Increased plasma hyaluronan in severe pre-eclampsia and eclampsia

Pre-eclampsia is a serious multi-system disorder with general endothelial disease, often with a component of hepatic dysfunction. The pathogenesis of preeclampsia is not fully understood, and no specific diagnostic tests are available for early and reliable diagnosis, or for monitoring of the disease process. Hyaluronan is an extracellular matrix polysaccharide present at low concentrations in plasma. Normally, it is rapidly eliminated from the blood by the liver. Increased concentrations of circulating hyaluronan are seen in conditions with impaired hepatic function such as liver cirrhosis, and hyaluronan concentrations have previously been used to evaluate hepatic function in other diseases. In the present study, 11 pregnant women admitted to the intensive care unit with severe pre-eclampsia or eclampsia were studied. As control 31 healthy pregnant women, 18 undergoing vaginal delivery and 13 caesarean section, were included. Plasma hyaluronan was measured before and after delivery. Increased concentrations of plasma hyaluronan were found in the pre-eclampsia group both before (171 (75-586) microg/L (p<0.01)) and after delivery (215 (124-768) microg/L (p<0.001)) (median and inter-quartile range), as compared to both caesarean section (13 (7-28) microg/L before and 28 (18-48) microg/L after delivery) and vaginal delivery healthy controls (12 (8-24) microg/L before and 30 (13 63) microg/L after delivery). In the control groups, a small increase in plasma hyaluronan was seen after delivery, after both caesarean section (p<0.05) and vaginal delivery (p<0.01). In conclusion, plasma hyaluronan is increased in severe pre-eclampsia and eclampsia. The cause of the increase is unknown.