High sensitivity C-reactive protein in pre-eclamptic women living with HIV at a tertiary hospital in Zambia: a preliminary study

Abstract

Introduction: pre-eclampsia affects an estimated 8% of pregnant women and contributes to over 12% of global maternal deaths. High-sensitivity C-reactive protein (hs-CRP) is a potential marker of pre-eclampsia. However, little is known about hs-CRP levels in women with pre-eclampsia in Zambia. This study examined whether hs-CRP levels differ between women who develop pre-eclampsia compared with controls overall and in subgroups of women living with and without HIV. Methods: a case-control study was conducted among 40 pregnant women who developed preeclampsia (cases) and 40 normotensive pregnant women (controls) living with (n=20) and without HIV (n=20) at women and newborn hospital from February to May 2022. Standard ELISA kits were used to determine hs-CRP levels. The conditional logistic regression model calculated the odds ratios for hs-CRP and other predictor variables with their 95% confidence intervals. Results: the median hs-CRP levels were higher among the cases than controls (7.84mg/ml vs 6.13mg/ml, p<0.001). Similar hs-CRP levels were observed among pre-eclamptic women living with HIV on antiretroviral therapy (ART) compared to HIV-negative women (7.92mg/ml vs 7.17mg/ml, p=0.862). On the other hand, normotensive women living with HIV on ART had different hs-CRP levels than HIV-negative women (6.60mg/ml vs 3.96mg/ml, p<0.001). Multivariable conditional logistic regression showed that pregnant women with higher levels of hs-CRP (AOR=1.01, 95% CI=1.01, 1.01) were more likely to have pre-eclampsia after adjusting for significant predictors. Pre-eclampsia was less likely among women living with HIV on ART (AOR=0.26, 95% CI=0.07, 0.99), married (AOR=0.15, 95% CI=0.03, 0.71), and multiparous (AOR=0.16, 95% CI=0.03, 0.80). Conclusion: high-sensitivity C-reactive protein levels were higher among the cases than controls. However, similar levels were observed in the subgroup of women living with HIV on ART. Participants with high hs-CRP levels had the highest odds of preeclampsia, suggesting that hs-CRP may be useful in predicting preeclampsia.