CIRCULATING VASCULAR CELL-ADHESION MOLECULE-1 IN PREECLAMPSIA, GESTATIONAL HYPERTENSION, AND NORMAL-PREGNANCY - EVIDENCE OF SELECTIVE DYSREGULATION OF VASCULAR CELL-ADHESION MOLECULE-1 HOMEOSTASIS IN PREECLAMPSIA

OBJECTIVE: Our purpose was to investigate circulating levels of vascul ar cell adhesion molecule-1 in the peripheral and uteroplacental circu lations during normotensive and hypertensive pregnancies. STUDY DESIGN : This prospective observational study involved 2 patient groups. Grou p 1 consisted of 22 women with pre-eclampsia and 30 normotensive women followed up longitudinally through pregnancy and post partum. There w ere an additional 13 women with established gestational hypertension. Group 2 consisted of 20 women with established pre-eclampsia and 19 no rmotensive control subjects undergoing cesarean delivery. Plasma level s of vascular cell adhesion molecule-1 were measured in blood drawn fr om the antecubital vein (group 1) and from both the antecubital and ut erine veins (group 2). Data were analyzed by analysis of variance. RES ULTS: In group 1 vascular cell adhesion molecule-1 levels did not chan ge significantly throughout normal pregnancy and post parium. Women wi th established pre-eclampsia had increased vascular cell adhesion mole cule-1 levels compared with the normotensive pregnancy group (P =.01). Vascular cell adhesion molecule-1 levels were not elevated in women w ith established gestational hypertension. In group 2 significantly hig her levels of vascular cell adhesion molecule-1 were detected in the u teroplacental (P<.0001) and peripheral (P<.0001) circulations of pre-e clamptic women by comparison with normotensive women. In the pre-eclam ptic group there was a tendency toward higher vascular cell adhesion m olecule-1 levels in the peripheral circulation than in the uteroplacen tal circulation (P=.06). in contrast to vascular cell adhesion molecul e-1, circulating levels of E-selectin and intercellular adhesion molec ule-1, other major leukocyte adhesion molecules expressed by the endot helium, were not different in pre-eclamptic and normotensive pregnanci es. CONCLUSION: Established pre-eclampsia is characterized by selectiv e dysregulation of vascular cell adhesion molecule-1 homeostasis. This event is not an early preclinical feature of pre-eclampsia, does not persist post partum, is not a feature of nonproteinuric gestational hy pertension, and is not observed with other major leukocyte adhesion mo lecules. Induction of vascular cell adhesion molecule-1 expression in pre-eclampsia may contribute to leukocyte-mediated tissue injury in th is condition or may reflect perturbation of other, previously unrecogn ized, functions of this molecule in pregnancy.