title: Pregnancy, parturition and preeclampsia in women of African ancestry.
abstract: Maternal and associated neonatal mortality rates in sub-Saharan Africa remain unacceptably high. In Mulago Hospital (Kampala, Uganda), 2 major causes of maternal death are preeclampsia and obstructed labor and their complications, conditions occurring at the extremes of the birthweight spectrum, a situation encapsulated as the obstetric dilemma. We have questioned whether the prevalence of these disorders occurs more frequently in indigenous African women and those with African ancestry elsewhere in the world by reviewing available literature. We conclude that these women are at greater risk of preeclampsia than other racial groups. At least part of this susceptibility seems independent of socioeconomic status and likely is due to biological or genetic factors. Evidence for a genetic contribution to preeclampsia is discussed. We go on to propose that the obstetric dilemma in humans is responsible for this situation and discuss how parturition and birthweight are subject to stabilizing selection. Other data we present also suggest that there are particularly strong evolutionary selective pressures operating during pregnancy and delivery in Africans. There is much greater genetic diversity and less linkage disequilibrium in Africa, and the genes responsible for regulating birthweight and placentation may therefore be easier to define than in non-African cohorts. Inclusion of African women into research on preeclampsia is an essential component in tackling this major disparity of maternal health.
authors.affiliation: Department of Obstetrics and Gynaecology, Makerere University and Mulago Hospital, Kampala, Uganda.
authors.forename: Annettee
authors.initials: A
authors.lastname: Nakimuli
authors.affiliation: Department of Pathology and Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Olympe
authors.initials: O
authors.lastname: Chazara
authors.affiliation: Department of Obstetrics and Gynaecology, Makerere University and Mulago Hospital, Kampala, Uganda.
authors.forename: Josaphat
authors.initials: J
authors.lastname: Byamugisha
authors.affiliation: Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Elliott
authors.affiliation: Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Pontiano
authors.initials: P
authors.lastname: Kaleebu
authors.affiliation: Department of Obstetrics and Gynaecology, Makerere University and Mulago Hospital, Kampala, Uganda.
authors.forename: Florence
authors.initials: F
authors.lastname: Mirembe
authors.affiliation: Department of Pathology and Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom. Electronic address: am485@cam.ac.uk.
authors.forename: Ashley
authors.initials: A
authors.lastname: Moffett
mesh_terms: D000349:Africa / Q000208:ethnology; D044383:Black People / Q000235:genetics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D038622:Internationality; D008428:Maternal Mortality / Q000208:ethnology*; D007744:Obstetric Labor Complications / Q000208:ethnology*; D036801:Parturition / Q000208:ethnology*; D011225:Pre-Eclampsia / Q000208:ethnology* / Q000235:genetics; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology* / Q000235:genetics; D014454:Uganda
keywords: evolutionary selective pressure; great obstetric syndromes; length of gestation; obstetric dilemma