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Inflammatory Markers and Preeclampsia: A Systematic Review
Kathleen Darrah Black1, June Andrews Horowitz
1Kathleen Darrah Black, PhD, MSN, RNC-OB, is Adjunct instructor, College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania. June Andrews Horowitz, PhD, RN, PMHCNS-BC, FAAN, is Associate Dean for Graduate Studies and Research & Professor, University of Massachusetts Dartmouth.
Insights
Inflammation plays a role in preeclampsia (PE), a pregnancy complication. While C-reactive protein and certain cytokines show promise, no single marker reliably predicts PE, necessitating further research into marker combinations.
Area of Science:
- Obstetrics and Gynecology
- Immunology
- Biomarker Research
Background:
- Preeclampsia (PE) is a significant pregnancy complication affecting 5%-10% of pregnancies.
- The etiology of PE remains unclear, but inflammation and endothelial dysfunction are associated with its development.
Purpose of the Study:
- To systematically review existing evidence on the association between PE and inflammatory markers.
- To assess the utility of these markers for predicting or early identification of PE in clinical settings.
Main Methods:
- Systematic review conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Searched MEDLINE/OVID and Cumulative Index for Nursing and Allied Health databases with no publication year restrictions.
- Reviewed 73 articles, examining 57 unique inflammatory markers.
Main Results:
- C-reactive protein and pro-inflammatory cytokines (IL-6, IL-8, tumor necrosis factor alpha) showed the most support as potential markers for PE surveillance.
- These markers appear most relevant during the second and third trimesters of pregnancy.
Conclusions:
- Currently, no single inflammatory marker is recommended for routine clinical prediction or identification of PE.
- Further research is needed to evaluate panels of these four inflammatory markers, potentially combined with clinical risk factors, for clinical application.
Background:
Preeclampsia (PE), a serious and variable pregnancy complication affecting 5%-10% of the obstetric population, has an undetermined etiology, yet inflammation is concomitant with its development, particularly in relation to endothelial dysfunction.
Objective:
The purpose of this systematic review was to examine the published evidence concerning an association between PE and inflammatory markers for their usefulness in the prediction or early identification of women with PE in antepartum clinical settings.
Methods:
In this systematic review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cumulative Index for Nursing and Allied Health and MEDLINE/OVID were the electronic databases used for identifying published articles. We placed no time limit on the publication year.
Results:
The search generated 798 articles. After removing duplicates, screening abstracts, and conducting full-text reviews, we retained 73 articles and examined 57 unique markers. This review shows that C-reactive protein and the cytokines, specifically the proinflammatory markers IL-6, IL-8, and tumor necrosis factor alpha, garner the most support as potential inflammatory markers for clinical surveillance of PE, particularly during the second and third trimesters.
Discussion:
Based on this review, we cannot recommend any single inflammatory marker for routine clinical use to predict/identify PE onset or progression. Research is recommended to examine a combination panel of these four inflammatory markers both with and without clinical risk factors toward the goal of translation to practice.
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