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C-reactive protein is elevated 30 years after eclamptic pregnancy
Carl A Hubel1, Robert W Powers, Sunna Snaedal
1Magee-Womens Research Institute and Department of Obstetrics and Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pa., USA.
Insights
Women with a history of eclampsia show higher C-reactive protein (CRP), indicating inflammation. This inflammation, along with dyslipidemia and insulin resistance, may increase long-term cardiovascular disease risk.
Area of Science:
- Obstetrics and Gynecology
- Cardiovascular Medicine
- Endocrinology
Background:
- Women with a history of preeclampsia/eclampsia face increased cardiovascular disease (CVD) risk post-pregnancy.
- Inflammation, dyslipidemia, and insulin resistance are linked to preeclampsia risk during pregnancy.
- Elevated C-reactive protein (CRP) signifies inflammation and heightened CVD risk.
Purpose of the Study:
- To investigate if Icelandic postmenopausal women with a history of eclampsia exhibit higher serum CRP levels compared to controls.
- To determine if elevated CRP is associated with dyslipidemia and insulin resistance in women with a history of eclampsia.
Main Methods:
- Serum CRP levels were measured using high-sensitivity enzyme-linked immunoassay in postmenopausal women.
- Participants included women with a history of eclampsia (n=25) and controls with uncomplicated pregnancies (n=28).
- Statistical analysis adjusted for body mass index, smoking, hormone replacement, and age.
Main Results:
- Women with prior eclampsia had significantly higher median CRP levels than controls (9.0 vs. 2.0 mg/L, P<0.03).
- The eclampsia group segregated into high CRP (n=13) and lower CRP (n=12) subsets.
- The high CRP subset showed elevated systolic blood pressure, lower HDL cholesterol, higher apolipoprotein B, and insulin resistance (HOMA) compared to controls.
Conclusions:
- History of eclampsia is associated with elevated systemic inflammation (CRP) in postmenopausal women.
- A subset of women with prior eclampsia exhibits a triad of inflammation, dyslipidemia (low HDL), and insulin resistance.
- This triad may contribute to the elevated risk of both eclampsia and later-life cardiovascular disease.
Abstract:
Women with a history of preeclampsia or eclampsia (seizure during preeclamptic pregnancy) are at increased risk for cardiovascular disease after pregnancy for reasons that remain unclear. Prospective studies during pregnancy suggest that inflammation, dyslipidemia, and insulin resistance are associated with increased risk of preeclampsia. Elevated serum C-reactive protein (CRP >3 mg/L) is an indicator of inflammation and cardiovascular risk. We hypothesized that Icelandic postmenopausal women with a history of eclampsia would manifest higher concentrations of serum CRP than Icelandic postmenopausal controls with a history of uncomplicated pregnancies. We also asked whether elevated CRP is associated with the dyslipidemia and insulin resistance previously identified in this cohort. CRP, measured by high-sensitivity enzyme-linked immunoassay, was higher in women with prior eclampsia (n=25) than controls (n=28) (median mg/L [interquartile range]: 9.0 [0.9 to 13.2] versus 2.0 [0.3 to 5.1]; P<0.03). This difference remained significant after adjustment for body mass index, smoking, hormone replacement, and current age. Women with prior eclampsia clustered into either high CRP (range 8.97 to 40.6 mg/L, n=13) or lower CRP (median 1.0, range 0.05 to 3.77, n=12) subsets. The prior eclampsia/high CRP subset displayed significantly elevated systolic blood pressures, lower high-density lipoprotein (HDL) cholesterol, higher apolipoprotein B, and higher fasting insulin and homeostasis model of insulin resistance (HOMA) values compared to controls, whereas the prior eclampsia/low CRP subset differed from controls only by marginally increased apolipoprotein B. The triad of inflammation, low HDL, and insulin resistance may elevate risk for both preeclampsia/eclampsia and cardiovascular disease in later life.
