Browsing by Author "Obiri, D."
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Item Advancing hypertensive disorders of pregnancy management: insights from the 5th preeclampsia scientifc symposium in Ghana(BMC Proceedings, 2024) Koi‑Larbi, K.; Obiri, D.; Browne, J. L.; et al.The 5th Preeclampsia Scientific Symposium (PSS2023) organized by Action on Preeclampsia (APEC) Ghana was themed: ‘Realign, Refocus: Improving outcomes of Hypertensive Disorders of Pregnancy through Shared Decision Making, Research & Quality of Care’. It took place on the 18th and 19th of May 2023 at the Ghana College of Physicians and Surgeons (GCPS), Accra Ghana. This transdisciplinary symposium brought together a national representation of experts, policy makers, scientists, and healthcare professionals to discuss key priorities, opportunities, approaches, and strategies to improve the maternal and perinatal outcomes of hypertensive disorders of pregnancy (HDP) in Ghana and the sub-region. The symposium centered around three key themes: realigning/refocusing patient-doc‑ tor decision making processes to improve outcomes of HDP; realigning/refocusing clinical care to improve outcomes of HDP; and leveraging on research to predict, recognize and manage high-risk women. This report summarizes insights from the diverse presentations and discussions held at the #PSS2023. This will form a roadmap for future research, policy, and interventions to improve outcomes of HDP in Ghana and the sub region. The symposium provided a wealth of evidence and knowledge from various experts, highlighting the need for women-centered care, equitable re-allocation of resources, multi-sectoral and innovative approaches, capacity strengthening. Other highlights include knowledge base development and increased stakeholder and community engagement with an overall aim of improving outcomes of HDP. The symposium also fostered inclusivity, welcoming survivors of HDP and their families at a scientific platform. They provided invaluable insights into the challenges faced and the lived experiences of those affected by the disease. Trainees and students also benefited from the symposium as it provided networking opportunities with fellow researchers, and a front row to gaining insights into cutting-edge research in GhanaItem Circulating Endothelial Progenitor Cells and Preeclampsia in Women with Placental Malaria(University Of Ghana, 2019-03) Obiri, D.Background Placental malaria and preeclampsia are major complications of pregnancy associated with high incidence of maternal/foetal Morbidity and mortality particularly in sub-Saharan Africa. Similarities in pathophysiology such as systemic inflammation and generalized endothelial activation/dysfunction exist and are exacerbated in concurrent situations. The combined pathologic and immunologic effects of these pregnancy disorders, prevalent in malaria endemic regions, have not been tested. This study evaluated the pathologic risk associated with Plasmodium falciparum infection in the placenta and the outcome of preeclampsia. Immune mediators associated with placental malaria and the risk of preeclampsia were evaluated. In addition, the relationship between endothelial cell phenotypes implicated in vascular activation/injury/damage/repair and the factors that mediate their release were assessed. Methods A total of 140 pregnant women (18 - 42 years) diagnosed with and without preeclampsia were recruited into the study in Accra, Ghana. Peripheral blood samples were collected at delivery while cord blood, placental intervillous blood and placental biopsies were collected after delivery. Circulating endothelial cells (cECs) and circulating endothelial progenitor cell phenotypes (cEPCs, mEPCs and iEPCs) were quantified by flow cytometry. Immunological (inflammatory and angiogenic) factors were tested by multiplex ELISA using plasma separated from whole blood. Placental biopsies were histologically evaluated for unique placental lesions and placental malaria (classified as active and past infections). Results Of 133 placentas scored for placental malaria, women diagnosed with preeclampsia had 39 (29.3%) and 15 (11.3%) active and past infections respectively while the non-preeclamptic women had 25 (18.8%) active infections and 6 (4.5%) past infections. Both active (adjusted odds ratio (AOR) 6.7, 95% CI 2.3 – 18.9; P < 0.0001) and past infections (AOR 11.6, 95% CI 3.0 – 45.8; P < 0.0001) increased the risk of preeclampsia. This association was enhanced in primigravidae (AOR 6.6, 95% CI 2.4 – 18.2; P < 0.0001) and in women with pathological alterations in the placenta (AOR 3.0, 95% CI 1.2 – 7.5; P < 0.019). The preeclamptic pregnancies with active placental parasites showed higher levels of proinflammatory and antiangiogenic markers. In multivariate analysis, active parasite infection (AOR = 7.14, 95% CI = 1.1 – 44.7; P = 0.04), past infection (AOR = 12.9, 95% CI = 1.1 – 155.5; P = 0.04), primigravidity (AOR = 7.2, 95% CI = 1.1 – 48.0; P = 0.04) and increased levels of the plasminogen activator inhibitor (PAI)-1 molecule (AOR = 7.1, 95% CI = 1.3 – 38.3; P = 0.02) were all associated with placental malaria. Furthermore, proportions of endothelial cell phenotypes were higher in the placenta and cord compared to peripheral blood. Alterations in their levels correlated strongly with angiogenic factors that stimulate their release mostly in non-preeclamptic compared to preeclamptic pregnancies. Conclusion Findings from this study have demonstrated that the pathophysiology of preeclampsia is pathologically and immunologically exacerbated in women exposed to placental malaria. In addition, endothelial cell phenotypes that contribute to vascular homeostasis and the factors that mediate their release into circulation are altered. Altogether, this study provides a new paradigm in assessing preeclampsia in malaria endemic regions.Item Histopathological lesions and exposure to Plasmodium falciparum infections in the placenta increases the risk of preeclampsia among pregnant women(Scientific Reports, 2020-05-19) Obiri, D.; Erskine, I.J.; Oduro, D.; Kusi, K.A.; Amponsah, J.; Gyan, B.A.; Adu-Bonsaffoh, K.; Ofori, M.F.Preeclampsia (PE) is a placental disorder with different phenotypic presentations. In malaria-endemic regions, high incidence of PE is reported, with debilitating foeto-maternal effects, particularly among primigravid women. However, the relationship between placental pathology and Plasmodium falciparum infection in the placenta with PE is underexplored. Placentas from 134 pregnant women were examined after delivery for pathological lesions and placental malaria (PM). They comprised of 69 women without PE (non-PE group) and 65 women diagnosed with PE (PE group). The presence of placental pathology increased the risk of PE, with particular reference to syncytial knots. Placental malaria was 64 (48.1%) and 21 (15.8%) respectively for active and past infections and these proportions were significantly higher in the PE group compared to the non-PE group. Further multivariate analyses showed placental pathology (adjusted (aOR) 3.0, 95% CI = 1.2–7.5), active PM (aOR 6.7, 95% CI = 2.3–19.1), past PM (aOR 12.4, 95% CI = 3.0–51.0) and primigravidity (aOR 6.6, 95% CI 2.4–18.2) to be associated with PE. Our findings suggest that placental histological changes and PM are independent risk factors for PE particularly in primigravida. These findings might improve the management of PE in malaria-endemic regions.