Pregnancy-Induced Hypertension: The Potential Role of Cholesterol Crystals in the Maternal Decidua

Abstract

Lead Author's Financial Disclosures Quest Diagnostics. Study Funding None. Background/Synopsis Pregnancy-induced hypertension/preeclampsia are highly concerning complications of pregnancy, known risk factors for cardiovascular disease including endothelial dysfunction, proteinuria, elevated blood pressure, and presence of atherogenic very small LDL cholesterol particles. Cholesterol crystals (CCs) can form at sites of elevated cholesterol deposition including at the maternal uterine decidua in preparation for embryo implantation. However, CCs can injure the endothelial surfaces of arteries leading to vasospasm - with subsequent placental ischemia - important in the development of hypertension/preeclampsia. Objective/Purpose: Since dyslipidemia is associated with pregnancy complications we sought to determine if CCs are present in the post-delivery decidual tissue attached to the placenta in patients who developed a hypertensive disorder during their pregnancy in the Child Health Advances through Research with Mothers (CHARM) study. Methods Maternal decidua was dissected from placental tissues from both normal (n=5) and late gestational age hypertensive disorder in pregnancy cases (n=5). Cases were of similar gestational age, birth weight, and race. Tissues were prepared by avoiding ethanol to preserve CCs and then examined by scanning electron microscopy (SEM). Two sample runs were performed by SEM and tissues were scored in a blinded manner for presence or absence of CCs. Results Presence of CCs was detected in decidual placental specimens in 4/5 pregnancy- induced hypertensive disorder cases and 2/5 from normal gestational age-matched pregnancies. By SEM both needle and rhomboid forms (representing the anhydrous and monohydrate version of CCs) were found (Figure). Conclusions The presence of CCs in the maternal decidua is a critical finding. CCs are known to trigger an inflammatory response and cause arterial vasospasm. Although preliminary, this is an important finding that could be mechanistically critical in the development of hypertensive disorders of pregnancy. Quest Diagnostics.