Abstract
BackgroundBlack women in the United States and Africa are at an increased risk for preeclampsia. Allelic variants in the gene for apolipoprotein LI, APOL1, are found only in populations of African ancestry, and have been shown to contribute significant risk for kidney disease. Recent studies suggest these APOL1 variants also may contribute risk for preeclampsia.MethodsThe association of preeclampsia with carriage of APOL1 risk alleles was evaluated in a case-control study of deliveries from black women at a single center in Cleveland, Ohio that included gross and histopathologic evaluations of placental tissues (395 cases and 282 controls). Using logistic regression models, associations between fetal APOL1 genotype and preeclampsia were evaluated using several case definitions based on prematurity and severity of preeclampsia, with uncomplicated term pregnancies as controls. Associations between APOL1 genotype and pathological features were also examined.ResultsThe infant APOL1 genotype was significantly associated with preeclampsia in a dominant inheritance pattern with odds ratio of 1.41 (P=0.029, 95% CI 1.037, 1.926). Stratifying preeclampsia cases by preterm birth, significant associations were detected for both recessive (O.R.=1.70, P=0.038) and additive (O.R.=1.33, P=0.028) inheritance patterns. APOL1 genotype, however, was not significantly associated with pathological changes or other perinatal observations.ConclusionsPreeclampsia appears to be another disease associated with APOL1 variants, however, further studies are needed to increase confidence in the mode of inheritance. By understanding the association of APOL1 variants with preeclampsia, genetic screening tests for APOL1 may be useful to predict at-risk pregnancies and targeted interventions may be developed to improve pregnancy outcomes.
Highlights
Black women in the United States and Africa are at an increased risk for preeclampsia
PE prevalence ranges from 3-8% in developed countries and as high as 26% in sub-Saharan African countries, and African American women are three times more likely to die from PE compared to European Americans
To further establish association of PE with Apolipoprotein 1 (APOL1) risk alleles in the infant, and to assess correlates with placental pathology, we examined an archival collection of placental tissues from black women in the Cleveland area
Summary
Black women in the United States and Africa are at an increased risk for preeclampsia. Allelic variants in the gene for apolipoprotein LI, APOL1, are found only in populations of African ancestry, and have been shown to contribute significant risk for kidney disease. Recent studies suggest these APOL1 variants may contribute risk for preeclampsia. Preeclampsia (PE) is a common complication of pregnancy and occurs more frequently in women of African ancestry (reviewed in [1, 2]). The American College of Obstetricians and Gynecologists [3] defines PE as new onset hypertension of ≥140mmHg systolic or ≥90mmHg diastolic along with proteinuria or other end organ dysfunction. Like PE, chronic kidney disease (CKD) is more prevalent in African Americans, and the recent description PE is a heterogeneous disorder, with differences in clinical presentation and outcomes for early onset PE (placental type) in which symptoms occur before 34 weeks gestation, and late onset PE (maternal type) in which symptoms occur ≥34 weeks gestation (reviewed in [4]).
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