This study was designed to test the hypothesis that altered angiogenic factors together with increased oxidative stress and reduced docosahexaenoic acid (DHA) levels may be associated with altered birth outcome parameters. To test this hypothesis, levels of plasma vascular endothelial growth factor (VEGF), placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), the oxidative stress marker malondialdehyde (MDA) and fatty acids were estimated in women with preeclampsia and their cord samples and compared with those in normotensive women. The association of these parameters with birth outcome was also examined. Our results show that in preeclamptic women, maternal plasma VEGF and PlGF levels were lower, whereas sFlt-1 levels were higher (Po0.05 for all) than in normotensive women. In contrast, cord plasma VEGF levels were higher (Po0.05) in preeclamptic women, whereas there was no difference in sFlt-1 levels. Plasma DHA levels in both the mother and cord were lower (Po0.05) in the preeclamptic group compared with normotensive women. Maternal plasma sFlt-1 levels were positively (n¼23, r¼0.415, P¼0.039) associated with MDA concentrations in preeclamptic women. Maternal plasma sFlt-1 levels showed a strong negative association with baby weight (n¼37, r¼À0.547, P¼0.001), head circumference (n¼37, r¼À0.472, P¼0.005) and baby chest circumference (n¼37, r¼À0.375, P¼0.032) in the preeclamptic group. Cord plasma sFlt-1 concentrations were negatively associated with cord plasma DHA concentrations (n¼28, r¼À0.552, P¼0.004). This study suggests that dysregulation of angiogenic factors may be associated with maternal oxidative stress. Increased oxidative stress may reduce cord DHA levels and increase sFlt-1 levels, leading to poor birth outcomes in preeclampsia.

Reduced antioxidants and increased oxidative stress leading to impaired essential polyunsaturated fatty acid levels may be a key factor in the development of pre-eclampsia.

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The present study compares nerve growth factor (NGF) levels between preeclamptic (PE) (n=86) and normotensive (NT) women (n=105) and their associations with blood pressure and infant size. Maternal plasma NGF levels were reduced (p<0.05) in the PE group as compared to the NT group. Furthermore, NGF levels were reduced in PE mothers delivering low birth weight babies (LBW) as compared to NT mothers delivering LBW babies. Maternal NGF levels were negatively (p=0.029) associated with blood pressure in preeclamptic mothers. Cord NGF levels were negatively associated (p=0.026) with birth weight in the normotensive group. NGF levels are differently regulated in preeclamptic and normotensive mothers delivering LBW babies. Future studies need to investigate mechanisms underlying this pathophysiology and follow-up of these babies to better understand the role of NGF in brain development in later life.

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