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Research Article

Hypertension and Maternal–Fetal Conflict during Placental Malaria

  • Atis Muehlenbachs,

    Affiliations: MOMS Project, Seattle Biomedical Research Institute, Seattle, Washington, United States of America, University of Washington, Seattle, Washington, United States of America

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  • Theonest K Mutabingwa,

    Affiliations: MOMS Project, Seattle Biomedical Research Institute, Seattle, Washington, United States of America, London School of Hygiene and Tropical Medicine, London, United Kingdom, National Institute for Medical Research, Dar es Salaam, Tanzania, Muheza Designated District Hospital, Muheza, Tanzania

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  • Sally Edmonds,

    Affiliation: Muheza Designated District Hospital, Muheza, Tanzania

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  • Michal Fried,

    Affiliations: MOMS Project, Seattle Biomedical Research Institute, Seattle, Washington, United States of America, University of Washington, Seattle, Washington, United States of America

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  • Patrick E Duffy mail

    To whom correspondence should be addressed. E-mail: pduffy@sbri.org

    Affiliations: MOMS Project, Seattle Biomedical Research Institute, Seattle, Washington, United States of America, University of Washington, Seattle, Washington, United States of America, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America

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  • Published: November 14, 2006
  • DOI: 10.1371/journal.pmed.0030446

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Placental Malaria: Hypertension, VEGF, and Prolactin?

Posted by plosmedicine on 31 Mar 2009 at 00:05 GMT

Author: Roy Douglas Pearson
Position: -
Institution: Gerstein Science Information Center
E-mail: r.pearson@utoronto.ca
Additional Authors: n/a
Submitted Date: February 05, 2007
Published Date: February 6, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Placental Malaria: Hypertension, VEGF, and Prolactin?

The findings byMuehlenbachs [1] et al. that placental malaria (PM) is associated with hypertension in the primigravidae (18-20y) is significant, and not to be explained at this time of writing. The authors also provide data suggesting that the maternal-fetal conflict, during chronic PM and hypertension in first-time mothers involves the VEGF pathway.

Previously [2-5], I have posited that prolactin might have a role in PM and these new findings might provide further indirect evidence for such a role. It should be remembered that there is an extensive and decades-old literature [see Horrobin’s chpt. 23, in (6)] on the role of prolactin in hypertension; and moreover specifically, the relationship between prolactin and pregnancy-related hypertension [7, 8].

Regarding the VEGF pathway, Malaguarnera et al. [9] have recently shown that prolactin induces VEGF production in human macrophages. It is conceivable that hyperprolactinemia (pituitary and or placental) could up-regulate placental macrophage production of VEGF.

Space does not permit a discussion of the well known fact of increased pregnancy related prolactin in the primigravidae, but this has been noted elsewhere [2] concerning maternal malaria.

Although there has been controversy of late [2, 10], regarding my “prolactin hypothesis” in maternal malaria, it is time definitive experiments be conducted to ascertain if prolactin is playing a role in PM, and in other infectious diseases as well.

References
1. Muehlenbachs A, Mutabinwa TK, Edmonds S, Fried M, Duffy PE (2006) Hypertension and maternal-fetal conflict during pregnancy. PLoS Med 3:e446.
2. Pearson RD (2004) Malaria in pregnancy: the “cortisol” and “prolactin” hypotheses. Clin Infect Dis 39: 146-147.
3. Pearson RD (2003) HIV (AIDS), maternal malaria and prolactin. AIDS 17: 2002-2003.
4. Pearson RD (2002) Is prolactin responsible for avian, saurian, and mammalian relapse and periodicity of fever in malarial infections? Can J Zool 80:1313-1315.
5. Pearson RD (2001) Prolactin, pregnancy and anaemia in severe malaria. Trends Parasitol 17: 362.
6. Horrobin DF (1973) Prolactin: Physiology and Clinical Significance. Lancaster: MTP Pub. 240 p.
7. Marlettini MG, Cassani A, Morselli-Labate AM, Crippa S, Contarini A, et al. (1990) Maternal and fetal prolactin in pregnancy-induced hypertension. Arch Gynecol Obstet 247: 73-81.
8. Bellmann O, Praetorius D, Sonntag M, Hansmann M, Fimmers R (1987) Relationship between prolactin in amniotic-fluid during early 2nd trimester and pregnancy-induced hypertension. Clin Exp Hypert – Part B- Hypert Preg 6:34-34.
9. Malaguarnera L, Imbesi RM, Scuto F, D’Amico F, Licata A, et al. (2004) Prolactin increases HO-1 expression and induces VEGF production in human macrophages. J Cell Biochem 93: 197-206.
10. Mavoungou E (2006) Interactions between natural killer cells, cortisol and prolactin in malaria during pregnancy. Clin Med Res 4:33-41.

Roy Douglas Pearson
Gerstein Science Information Centre
9 Kings College Circle,
Toronto, Ontario
CANADA M5S 1A5

No competing interests declared.