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American Journal of Epidemiology Advance Access originally published online on August 13, 2009
American Journal of Epidemiology 2009 170(7):847-853; doi:10.1093/aje/kwp207
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Placental Malarial Infection as a Risk Factor for Hypertensive Disorders During Pregnancy in Africa: A Case-Control Study in an Urban Area of Senegal, West Africa

C. T. Ndao, A. Dumont, N. Fievet, S. Doucoure, A. Gaye and J. Y. Lehesran

Correspondence to Dr. Cheikh Tidiane Ndao, UR010, Santé de la mere et de l'enfant en milieu tropical, Institut de Recherche pour le Développement, Postal Box 1386, Dakar, Senegal (e-mail: cheikhtidiane.ndao{at}gmail.com).

Received for publication December 30, 2008. Accepted for publication June 11, 2009.

In tropical countries, malaria and hypertension are common diseases of pregnancy. They have physiopathologic similarities such as placental ischemia, endothelial dysfunction, and production of proinflammatory cytokines. Recent findings suggested their possible link. The authors conducted a case-control study to explore the relation between malaria and hypertension at Guediawaye, a hypoendemic malarial setting in Senegal. Cases were pregnant women admitted to the delivery unit for hypertension. Controls were pregnant women admitted for normal delivery, without any history of hypertension or proteinuria during the present pregnancy. Malarial infection was determined by placental tissue examination. From January to December 2002, 77 cases of gestational hypertension, 113 cases of preeclampsia, 59 cases of eclampsia, and 241 controls were enrolled. Placental malarial infection (PMI) was present in 14 cases (6.3%) and in 15 controls (6.2%). The prevalence of PMI was 4.6% for eclampsia, 4.0% for preeclampsia, and 11.6% for gestational hypertension. In multivariate analysis, PMI appeared to be an independent risk factor for gestational hypertension (adjusted odds ratio = 2.7, 95% confidence interval: 1.0, 7.6). The authors found an association between PMI and nonproteinuric hypertension in women living in a malaria-hypoendemic area. The exact significance of such relation should be clarified in further studies in different settings of malarial endemicity.

Africa; hypertension; malaria; placenta; pre-eclampsia; pregnancy; Senegal

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; PMI, placental malarial infection


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