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Preeclampsia (PreE) contributes to long-term maternal cardiovascular disease risk. By 2025, it is estimated that more women than men will have hypertension (HTN), yet the mechanisms contributing to the development of HTN in women are less understood. Anti- and pro- inflammatory T helper (Th) responses are dysregulated in PreE. A persistent imbalance of these Th responses following PreE may underlie the future development of HTN in women. Therefore, the objective of this study was to determine if the immune Th changes observed during PreE persist post-partum (PP).
De-identified and coded plasma samples were obtained from the Magee-Women’s Research Institute & Foundation or the University of Iowa Maternal-Fetal Tissue Bank (IRB 201808705) from women 1-3 (N=93) or 8-10 (N=58) years (yrs) following a normotensive or PreE-affected pregnancy. PP HTN was defined as having stage 1 or higher HTN as designated in the updated 2017 ACC/AHA guidelines. Th cytokine concentrations were determined via ELISAs and normalized to total protein. Average cytokine concentrations are reported in pg/g.
Women with prior PreE had higher rates of HTN at 1-3 and 8-10 yrs PP (Table 1), compared to women with a normotensive pregnancy. At 1-3 yrs PP, concentrations of anti-inflammatory cytokines IL-4, IL-10, and TGFb were reduced in women with a prior PreE pregnancy. At 8-10 yrs PP, pro-inflammatory IL-6 and TNFa were significantly increased in women with prior PreE compared to women with a normotensive pregnancy (Table 2).
Women with a prior PreE pregnancy had a higher incidence of HTN early (1-3 yrs) and late (8-10 yrs) PP compared to women with a normotensive pregnancy. Following PreE, anti-inflammatory Th cytokines continue to be suppressed in the early PP period, creating an inflammatory milieu. By 8-10 yrs PP, this inflammatory environment is further exacerbated by elevated levels of IL-6 and TNFa. This Th-associated inflammation is associated with increased rates of HTN and thus, may underlie the future development of HTN in women with a history of PreE.