Obesity and preeclampsia: the potential role of inflammation.

Abstract

OBJECTIVE:

Systemic inflammation might contribute to the pathogenesis of preeclampsia. In addition, the association between obesity and inflammation in preeclampsia has not been examined in detail. We determined whether first-trimester elevation of serum C-reactive protein, an index of systemic inflammation, was associated with preeclampsia.

METHODS:

We conducted a prospective, nested case-control study among women enrolled in the Massachusetts General Hospital Obstetrical Maternal Study cohort. High-resolution C-reactive protein assays were performed on first-trimester (11 +/- 2 weeks' gestation) serum samples in 40 women in whom preeclampsia developed (blood pressure [BP] greater than 140/90 mmHg, and proteinuria, either 2+ or more by dipstick or greater than 300 mg per 24 hours), and in 80 matched controls. This sample size had greater than 80% power to detect a difference in C-reactive protein levels between cases and controls. We used nonparametric tests to compare C-reactive protein levels and conditional logistic regression to control for confounding variables.

RESULTS:

First-trimester C-reactive protein levels were significantly higher among women in whom preeclampsia subsequently developed compared with controls (4.6 compared with 2.3 mg/L, P =.04). When women were subdivided into C-reactive protein quartiles, the odds ratio (OR) of being in the highest quartile of C-reactive protein was 3.2 (95% confidence interval [CI] 1.1, 9.3, P =.02) among cases of preeclampsia compared with controls. When body mass index (BMI) was added to the multivariable model, the highest quartile of C-reactive protein was no longer associated with increased risk of preeclampsia (OR 1.1, 95% CI.3, 4.3, P =.94). In the same model without BMI, the highest quartile of C-reactive protein was associated with increased risk of preeclampsia (OR 3.5, 95% CI 1.3, 9.5, P =.01).

CONCLUSION:

In women with preeclampsia, there was evidence of increased systemic inflammation in the first trimester. Inflammation might be part of a causal pathway through which obesity predisposes to preeclampsia.

• Authors: M Wolf, E Kettyle, L Sandler, J L Ecker, J Roberts, R Thadhani
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 98 Issue 5 Pt 1 Pg. 757-62 (Nov 2001) ISSN: 0029-7844 [Print] United States
• PMID: 11704165 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• C-Reactive Protein

Topics

• Adult
• Body Mass Index
• C-Reactive Protein (analysis)
• Case-Control Studies
• Female
• Humans
• Obesity (blood, epidemiology)
• Parity
• Pre-Eclampsia (blood, epidemiology, etiology)
• Pregnancy
• Pregnancy Trimester, First
• Prospective Studies
• Risk Assessment
• Risk Factors