Maternal biomarkers of endothelial dysfunction and preterm delivery.
BACKGROUND
Endothelial dysfunction is key to the development of atherosclerosis. Preterm delivery foreshadows later maternal cardiovascular disease (CVD), but it is not known if endothelial dysfunction also occurs. We prospectively measured circulating biomarkers of endothelial dysfunction in pregnant women with preterm or term delivery.


METHODS
We conducted a case-control study nested within a large prospective epidemiological study of young, generally healthy pregnant women. Women who delivered preterm (<37 completed weeks gestation, n = 240) and controls who delivered at term (n = 439) were included. Pregnancies complicated by preeclampsia were analyzed separately. Circulating endothelial dysfunction biomarkers included soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1) and soluble E-selectin (sE-selectin).


RESULTS
Elevated levels of sICAM-1 and sVCAM-1 were positively associated with preterm delivery independent of usual risk factors. At entry (∼16 wks), the adjusted odds ratio (AOR) was 1.73 (95% confidence interval (CI) 1.09-2.74) for the highest quartile of sICAM-1 versus the lowest quartile and for sVCAM-1 the AOR was 2.17 (95% CI 1.36-3.46). When analysis was limited to cases with a spontaneous preterm delivery, the results were unchanged. Similar results were obtained for the 3rd trimester (∼30 wks). Elevated sE-selectin was increased only in preterm delivery complicated by preeclampsia; risk was increased at entry (AOR 2.32, 95% CI 1.22-4.40) and in the 3rd trimester (AOR 3.37, 95% CI 1.78-6.39).


CONCLUSIONS
Impaired endothelial function as indicated by increased levels of soluble molecules commonly secreted by endothelial cells is a pathogenic precursor to CVD that is also present in women with preterm delivery. Our findings underscore the need for follow-up studies to determine if improving endothelial function prevents later CVD risk in women.
Department of Obstetrics and Gynecology, Rowan University - School of Osteopathic Medicine, Stratford, New Jersey, United States of America.
Xinhua
X
Chen
Department of Obstetrics and Gynecology, Rowan University - School of Osteopathic Medicine, Stratford, New Jersey, United States of America.
Theresa O
TO
Scholl
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology; D016022:Case-Control Studies; D019040:E-Selectin / Q000097:blood*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D016015:Logistic Models; D011225:Pre-Eclampsia / Q000097:blood / Q000503:physiopathology; D011247:Pregnancy; D011263:Pregnancy Trimester, Third / Q000097:blood; D047928:Premature Birth / Q000097:blood / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood*; D055815:Young Adult
D015415:Biomarkers; D019040:E-Selectin; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1