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The maternal predisposition to the syndrome of pre-eclampsia Alasaly, Kadria A.

Abstract

Pre-eclampsia, which is characterized by maternal hypertension, proteinuria, hypoperfusion of end organs and a systemic maternal innate inflammatory response, is a leading cause of maternal mortality and morbidity world-wide. When of early-onset, pre-eclampsia is associated with fetal intrauterine growth restriction (IUGR). IUGR can occur in isolation, so-called normotensive IUGR. What is poorly understood is that some women develop the maternal syndrome of pre-eclampsia whilst others have only the fetal syndrome (normotensive IUGR), despite the fact that the initiating event in both is believed to be reduced uteroplacental perfusion. In this thesis I have asked two questions: First, could the maternal innate inflammatory response of pre-eclampsia predict an increased lifetime risk for developing the systemic inflammatory response syndrome (SIRS), as it is with later atherosclerosis (another disease of inflammation)? My hypothesis was the maternal syndrome of pre-eclampsia is a form of the systemic inflammatory response syndrome. Second, could it be that the maternal syndrome of pre-eclampsia is triggered by a reactivation of chronic infections common in the community, mainly infection with Chlamydophila pneumoniae (Chl pneumoniae) or cytomegalovirus (CMV) infections? This is especially pertinent as these infectious agents have been implicated in the development of atherosclerosis. We wanted to determine whether or not the dichotomous response of pre-eclampsia and normotensive IUGR could be explained by reactivation of chronic infection with Chl pneumoniae or CMV during preeclampsia, but not normotensive IUGR. My hypothesis was, could reactivated infectious trigger explain the differential maternal response to the shared placental pathology of pre-eclampsia and normotensive growth restriction? This would provide a link between pre-eclampsia and its attendant lifelong risk of atherosclerosis. Study designs SIRS. Cases were selected from women admitted to the intensive care unit (ICU) of St. Paul's Hospital with the diagnosis of SIRS. Controls were women without SIRS, admitted to general medical/surgical wards with the same primary diagnosis and same underlying problem (eg: pneumonia, bowel resection) but unremarkable in-hospital course (NO SIRS). The controls were matched for both age (±5 years) and ethnicity. Chl pneumoniae and CMV. Seroprevalence and levels of anti-CMV and Chl pneumoniae IgG were compared in a nested case-control study. We compared between women with early-onset preeclampsia (

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