Context: Pre-eclampsia and placental malaria, are two diseases that share pathophysiological similarities, such as placental ischemia, endothelial dysfunction and production of pro-inflammatory cytokines. Objective: The objective of our study was to investigate the association between placental malaria lesions and severe pre-eclampsia. Methodology: We conducted a prospective analytical cross-sectional study in two University Hospitals in the city of Yaounde (Yaounde Central Hospital and the Gynaecological Obstetrics and Paediatrics Hospital), and in the laboratory of the Centre Pasteur in Yaounde over an eight-month period (1st January 2021 – 1st September 2021). All patients with pre-eclampsia diagnosed according to the criteria of the International Society for the Study of Hypertension (ISSHP) and free of chronic metabolic or infectious pathology were included in this study. The patients were divided into two groups: group 1 (mild pre-eclampsia) and group 2: severe pre-eclampsia. Socio-demographic, clinical and histopathological characteristics specific to pre-eclampsia and placental malaria were investigated. Statistical analysis was performed with SPSS 23.0 software, Chi 2 was used to compare categorical variables, Student t-test was used to compare means, and logistic regression was used to assess the association between placental malaria lesions and PES. Results: The mean age of our study population was 29.93 ± 7.36 years versus 28.28 ± 7.18 years in patients with mild and severe pre-eclampsia respectively. Pre-eclampsia placental lesions (accelerated villous maturation, infarction) were significantly greater in patients with severe pre-eclampsia (p < 0.001), as were placental malaria lesions (syncytial knots, acute inflammation, chronic inflammation; p < 0.001). The mean placental weight was significantly lower in patients with severe pre-eclampsia (511.67 ± 125.01 g versus 454.37 ± 121.96 g; P = 0.024). On univariate analysis, the absence of antenatal care (OR: 2.33; 95% CI: 1.02 - 5.32) and the absence of intermittent preventative treatment (OR: 3.06; 95% CI: 1.22 - 7.77) were significantly associated with severe pre-eclampsia. After multivariate analysis and regardless of wide confidence intervals, there was a strong association between placental malaria lesions and severe pre-eclampsia (aOR: 31.92; 95% CI: 8.67 - 117.47; p < 0.001); and a strong association between placental malaria lesions and pre-eclampsia placental lesions in patients with severe PE (aOR:
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