Oxidative stress in healthy pregnancy and preeclampsia is linked to chronic inflammation, iron status and vascular function

PLoS One. 2018 Sep 11;13(9):e0202919. doi: 10.1371/journal.pone.0202919. eCollection 2018.


Background: During normal pregnancy, placental oxidative stress (OS) is present during all three trimesters and is necessary to obtain normal cell function. However, if OS reaches a certain level, pregnancy complications might arise. In preeclampsia (PE), a dangerous pregnancy specific hypertensive disorder, OS induced in the ischemic placenta causes a systemic inflammatory response and activates maternal endothelial cells. In this study, we aimed to quantify superoxide concentrations (as a measure of systemic OS) using electron paramagnetic resonance (EPR) and correlate them to markers of systemic inflammation, iron status and vascular function.

Methods: Fifty-nine women with a healthy pregnancy (HP), 10 non-pregnant controls (NP) and 28 PE patients (32±3.3weeks) were included. During HP, blood samples for superoxide, neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV) and iron status were taken at 10, 25 and 39 weeks. Vascular measurements for arterial stiffness (carotid-femoral pulse wave velocity (CF-PWV), augmentation index (AIx), augmentation Pressure (AP)) and microvascular endothelial function (reactive hyperemia index (RHI)) were performed at 35 weeks. In PE, all measurements were performed at diagnosis. CMH (1-hydroxy-3-methoxycarbonyl-2,2,5,5-tetramethylpyrrolidine) was used as spin probe for EPR, since the formed CM radical corresponds to the amount of superoxide.

Results: Superoxide concentration remains stable during pregnancy (p = 0.92), but is significantly higher compared to the NP controls (p<0.0001). At 25 weeks, there is a significant positive correlation between superoxide and ferritin concentration. (p = 0.04) In PE, superoxide, systemic inflammation and iron status are much higher compared to HP (all p<0.001). During HP, superoxide concentrations correlate significantly with arterial stiffness (all p<0.04), while in PE superoxide is significantly correlated to microvascular endothelial function (p = 0.03).

Conclusions: During HP there is an increased but stable oxidative environment, which is correlated to ferritin concentration. If superoxide levels increase, there is an augmentation in arterial stiffness. In PE pregnancies, systemic inflammation and superoxide concentrations are higher and result in a deterioration of endothelial function. Together, these findings support the hypothesis that vascular function is directly linked to the amount of OS and that measurement of OS in combination with vascular function tests might be used in the prediction of PE.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / blood
  • Endothelial Cells / physiology
  • Female
  • Ferritins / blood
  • Humans
  • Inflammation / physiopathology*
  • Iron / blood*
  • Microvessels / physiopathology
  • Oxidative Stress* / physiology
  • Pre-Eclampsia / physiopathology*
  • Pregnancy
  • Superoxides / blood
  • Vascular Stiffness* / physiology


  • Biomarkers
  • Superoxides
  • Ferritins
  • Iron

Grant support

This study is part of a PhD-thesis which is supported by the University of Antwerp and the Department Obstetrics and Gynaecology of the Antwerp University Hospital. The University of Antwerp provides the earnings for the principal investigator (DM) who is responsible for the design of the study, data collection and interpretation and writing of the manuscript. The Antwerp University Hospital supports the financial part of data collection. EMVC is supported by the fund for scientific research-Flanders (FWO) as senior clinical investigator.