Atherogenic Lipid Profile in Early Pregnancy Associated with Pre-Eclampsia

Preeclampsia, a syndrome defined by hypertension and proteinuria is associated with increased maternal mortality and morbidity in United States and worldwide. There is no clear distinction between normotensive and preeclamptic pregnancies in terms of pathogenic factors and disease mechanisms. However, various factors are implicated in the pathogenesis of pre-eclampsia including genetic, immune, vascular, and oxi- dative stress. These have led to identification of potential candidate markers from cross-sectional studies. Maternal plasma lipids are significantly elevated during pregnancy. Women who develop preeclampsia experience even more dramatic lipid changes. Most, although not all, case-control studies have shown a preeclampsia dyslipi- demic pattern of increased triglycerides, cholesterol, low- density lipoprotein (LDL) and decreased high-density lipoprotein (HDL) concentrations. Inferences from these studies are limited by the fact that plasma lipid profiles were determined using blood samples collected after the diagnosis of preeclampsia. Evidence from few available prospective cohort studies suggest that women destined to develop the disorder are more likely to have elevated plasma triglycerides and decreased HDL cholesterol concentrations compared with their normotensive counterparts. However, results are not consistent, and investigators generally have not adjusted for possible confounding factors. We therefore used available information and plasma specimens from an ongoing prospective cohort study of women receiving prenatal care before 16 weeks gestation to examine whether varying concentrations of maternal plasma lipids and lipoproteins, measured in early pregnancy, are independently associated with an increased risk of preeclampsia.