The Relationship between Placental Malaria and Preeclampsia in Blantyre, Malawi

Preeclampsia (PreE) and placental malaria (PM) are leading causes of perinatal morbidity and mortality in Africa with overlapping pathophysiology. Utilizing data collected during a randomized, controlled clinical trial of intermittent preventive therapy during pregnancy in Malawi, we examined the association between PM and PreE, including severe manifestations, such as eclampsia. All singleton pregnancies with placental histopathology and polymerase chain reaction (PCR) were included. Among 751 pregnancies, 125 (16.7%) had evidence of PM by histopathology or PCR identifying PM parasites, including 105 with hemozoin pigment indicative of infection during early pregnancy. Twenty-five patients (3.3%) had PreE without eclampsia, 6 (0.7%) had eclampsia, and 98 (13.0%) had any hypertensive disorder. Individuals with hemozoin had nearly twice the rate of PreE as those without, although this difference did not achieve statistical significance (6.7% versus 3.7%, P = 0.16). This study is limited by sample size and was underpowered to detect this difference. Further research characterizing the relationship between PM and PreE is warranted.