Evidence and opportunities for preeclampsia and cardiovascular disease prevention in malaria endemic settings

Sub-Saharan Africa bears a high burden of both malaria in pregnancy and hypertensive disorders of pregnancy including preeclampsia, a leading cause of maternal and perinatal deaths. Increasing evidence suggests that infection with Plasmodium falciparum, which causes placental malaria, is associated with increased preeclampsia risk. Here we discuss how epidemiologic and biological evidence link malaria to preeclampsia by examining shared pathways, including placental inflammation and vascular disruptions, which culminate in the unifying phenomenon of placental dysfunction in both syndromes. With these shared mechanisms in mind, we discuss how malaria prevention strategies could reduce the risk of preeclampsia and related long-term cardiovascular disease in endemic settings. We also outline key research and implementation priorities to support integrated prevention approaches in affected settings. Obionu et al. Synthesize epidemiologic and mechanistic evidence linking falciparum malaria in pregnancy to hypertensive disorders of pregnancy. They show that shared placental pathways may increase preeclampsia risk, highlighting opportunities for integrated prevention strategies.