Malaria and Pregnancy: Placental Cytokine Expression and Its Relationship to Intrauterine Growth Retardation

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Abstract
Malaria infections during pregnancy can lead to the delivery of low-birth-weight infants. In this study, cytokine mRNA was measured in placentas from 23 malaria-infected and 21 uninfected primigravid women who had delivered in Mangochi, Malawi, a region with a high rate of transmission of falciparum malaria. Significantly increased expression of interleukin (IL)—1β, IL-8, and tumor necrosis factor (TNF)—α and decreased expression of IL-6 and transforming growth factor-β1 were found in malaria-infected compared with uninfected placentas. TNF-α and IL-8 were produced by maternally derived hemozoin-laden placental macrophages. Increased TNF-α expression was associated with increased placental hemozoin concentrations. Increased TNF-α or IL-8 expression in the placenta was associated with intrauterine growth retardation but not with preterm delivery. The results suggest that malaria infections induce a potentially harmful proinflammatory response in the placenta.

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