Objective To determine whether the cellular inflammatory marker of activated macrophages and monocytes, neopterin (NEO) and the acute phase inflammatory markers sialic acid (SA) and C-reactive protein (CRP) are elevated in pregnancy and further elevated in the pregnancy syndrome preeclampsia. Methods Maternal plasma concentrations of NEO, SA and CRP were measured by high sensitivity ELISA or HPLC in 20 non-pregnant women, 40 women with uncomplicated pregnancies, 50 women with transient hypertension of pregnancy alone, 49 women with small for gestational age (SGA) infants without preeclampsia, and 47 women with preeclampsia. Results The mean concentration of plasma NEO, SA and CRP were all significantly elevated in all groups of pregnant women compared to non-pregnant women (p<0.001 for all). In addition, maternal plasma NEO concentrations were further elevated in women with preeclampsia compared to the other groups of pregnant women (p<0.01). As expected, the acute phase inflammatory markers CRP and SA correlated positively with each other. However, CRP was also correlated with the activated macrophage and monocyte marker NEO in women with transient hypertension of pregnancy and women with preeclampsia (p<0.05). Conclusion The inflammatory markers NEO, SA and CRP are all elevated during pregnancy. However, only NEO, a marker of macrophage and monocyte activation, was further elevated in women with preeclampsia. These data suggest that there is a striking increase in inflammation during pregnancy, and cellular immune activation is further elevated during preeclampsia.

Adaptation to pregnancy in humans involves major anatomic, physiologic and metabolic changes in the mother in order to support and provide for the nutritional and metabolic needs of the growing conceptus. Metabolically, pregnancy is marked by several important and dynamic adjustments including increased insulin resistance, hyperlipidemia and changes in protein and amino acid metabolism. In general, these metabolic adaptations serve to increase nutrient availability for the benefit of the growing fetal-placental unit. Interestingly, the pregnancy complication preeclampsia is recognized to evidence biologic exaggerations of these normal metabolic adaptations of pregnancy. Specifically, preeclampsia is associated with increased insulin resistance, hypertriglyceridemia, high circulating free fatty acids, low high-density lipoprotein particles, and high maternal and fetal plasma amino acid concentrations. These metabolic alterations may contribute to the pathophysiology of the syndrome and may also influence fetal growth. The focus of this review will be to summarize the normal metabolic adaptations, transport and utilization of carbohydrates, lipids and amino acids that occur during pregnancy. Furthermore, we will review the differences in carbohydrate, lipid and amino acid metabolism in pregnancies complicated by preeclampsia in comparison to uncomplicated pregnancies.