Is infection a major risk factor for preeclampsia?

Recently in an open population-based program composed of 15 354 pregnant wo men in Colombia we applied a biopsychosocial risk model, which permitted us to identify pregnant women at high risk of preeclampsia. 1443 (9.4%) of pa tients at high risk for developing preeclampsia received 450 mg of linoleic acid, and 1.5 g/day of calcium. Bacteriuria was identified in 1766 (11.5%) and vaginal infections in 2150 (14.0%) of the pregnant women. These women received oral antibiotics for 10 days. The incidence of low birthweight, pr eterm delivery and preeclampsia were reduced by 53% (6.2% vs 13.2%), 64.7% (1.8% vs 5.1%), and 52.5% (3.8% vs 8.0%) respectively, when compared with t he incidence of the preceeding five years. We believe that these dramatic r eductions were due to early identification of risk factors, administration of nutritional supplements and principally by treatment of asymptomatic inf ections. Unfortunately, because of the study design it is not possible to c onfirm that infection was the major risk factor for preeclampsia in our pop ulation. However, we hypothesize that chronic subclinical infections may ca use increased maternal cytokine levels sufficient to affect vascular endoth elial function, and so prime individuals for the subsequent development of preeclampsia. This hypothesis can be tested in a more appropriately designe d clinical trial to assess whether there is a relationship between infectio n, inflammation and preeclampsia. (C) 2001 Harcourt Publishers Ltd.