Biochemical and clinical factors which are associated with or predictive of pre-eclampsia in healthy women and those with chronic kidney disease

Sarween, Nadia ORCID: 0000-0001-8707-8908 (2020). Biochemical and clinical factors which are associated with or predictive of pre-eclampsia in healthy women and those with chronic kidney disease. University of Birmingham. Ph.D.

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Abstract

Pre-eclampsia (PE) complicates around 5% of all pregnancies and over 20% of pregnancies in women with chronic kidney disease (CKD). The cause of PE is unknown, but dysregulation of the maternal immune system and an imbalance in angiogenic factors, characterised by a high ratio of soluble fms-like tyrosine kinase-1 (sFLT-1) to placental growth factor (PIGF), are implicated as important aetiological factors. There are limited data published on disturbances in humoral-mediated immunity in PE and it is not well established how important immunological factors are in the development of superimposed PE in CKD. The work of this thesis comprises of three studies and I report:
• An increase in polyclonal free immunoglobulin light chains and a reduction in IgG whole immunoglobulin, specifically IgG1 and IgG3, concentrations at the time of PE in previously healthy women compared to uncomplicated pregnancies at term. Beta-2-microgobulin levels had comparable diagnostic association for PE with sFLT-1/PIGF.
• Healthy pregnant women who subsequently develop PE had lower levels of circulating IgM compared to matched healthy pregnant women who had uncomplicated pregnancies. Higher IgG levels were independently predictive of adverse pregnancy outcomes in the PE but not in the non-PE group.
• In CKD pregnancies, immune system and angiogenic markers were not associated with, or strongly predictive of, superimposed PE. This is in contrast to findings in the healthy pregnant cohort and suggests that the pathophysiological mechanisms involved in the development of PE differ between the two groups.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):