Aim: Pregnancies, including preeclampsia, are low-grade systemic inflammation which has been associated with complications. Endothelial dysfunction in preeclampsia is accompanied by elevated levels of inflammatory markers and cytokines such as high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10). Our aim in this study is to assess the levels of these above markers in preeclampsia and to predict its severity.
Materials and methods: A case-control study was performed on 100 pregnant women with preeclampsia as cases (50 mild and 50 severe) as per clinical guidelines and 50 healthy pregnant women as controls. They were all age and parity-matched primigravidas at the third trimester of pregnancy.
Results: Significantly increased (p <0.001) serum levels of hs-CRP, TNF-α and IL-10 were found in cases of mild and severe preeclamptic when compared to controls. In severe preeclamptics, all these parameters were also found highly significant in comparison to mild.
Conclusion and clinical significance: The observed high levels of hs-CRP, TNF-α, and IL-10 in preeclamptic women indicate that these markers can be used in identifying the severity of preeclampsia and it can help the clinician in their diagnosis, treatment, and management.
Ambreen AA, Melinda H. Pre-eclampsia: systemic endothelial damage leading to increased activation of the blood coagulation cascade. Journal of Biotech. Research. 2012;4:26-43.
Wallis AB, Saftlas AF, Hsia AJ, Atrash HK. Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987-2004. Am J Hypertens. 2008;21:521-526.
Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. Bmj. 2013 Nov 7;347:f6564.
World Health Organisation. The world health report: 2005: make every mother and child count. Geneva: WHO; 2005. Available at http://www.who.int/whr/2005/whr2005_en.pdf. Retrived March 20, 2013.
Dubey L. Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and Caribbean. Br J Obstet Gynaecol. 1992;99:547-553.
Moffett A, Hiby SE. How does the maternal immune system contribute to the development of Preeclampsia? Placenta. 2007;4:51-56.
Roberts JM, Cooper DW. Pathogenesis and genetics of preeclampsia. The Lancet. 2001 Jan 6;357(9249):53-56.
Aziz SB. High sensitivity C-reactive protein in preeclamptic (PE) women. Medical Journal of Tikrit. 2015;20(1):55-62.
Tjoa ML, Van Vugt JM, Go AT, Blankenstein MA, Oudejans CB, Van Wijk IJ. Elevated C-reactive protein levels during first trimester of pregnancy are indicative of preeclampsia and intrauterine growth restriction. Journal of reproductive immunology. 2003 Jun 1;59(1):29-37.
Qui C, Luthy DA, Zhang C, Walsh SW, Leisenring WM, Williams MA. A prospective study of maternal serum C-reactive protein concentration and risk of preeclampsia. 2004;17(2): 154-160.
Sowmya S, Ramaiah A, Sunitha T, Nallari P, Jyothy A, Venkateswari A. Evaluation of Interleukin-10 (G-1082A) Promoter Polymorphism in Preeclampsia. Preeclampsia. J Reprod Infertil. 2013;14(2):62-66.
Patigaroo FA, Siddiqui AH, Gulati R, Mohsin Z. Tumor Necrosis Factor Alpha In Preeclampsia. International Journal of Basic and Applied Physiology. 2013;2(1):224-228.
Diniz D, Corrêa M. The Helsinki Declaration: relativism and vulnerability. Cadernos de saude publica. 2001 Jun;17(3): 679-688.
Moore KW, O'Garra A, de Waal Malefyt R, Vieira P, Mosmann TR. Interleukin-10. Annu Rev Immunol. 1993;11:165-190.
Aderka D, Engelmann H, Maor Y, Brakebusch C, Wallach D. Stabilization of the bioactivity of tumor necrosis factor by its soluble receptors. Journal of Experimental Medicine. 1992 Feb 1;175(2):323-329.
Otsuji S, Shibata H, Umeda M. Turbidimetric immunoassay of serum C-reactive protein. Clinical Chemistry. 1982 Oct 1;28 (10):2121-2124.
Watanabe N, Kamei S, Ohkubo A, Yamanaka M, Ohsawa S, Makino K, Tokuda K. Urinary protein as measured with a pyrogallol red-molybdate complex, manually and in a Hitachi 726 automated analyzer. Clinical chemistry. 1986 Aug 1;32(8): 1551-1554.
Nanda K, Sadanand G, Muralidhara Krishna CS, Mahadevappa KL. C-reactive protein as a predictive factor of pre-eclampsia. Int J Biol Med Res. 2012;3(1):1307-1310.
Oancea MD, Costin N, Pop DM, Ciortea R, Trif I, Mihu D. Evaluation of Inflammatory Markers in Pregnant Women at Risk, for the Prediction of Preeclampsia. Acta Medica Marisiensis. 2014 Jun 1;60(3):94-98.
Sharma A, Satyam A, Sharma JB. Leptin, IL 10 and inflammatory markers (TNF, IL 6 and IL 8) in pre eclamptic, normotensive pregnant and healthy non pregnant women. American Journal of Reproductive Immunology. 2007 Jul 1;58(1):21-30.
Kalantar F, Rajaei S, Heidari AB, Mansouri R, Rashidi N, Izad MH, et al. Serum levels of tumor necrosis factor-, interleukin- 15 and interleukin-10 in patients with pre-eclampsia in comparison with normotensive pregnant women. Iranian journal of nursing and midwifery research. 2013 Nov;18(6):463.
Lau SY, Guild SJ, Barrett CJ, Chen Q, McCowan L, Jordan V, et al. Tumor necrosis factor alpha, interleukin 6, and interleukin 10 levels are altered in preeclampsia: a systematic review and meta analysis. American journal of reproductive immunology. 2013 Nov;70(5):412-427.
Jonsson Y, Rubèr M, Matthiesen L, Berg G, Nieminen K, Sharma S, Ernerudh J, Ekerfelt C. Cytokine mapping of sera from women with preeclampsia and normal pregnancies. Journal of reproductive immunology. 2006 Jun 1;70(1-2): 83-91.
Vijayalakshmi P, Usha MR, Shetty HV, Priyadarshini KS, Victoria SH, Montey N. Study of serum hsCRP and lipid profile in pre-eclampsia. International Journal of Recent Trends in Science And Technology. 2015;14(3):605-609.
Kanak KM, Arpita D, Lakhipyari D, Omita N, Nabakishore S, Singh WG. Serum high sensitivity C - reactive protein as predictor of Preeclampsia. IOSR-JDMS. 2016;15(2):26-31.
Rifai N, Ridker PM. Population distributions of C-reactive protein in apparently healthy men and women in the United States: implication for clinical interpretation. Clinical Chemistry. 2003 Apr 1;49(4):666-669.
Xie C, Yao MZ, Liu JB, Xiong LK. A meta-analysis of tumor necrosis factor-alpha, interleukin-6, and interleukin-10 in preeclampsia. Cytokine. 2011;56(3):550-559.
Celik H, Avi B, Alper T. Comparison of maternal serum levels of interleukin-10, interleukin-12, and interleukin-2 in normal and pre-eclamptic pregnancies. Pregnancy Hypertens Int J Women Cardiovasc Health. 2012;2:39-42.
Haedersdal S, Salvig J, Aabye M, Christian W, Thorball, Ruhwald M, et al. Inflammatory Markers in the Second Trimester Prior to Clinical Onset of Preeclampsia, Intrauterine Growth Restriction, and Spontaneous Preterm Birth. Inflammation. 2013;4:907-913.