Levels of antibodies against cytomegalovirus and Chlamydophila pneumoniae are increased in early onset pre‐eclampsia

Objective The origins of pre‐eclampsia/eclampsia lie in a mismatch between feto‐placental demands and utero‐placental supply, a situation that also arises in normotensive intrauterine growth restriction (IUGR). Could reactivated chronic infection be both a trigger for these differential maternal responses to the same underlying pathology and a link between pre‐eclampsia and its attendant lifelong risks of atherosclerosis? Design Nested case–control study. Setting Tertiary obstetric centre. Population Cases of pre‐eclampsia, normotensive IUGR and controls. Methods A nested case–control study of serum from a population‐based bank was performed. Seroprevalence and levels of anti‐cytomegalovirus (CMV) and Chlamydophila pneumoniae immunoglobulin G (IgG) were compared (non‐parametrically) between women with early onset pre‐eclampsia (<34 weeks of gestation, n = 9 ), late onset pre‐eclampsia (≥34 + 0 weeks of gestation, n = 29 ), normotensive IUGR (birthweight less than third centile, n = 33 ) and matched normal pregnancy ( n = 113 , up to 2 per case). Results There was a significant difference in both anti‐CMV and Chl. pneumoniae antibodies between groups (Kruskal–Wallis test, P < 0.05 ). Women with early onset pre‐eclampsia had higher anti‐CMV levels (median: 79, 95% confidence interval [95% CI] = 47, 164) than women with late onset pre‐eclampsia (26 [95% CI = 22, 82], P < 0.05 ), normotensive IUGR (40 [95% CI = 31, 72], P < 0.05 ) and normal pregnancy (49 [95% CI = 45, 70], P < 0.05 ). Women with normotensive IUGR had significantly lower anti‐ Chl. pneumoniae antibodies (0.10 [95% CI = 0.08, 0.38]) than did normal pregnancy controls (0.21 [95% CI = 0.20, 0.28], P < 0.05 ). Conclusions The anti‐CMV and anti‐ Chl. pneumoniae antibodies were higher in early onset pre‐eclampsia than in late onset pre‐eclampsia, normotensive IUGR and normal pregnancy. This may provide a pathophysiological link between pre‐eclampsia and the known increased risk for subsequent atherosclerosis.