Gut Dysbiosis Promotes Preeclampsia by Regulating Macrophages and Trophoblasts

Circ Res. 2022 Sep 2;131(6):492-506. doi: 10.1161/CIRCRESAHA.122.320771. Epub 2022 Aug 11.


Background: Preeclampsia is one of the leading causes of maternal and perinatal morbidity and is characterized by hypertension, inflammation, and placental dysfunction. Gut microbiota plays key roles in inflammation and hypertension. However, its roles and mechanisms in preeclampsia have not been fully elucidated.

Methods: 16S rRNA gene sequencing and targeted metabolomics were conducted on stool samples from 92 preeclamptic patients and 86 normal late-pregnant women. Then, fecal microbiota transplantation and in vitro and in vivo functional experiments were performed to explore the roles and mechanisms of gut microbiota in preeclampsia development.

Results: We revealed the gut microbiota dysbiosis in preeclamptic patients, including significant reductions in short-chain fatty acid-producing bacteria and short-chain fatty acids. The gut microbiota of preeclamptic patients significantly exacerbated pathologies and symptoms of preeclamptic rats, whereas the gut microbiota of healthy pregnant women had significant protective effects. Akkermansia muciniphila, propionate, or butyrate significantly alleviated the symptoms of preeclamptic rats. Mechanistically, they significantly promoted autophagy and M2 polarization of macrophages in placental bed, thereby suppressing inflammation. Propionate also significantly promoted trophoblast invasion, thereby improved spiral arterial remodeling. Additionally, we identified a marker set consisting of Akkermansia, Oscillibacter, and short-chain fatty acids that could accurately diagnose preeclampsia.

Conclusions: Our study revealed that gut microbiota dysbiosis is an important etiology of preeclampsia. Gut microbiota and their active metabolites have great potential for the treatment and diagnosis of preeclampsia. Our findings enrich the gut-placenta axis theory and contribute to the development of microecological products for preeclampsia.

Keywords: dysbiosis; gut microbiota; hypertension; placenta; preeclampsia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Dysbiosis / microbiology
  • Fatty Acids, Volatile / metabolism
  • Female
  • Humans
  • Hypertension*
  • Inflammation / complications
  • Macrophages / metabolism
  • Placenta / metabolism
  • Pre-Eclampsia*
  • Pregnancy
  • Propionates
  • RNA, Ribosomal, 16S / genetics
  • Rats
  • Trophoblasts / metabolism


  • Fatty Acids, Volatile
  • Propionates
  • RNA, Ribosomal, 16S