Placental malaria and pre-eclampsia through the looking glass backwards?

Placental malaria and pre-eclampsia occur frequently in women in developing countries and are leading causes of fetal growth restriction. Reduced placental perfusion, loss of placental integrity and endothelial cell dysfunction are characteristics of both conditions, and several common factors can be implicated in their causation as well as leading to a cascade of responses with pathophysiological effects. Discrimination between risk factors which result in a loss of endothelial integrity from pathogenic factors which occur as a consequence of this is essential for understanding the potential influence of malaria on pre-eclampsia. This article summarises the evidence linking the two conditions in relation to their epidemiological, immunological, haematological and biochemical characteristics as well as the pathological similarities and differences related to placental structure and function. The potential similar role for nitric oxide synthase involvement in both placental malaria and pre-eclampsia is considered. Several research implications are highlighted which follow from this analysis. We consider that there is no clear dividing line between pathogenic mechanisms related to both conditions, a better understanding of which should be of benefit to millions of women in developing countries. (C) 2004 Elsevier Ireland Ltd. All rights reserved.