at second trimester).
Learn more about Dr. Harrington’s research.