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BMJ. 2007 November 24; 335(7629): 1059.
PMCID: PMC2094173
Pre-Eclampsia

Pre-eclampsia is an inflammatory disorder

Jecko V Thachil, haematologist

Two research articles highlight the link between pre-eclampsia and cardiovascular diseases including ischaemic heart disease, hypertension, and stroke.1 2 The common factor in these conditions is endothelial dysfunction. What triggers this endothelial damage is not clear. Interestingly, atherosclerosis—an initiating factor for most of these diseases—has been increasingly recognised as an inflammatory disorder. Inflammatory markers, such as C reactive protein (CRP), increase in atherosclerosis and are risk factors for ischaemic heart disease, diabetes mellitus, and cerebrovascular disease. If these different conditions are risk factors for pre-eclampsia, then inflammation may be important in the pathophysiology of pre-eclampsia.

Evidence suggests pre-eclampsia may be an inflammatory disorder. Serum CRP concentrations were significantly higher in all groups of women whose hypertension developed during pregnancy than in controls and those with chronic hypertension.3

Other workers have investigated haemostatic function after pre-eclampsia to determine future risk of coronary heart disease.4 Patients with a history of pre-eclampsia had higher plasma concentrations than controls of von Willebrand factor and fibrinogen, which correlated with blood pressure increases but not proteinuria during the index pregnancy. The authors concluded that persistent endothelial dysfunction, continuing haemostatic alterations, and dyslipoproteinaemia after pre-eclampsia may be associated with future coronary heart disease.

Another study measured plasma thrombomodulin values in primigravidas at risk of pre-eclampsia.5 Increases in plasma thrombomodulin were not seen until week 32 in uneventful pregnancies, but were present by week 24 in women who later developed hypertensive complications.

Thus, in addition to considering pre-eclampsia as a risk factor for future vascular events in women, it should be considered an inflammatory disease to help identify factors that can predict its severity and develop new therapeutic strategies.

Notes

Competing interests: None declared.

References

1. Magnussen EB, Vatten LJ, Lund-Nilsen TI, Salvesen KA, Smith GD, Romundstad PR. Prepregnancy cardiovascular risk factors as predictors of pre-eclampsia: population based cohort study. BMJ 2007;335:978 (10 November.) [PMC free article] [PubMed]
2. Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007;335:974 (10 November.) [PMC free article] [PubMed]
3. Paternoster DM, Fantinato S, Stella A, Nanhorngue KN, Milani M, Plebani M, et al. C-reactive protein in hypertensive disorders in pregnancy. Clin Appl Thromb Hemost 2006;12:330-7. [PubMed]
4. He S, Silveira A, Hamsten A, Blomback M, Bremme K. Haemostatic, endothelial and lipoprotein parameters and blood pressure levels in women with a history of preeclampsia. Thromb Haemost 1999;81:538-42. [PubMed]
5. Boffa MC, Valsecchi L, Fausto A, Gozin D, Vigano' D'Angelo S, Safa O, et al. Predictive value of plasma thrombomodulin in preeclampsia and gestational hypertension. Thromb Haemost 1998;79:1092-5.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group