Raised C-reactive protein and impaired flow-mediated vasodilation precede the development of preeclampsia

Background: The aim of this study was to investigate whether impaired flow mediated vasodilation precedes the clinical manifestations of preeclampsia and whether is associated with inflammation. Methods: We conducted a nested case-control study in a prospective cohort of 506 normotensive women recruited before the 30(th) week of gestation (mean gestational age of 21.8 weeks). At enrollment, flow-mediated dilation was measured in the brachial artery using a 7.5-MHz transducer. C-reactive protein plasma concentrations and leukocyte count were also determined at study entry. Patients were followed until delivery, and medical records were reviewed for each patient to confirm the presence or absence of preeclampsia or gestational hypertension. Results: Of the women studied, 14 developed preeclampsia, 18 developed gestational hypertension, and 474 remained normotensive. Two normotensive pregnant control subjects were randomly selected for each case, matched by maternal age, gestational age, and body mass index at enrollment. Women who subsequently developed preeclampsia had lower flow-mediated dilation (13.4% +/- 4.3% v 18.2% +/- 7.2, P = .026), higher C-reactive protein plasma concentrations (8.7 +/- 5.5 mg/dL v 5.3 +/- 4.3 mg/dL, P = .022) and leukocyte count (10.3 +/- 2.0 X 10(9)/L v 9.1 +/- 2.0 x 10(9)/L, P = .036) at study entry. Conclusions: Decreased flow-mediated vasodilation and higher levels of CRP are present in early stages of gestation in women who subsequently develop preeclampsia. These alterations occur before the onset of clinical symptoms of PE. Further studies are needed to confirm that flow-mediated dilation and C-reactive protein could be useful methods to screen women at risk of developing preeclampsia.