Bilirubin influences the clinical presentation of pre-eclampsia

Pre-eclampsia is a placental, inflammatory disease modified by maternal anti-oxidant status to give a syndrome. In its most severe forms pre-eclampsia is followed by maternal and neonatal mortality and morbidity. Bilirubin is a known antioxidant and as such is associated with a reduced risk of cardiovascular and respiratory disease. Hence we aimed to find an association between maternal bilirubin levels and the clinical severity of the disease.

A retrospective observational study of 50,712 pregnancies, 925 of which had pre-eclampsia (1999-2010), to examine the association between bilirubin level and perinatal outcome.

In women with pre-eclampsia, those with bilirubin levels in the lowest quintile were more likely to require caesarean section (p=0.001, aOR 2.59 (1.52-5.72)). The lowest quintile of bilirubin levels is associated with an increased risk of poor maternal (p=0.002, aOR 3.52 (95%CI 1.6-7.7)) and infant/fetal (p=0.001, OR=3.05 (95%CI=1.63-5.72)) outcome.

Low levels of bilirubin were associated with poor maternal and infant outcomes in women diagnosed with pre-eclampsia. Bilirubin may act as an anti-oxidant in this condition and thus modify the disease.