Perinatal immune changes to identify patients at risk of postpartum preeclampsia

Abstract

Background: Postpartum preeclampsia (PPPE) is a maternal condition characterized by de novo hypertension in the postpartum period with end-organ damage. We investigated the use of perinatal immune changes, through routine complete blood count (CBC), to identify high-risk individuals before PPPE development.

Methods: We performed a retrospective matched case-control study of 100 individuals with PPPE, 200 term pregnancies (Ctrl) and 200 antenatal preeclampsia (PE). Detailed demographic, obstetrical and laboratory data were retrieved from medical records. Statistical analysis was performed using one-way ANOVA, multivariate regression, and paired or unpaired t-tests, as appropriate.

Results: Individuals that developed PPPE were significantly older and predominantly Black vs Ctrl and PE. Both PE and PPPE had higher pre-pregnancy BMI and increased personal and family history of hypertension/PE vs Ctrl (p<0.001). Before delivery, individuals that later developed PPPE, had lower total leukocyte counts vs Ctrl (9.61 vs 10.75x109/L, p<0.05) whereas monocytes percentage were elevated (8.07 vs 7.27%, p<0.01). Comparing the postpartum/antenatal ratio in-between each condition revealed elevated leukocyte ratio in PPPE vs Ctrl (p<0.001). Neutrophils ratio was also increased whereas lymphocytes and monocytes were decreased in PPPE vs both Ctrl and PE. After adjusting for race, maternal age, pre-pregnancy BMI, personal history of PE/HT, and diabetes mellitus, perinatal immune changes were still significantly associated with PPPE.

Conclusions: Globally, perinatal immune changes were observed in individuals with a seemingly uncomplicated pregnancy prior to development of PPPE. This strongly supports that such changes could be used to identify high-risk individuals prior to disease onset.

Keywords: Postpartum preeclampsia; complete blood count; de novo hypertension; leukocytes; perinatal immune changes; women’s health.