title: Obesity and preeclampsia: the potential role of inflammation.
abstract: OBJECTIVE
  Systemic inflammation might contribute to the pathogenesis of preeclampsia. In addition, the association between obesity and inflammation in preeclampsia has not been examined in detail. We determined whether first-trimester elevation of serum C-reactive protein, an index of systemic inflammation, was associated with preeclampsia.
  
  
  METHODS
  We conducted a prospective, nested case-control study among women enrolled in the Massachusetts General Hospital Obstetrical Maternal Study cohort. High-resolution C-reactive protein assays were performed on first-trimester (11 +/- 2 weeks' gestation) serum samples in 40 women in whom preeclampsia developed (blood pressure [BP] greater than 140/90 mmHg, and proteinuria, either 2+ or more by dipstick or greater than 300 mg per 24 hours), and in 80 matched controls. This sample size had greater than 80% power to detect a difference in C-reactive protein levels between cases and controls. We used nonparametric tests to compare C-reactive protein levels and conditional logistic regression to control for confounding variables.
  
  
  RESULTS
  First-trimester C-reactive protein levels were significantly higher among women in whom preeclampsia subsequently developed compared with controls (4.6 compared with 2.3 mg/L, P =.04). When women were subdivided into C-reactive protein quartiles, the odds ratio (OR) of being in the highest quartile of C-reactive protein was 3.2 (95% confidence interval [CI] 1.1, 9.3, P =.02) among cases of preeclampsia compared with controls. When body mass index (BMI) was added to the multivariable model, the highest quartile of C-reactive protein was no longer associated with increased risk of preeclampsia (OR 1.1, 95% CI.3, 4.3, P =.94). In the same model without BMI, the highest quartile of C-reactive protein was associated with increased risk of preeclampsia (OR 3.5, 95% CI 1.3, 9.5, P =.01).
  
  
  CONCLUSIONS
  In women with preeclampsia, there was evidence of increased systemic inflammation in the first trimester. Inflammation might be part of a causal pathway through which obesity predisposes to preeclampsia.
authors.affiliation: Renal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. mswolf@partners.org
authors.forename: M
authors.initials: M
authors.lastname: Wolf
authors.forename: E
authors.initials: E
authors.lastname: Kettyle
authors.forename: L
authors.initials: L
authors.lastname: Sandler
authors.forename: J L
authors.initials: JL
authors.lastname: Ecker
authors.forename: J
authors.initials: J
authors.lastname: Roberts
authors.forename: R
authors.initials: R
authors.lastname: Thadhani
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D009765:Obesity / Q000097:blood / Q000453:epidemiology*; D010298:Parity; D011225:Pre-Eclampsia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D002097:C-Reactive Protein