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. 2020 May 19;10(1):8280.
doi: 10.1038/s41598-020-64736-4.

Histopathological lesions and exposure to Plasmodium falciparum infections in the placenta increases the risk of preeclampsia among pregnant women

Dorotheah Obiri  1   2 , Isaac Joe Erskine  3 , Daniel Oduro  4   5   6 , Kwadwo Asamoah Kusi  7   4 , Jones Amponsah  4 , Ben Adu Gyan  4 , Kwame Adu-Bonsaffoh  8 , Michael Fokuo Ofori  9   10
Affiliations

Histopathological lesions and exposure to Plasmodium falciparum infections in the placenta increases the risk of preeclampsia among pregnant women

Dorotheah Obiri et al. Sci Rep. .

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.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Photomicrographs of placental changes observed among pregnant women from the study. (a) A non-PE placenta showing normal villi (black arrow) and intervillous spaces (red arrow). (b) Calcifications (black arrow) in a 33-week old PE placenta. (c) Infarction (coagulative necrosis) of large area of the placenta from ischaemia (black arrow) in 29-week placenta with intrauterine foetal death). (d) Accelerated villous maturation (thin finger-like or slender villi with reduced branching). (e) Atherosis showing accumulation of lipid laden macrophages within sub-endothelial area of arterial wall. (f) Increased syncytial knots showing densely stained and closely packed nuclei.
Figure 2
Figure 2
Percentage of histological findings in normal and pathologic placentas. Bars represent non-PE (white bars) and PE (dark bars) women. Mixed = 2 or more placental abnormalities; accl. maturation = accelerated villous maturation.
Figure 3
Figure 3
Placental infections observed among pregnant women from the study. (a) Normal placental architecture with uninfected RBCs in the intervillous spaces. (b) Acute malaria infection with only parasitized red cells and no parasite pigments (c) Chronic malaria infection with parasites and parasite pigments present in red cells in a 38-week placenta (d) Past malaria infection showing pigments in fibrin.
Figure 4
Figure 4
Measure of exposure to placental malaria in women diagnosed with non-PE (white bars) and PE (dark bars). Data presented as proportions between active, past and no infection in non-PE and PE placentas by Fisher’s exact test. *(P < 0.05), **(P < 0.01); ****(P < 0.0001).
See this image and copyright information in PMC

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