Advertisement
Journal Home
Search for

Volume 198, Issue 4, Pages 385.e1-385.e9 (April 2008)


View previous. 13 of 56 View next.

Articles in fullAlternative complement pathway activation fragment Bb in early pregnancy as a predictor of preeclampsia

Presented at the 20th annual meeting of the Society for Pediatric and Perinatal Epidemiologic Research, Boston, MA, June 18-19, 2007.

Anne M. Lynch, MB, BCh, BAO, MSPHaCorresponding Author Informationemail address, James R. Murphy, PhDd, Tim Byers, MD, MPHb, Ronald S. Gibbs, MDa, Margaret C. Neville, PhDa, Patricia C. Giclas, PhDe, Jane E. Salmon, MDf, V. Michael Holers, MDc

Received 13 June 2007; received in revised form 15 August 2007; accepted 11 October 2007. published online 28 January 2008.

Objective

Preeclampsia is a multisystem disease classically defined on the basis of hypertension and proteinuria. As shown in animal studies, complement activation is associated with inflammation in the placenta and adverse pregnancy outcomes. The association between complement activation in humans and adverse pregnancy outcomes is unclear. The purpose of this study was to determine whether elevated levels of the activation fragment Bb in early pregnancy are predictive of preeclampsia.

Study Design

This prospective study of 701 women was conducted in Denver, CO. A single plasma sample was obtained from each woman before 20 weeks’ gestation. The cohort was followed up throughout pregnancy for the development of preeclampsia. Analysis included multivariate logistic regression to adjust for established risk factors for preeclampsia.

Results

Preeclampsia developed in 4.6% of the cohort. Women with elevated Bb (90th or greater percentile) were substantially more likely to develop preeclampsia than women who had levels less than the 90th percentile (unadjusted relative risk [RR], 3.3, 95% confidence interval [CI] 1.6 to 7, P = .0009). Other significant risk factors for preeclampsia included nulliparity (RR, 2.1, 95% CI, 1-4), a high body mass index (P = .006 for trend), and maternal medical (preexisting maternal hypertension, type 1 diabetes, systemic lupus erythematosus) disease (RR, 4.4, 95% CI, 2-10). Significant risk factors among multiparous women included a history of hypertension in a previous pregnancy (RR, 5, 95% CI, 1.6 to 16) and a change of paternity (RR, 5.1, 95% CI, 1.6 to 15). Adjustment for risk factors did not attenuate the association between an elevated Bb and preeclampsia (adjusted odds ratio [OR], 3.8, 95% CI, 1.6 to 9, P = .002) in the cohort. After removing women with plasma obtained before 10 weeks, the adjusted OR of Bb in the top decile for preeclampsia was 6.1 (95% CI 2.2, 17, P = .0005).

Conclusion

The complement activation product Bb in early pregnancy is a biomarker for elevated risk of preeclampsia. This observation suggests that events linked to activation of complement in early pregnancy are associated with the pathogenesis of preeclampsia.

a Department of Obstetrics and Gynecology, University of Colorado at Denver and Health Sciences Center, Denver, CO

b Department of Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Denver, CO

c Department of Medicine and Immunology, University of Colorado at Denver and Health Sciences Center, Denver, CO

d Division of Biostatistics and Bioinformatics, National Jewish Medical and Research Center, Denver, CO

e Department of Pediatrics, Division of Allergy and Immunology, National Jewish Medical and Research Center, Denver, CO

f Weill Medical College, Cornell University, New York, NY.

Corresponding Author InformationReprints: Anne Lynch MB, BCh, BAO, MSPH, Department of Obstetrics and Gynecology, University of Colorado at Denver and Health Sciences Center, Department of Obstetrics and Gynecology, Mail Stop B198-5, Academic Office One, 12631 East 17th Avenue, PO Box 6511, Aurora, CO 80045.

 This study was supported by Grant K23 HD049684 from the National Institute of Child Health and Human Development and Newborn Hope Colorado (to A.M.L.) and National Institutes of Health Grant R01 AI 55007 (to V.M.H.).

 Cite this article as: Lynch AM, Murphy JR, Byers T, et al. Alternative complement pathway activation fragment Bb in early pregnancy as a predictor of preeclampsia. Am J Obstet Gynecol 2008;198:385.e1-385.e9.

PII: S0002-9378(07)02015-7

doi:10.1016/j.ajog.2007.10.793


View previous. 13 of 56 View next.

Advertisement