Heart Disease Biomarker C-Reactive Protein Is Elevated 30 Years Following A Pregnancy Complicated By Eclampsia

Main Category: Pregnancy / Obstetrics
Also Included In: Cardiovascular / Cardiology;  Hypertension;  Women's Health / Gynecology
Article Date: 02 May 2008 - 1:00 PDT

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C-reactive protein (CRP), an inflammatory marker associated with a higher risk of cardiovascular disease, was found to be elevated even 30 years after a pregnancy distinguished by eclampsia, according to a University of Pittsburgh-affiliated Magee-Womens Research Institute (MWRI) study (now online) in Hypertension, a journal of the American Heart Association. The finding indicates that pregnancy outcome can be viewed as "a natural early stress test" for future risk of cardiovascular disease - the leading cause of death for women.

"We found that levels of CRP were doubled in postmenopausal women who had a prior episode of eclampsia compared to those who had a history of normal pregnancies," said Carl Hubel, Ph.D., lead author, assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and an MWRI assistant investigator. "The finding is even more striking because this difference remained after adjusting for other, potentially confounding risk factors such as age, weight, smoking and use of hormone-replacement therapy."

A life-threatening complication of pregnancy, eclampsia occasionally succeeds preeclampsia and can involve coma, convulsions and organ failure. About two women in 100 will develop preeclampsia during pregnancy. A smaller number, about seven in 10,000, will develop eclampsia. Although intravenous infusion of magnesium sulfate can decrease the likelihood that a woman with preeclampsia will develop eclamptic seizures, the only effective treatment for the syndrome is immediate delivery, which can be dangerous for the baby if it is too early in the pregnancy.

"We propose that prior preeclampsia - particularly severe preeclampsia - be considered as a red flag to identify women of reproductive age who stand to benefit from cardiovascular risk factor modification," said Dr. Hubel. "If we can identify these differences during a woman's reproductive years and intervene with lifestyle changes early and aggressively, we may be able to impact her future risk. Early screening here is vital."

For the study, Dr. Hubel and his colleagues compared data on 25 Icelandic women with prior eclampsia and 28 Icelandic women with normal pregnancies.

"In particular, elevated CRP during the first trimester of pregnancy has also been associated with a 2.5-fold increased risk of developing preeclampsia in leaner women, indicating that pathways of chronic, low-grade systemic inflammation may be involved in the development of the disease, perhaps persisting decades after childbirth," said Dr. Hubel. "Fasting insulin levels and systolic blood pressures also were significantly higher in women with previous eclampsia compared to controls."

Among women testing for elevated CRP, who had a history of eclampsia, 69 percent had systolic blood pressure greater than 140, and 62 percent were taking anti-hypertensive medications, the researchers found. "These women appear especially prone to developing insulin resistance syndrome later in life and are at increased risk to develop high blood pressure, heart disease or stroke," Dr. Hubel said.

Additional authors are Robert Powers, Ph.D., co-first author; Hilary Gammill, M.D.; James Roberts, M.D.; and Roberta Ness, M.D., M.P.H., all of the University of Pittsburgh; and Sunna Snaedal, M.D., co-first author, Karolinska University Hospital, Stockholm, Sweden; and Reynir Arngrimsson, Ph.D., senior author, University of Iceland, Reykjavik.

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