Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
Usher Institute, The University of Edinburgh, Edinburgh, UK.
J Glob Health. 2020 Dec;10(2):020417. doi: 10.7189/jogh.10.020417.
The World Health Organisation (WHO) estimates that hypertensive disorders of pregnancy (HDP) contribute 14% to global maternal mortality. HDP encompasses several subcategories, including gestational hypertension (GH) and pre-eclampsia. These two conditions are both characterised by a rise in blood pressure, with an onset from 20 weeks of gestation. They also share some common risk factors. The current definition of pre-eclampsia includes raised blood pressure in the absence of proteinuria, thus presenting the two conditions as a spectrum. In this article, we refer to both conditions as gestational hypertension, which is our outcome of interest. The aetiology of GH is not yet clearly understood. Observational studies have suggested that malaria may be associated with GH. However, the evidence from these small studies has been inconclusive. Having a better understanding of the association between malaria and GH may help inform prevention strategies to reduce maternal and infant mortality and morbidity.
In assessing the association between malaria infection and GH we explored open access articles published in the English language on Medline, Embase, WHO GIM and Google scholar. The subject related articles were retrieved and processed according to preferred reporting items in systematic reviews and meta-analyses (PRISMA) guidelines. Search date was 9th week of 2018. Inverse variance weighting method in Revman 5 software (Cochrane Collaboration, London, United Kingdom) was used to aggregate evidence by computing the pooled odds ratio to show the nature and strength of the relationship between malaria and GH.
Using critical appraisal skills program (CASP) checklist tool we identified four good quality case-control studies. The total sample size was 1281 women out of which 518 were cases. These studies together show malaria is associated with GH with an overall odds ratio of 2.67, 95% confidence interval (CI) = 1.58-4.53. Heterogeneity of the individual studies supported fixed effect modelling assumptions (I = 0%). Malaria infection may have a constant effect on GH across different African populations. The funnel plot did not suggest publication bias however, the four studies involved in the meta-analysis were insufficient to rule it out.
Our findings provide evidence of an association between malaria infection and gestational hypertension; this underscores the need to control malaria especially during pregnancy.
世界卫生组织（WHO）估计，妊娠高血压疾病（HDP）占全球产妇死亡率的 14%。HDP 包含几个亚类，包括妊娠期高血压（GH）和子痫前期。这两种情况的血压都升高，从妊娠 20 周开始发病。它们也有一些共同的危险因素。目前子痫前期的定义包括没有蛋白尿的高血压，因此将这两种情况视为一个谱系。在本文中，我们将这两种情况都称为妊娠期高血压，这是我们感兴趣的结果。GH 的病因尚不清楚。观察性研究表明，疟疾可能与 GH 有关。然而，这些小研究的证据尚无定论。更好地了解疟疾与 GH 之间的关联可能有助于为减少母婴死亡率和发病率提供预防策略。
在评估疟疾感染与 GH 之间的关联时，我们在 Medline、Embase、世界卫生组织全球疟疾计划和 Google Scholar 上搜索了以英语发表的开放获取文章。根据系统评价和荟萃分析（PRISMA）指南检索和处理相关主题文章。搜索日期为 2018 年第 9 周。Revman 5 软件（Cochrane 协作组织，英国伦敦）中的逆方差加权法用于通过计算汇总优势比来聚合证据，以显示疟疾与 GH 之间关系的性质和强度。
使用关键评估技能计划（CASP）检查表工具，我们确定了四项高质量的病例对照研究。总样本量为 1281 名女性，其中 518 名是病例。这些研究共同表明，疟疾与 GH 相关，总体优势比为 2.67，95%置信区间（CI）为 1.58-4.53。个体研究的异质性支持固定效应模型假设（I=0%）。疟疾感染可能对不同非洲人群的 GH 有恒定的影响。漏斗图不提示发表偏倚，但荟萃分析中涉及的四项研究不足以排除这种偏倚。
我们的研究结果提供了疟疾感染与妊娠期高血压之间存在关联的证据；这强调了需要控制疟疾，特别是在怀孕期间。
