Hypertension and maternal-fetal conflict during placental malaria
Hypertension and maternal-fetal conflict during placental malaria
复制标题
DOI：
10.1371/journal.pmed.0030446
复制
发表时间：
2006-11-01
期刊：
影响因子：
15.8
通讯作者：
Duffy, Patrick E.
中科院分区：
文献类型：
--
作者：
Muehlenbachs, Atis;Mutabingwa, Theonest K.;Duffy, Patrick E.
背景 疟疾和高血压是热带国家孕产妇死亡的主要原因，尤其是在第一次怀孕期间，但这些综合征之间关系的证据是相互矛盾的。 方法和结果 在对坦桑尼亚产妇的一项横断面调查中，胎盘疟疾 (PM) 阳性 (11/85 = 13%) 和 PM 阴性 (73/602 = 12%) 个体的高血压发生率相似。然而，我们发现 PM 与 18-20 岁首次母亲的高血压相关，但与其他母亲无关。高血压还与慢性疟疾的组织学特征有关，这在初为人母的人中很常见。可溶性血管内皮生长因子受体 1 (sVEGFR1)（一种先兆子痫生物标志物）的水平在患有 PM、高血压或两者兼而有之的首次母亲中升高，但在其他患有这些疾病的母亲中，其水平没有升高。在初产妈妈中，炎症介质血管内皮生长因子（VEGF）定位于胎盘中的母体巨噬细胞，而其可溶性抑制剂sVEGFR1定位于胎儿滋养层。结论数据提示，初产妈妈中发生了涉及VEGF通路的母胎冲突，sVEGFR1可能参与了初产妈妈慢性PM与高血压的关系。由于胎盘炎症会导致胎儿结局不佳，因此我们推测，在疟疾流行地区的首次妊娠期间，促进 sVEGFR1 表达的胎儿机制可能面临选择性压力。
Background Malaria and hypertension are major causes of maternal mortality in tropical countries, especially during first pregnancies, but evidence for a relationship between these syndromes is contradictory.Methods and Findings In a cross-sectional survey of Tanzanian parturients, the rate of hypertension was similar in placental malaria (PM)-positive (11/85 = 13%) and PM- negative (73/602 = 12%) individuals. However, we found that PM was associated with hypertension in first-time mothers aged 18-20 y but not other mothers. Hypertension was also associated with histologic features of chronic malaria, which is common in first-time mothers. Levels of soluble vascular endothelial growth factor receptor 1 (sVEGFR1), a preeclampsia biomarker, were elevated in first-time mothers with either PM, hypertension, or both, but levels were not elevated in other mothers with these conditions. In first-time mothers with PM, the inflammatory mediator vascular endothelial growth factor (VEGF) was localized to maternal macrophages in the placenta, while sVEGFR1, its soluble inhibitor, was localized to the fetal trophoblast.Conclusions The data suggest that maternal-fetal conflict involving the VEGF pathway occurs during PM, and that sVEGFR1 may be involved in the relationship between chronic PM and hypertension in first-time mothers. Because placental inflammation causes poor fetal outcomes, we hypothesize that fetal mechanisms that promote sVEGFR1 expression may be under selective pressure during first pregnancies in malaria-endemic areas.