Chronic Chlamydia pneumonia Infection and Risk of Early-Onset Versus Late-Onset Preeclampsia

Document Type : Original Articles


Al Iraqia University, College of Medicine, Baghdad, Iraq


Preeclampsia is one of the challenges associated with mother and baby health. Preeclampsia and atherosclerosis share certain similarities. Atherosclerosis has been previously linked to chronic Chlamydia pneumoniae infection. This investigation aimed to establish the role of chronic Chlamydia pneumoniae in the development and onset of preeclampsia. The research was conducted from October 1, 2018 to September 30, 2019 in the department of Obstetrics and Gynecology at Al-Yarmouk Teaching Hospital in Baghdad, Iraq. The study included 140 pregnant women divided into two groups: 70 women with early and late-onset preeclampsia and 70 women with late-onset preeclampsia. Group I (early-onset preeclampsia) included 35 singleton pregnant women who developed preeclampsia after 34 weeks with blood pressure>140/90 and proteinuria>1. Late-onset preeclampsia (group II) consisted of 35 singleton pregnant women who developed clinical preeclampsia after 34 weeks of pregnancy, with blood pressure>140/90 and proteinuria +1, and 70 healthy term pregnant women without complications who acted as the control group (Group III). Enzyme-Linked Immunosorbent Assay (ELISA) analyzers were utilized to measure serum Chlamydia pneumoniae IgG levels in all study groups. Women with early-onset preeclampsia had the highest median Chlamydia pneumonia IgG level, 0.3 U/ml, compared to 0.09 U/ml for women with late-onset preeclampsia and 0.19U/ml for healthy term pregnant women without complications; these differences were statistically significant (P=0.001). This study found that the IgG titer for Chlamydia pneumoniae was higher in early-onset preeclampsia than in late-onset preeclampsia and in healthy term pregnancy without complications. This substantial increase was a direct result of the onset of preeclampsia. This provided evidence for the pathophysiological connection between preeclampsia and the reactivation of a chronic or latent infection.


Main Subjects

  1. Bellizzi S, Ali M, Abalos E, Betran AP, Kapila J, Pileggi-Castro C, et al. Are hypertensive disorders in pregnancy associated with congenital malformations in offspring? Evidence from the WHO Multicountry cross sectional survey on maternal and newborn health. BMC Pregnancy Childbirth. 2016;16(1):1-10.
  2. Pauli JM, Repke JT. Pitfalls With the New American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy. Clin Obstet Gynecol. 2017;60(1):141-52.
  3. Jin W-Y, Lin S-L, Hou R-L, Chen X-Y, Han T, Jin Y, et al. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China. BMC Pregnancy Childbirth. 2016;16(1):1-9.
  4. Barakat R, Pelaez M, Cordero Y, Perales M, Lopez C, Coteron J, et al. Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial. Am J Obstet Gynecol. 2016;214(5):649. 1-8.
  5. Nourollahpour Shiadeh M, Behboodi Moghadam Z, Adam I, Saber V, Bagheri M, Rostami A. Human infectious diseases and risk of preeclampsia: an updated review of the literature. Infection. 2017;45(5):589-600.
  6. Bartsch E, Medcalf KE, Park AL, Ray JG. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016;353.
  7. Cardoso EM, Reis C, Manzanares-Céspedes MC. Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases. Postgrad Med. 2018;130(1):98-104.
  8. Mercer A. Updating the epidemiological transition model. Epidemiol Infect. 2018;146(6):680-7.
  9. Porritt RA, Crother TR. Chlamydia pneumoniae infection and inflammatory diseases. Onco Therapeutics. 2016;7(3-4).
  10. Amarasekara R, Jayasekara RW, Senanayake H, Dissanayake VH. Microbiome of the placenta in pre‐eclampsia supports the role of bacteria in the multifactorial cause of pre‐eclampsia. J Obstet Gynaecol Res. 2015;41(5):662-9.
  11. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373(5):415-27.
  12. Obstetricians ACo, Gynecologists. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ task force on hypertension in pregnancy. Obstet Gynecol. 2013;122(5):1122-31.
  13. Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, et al. Predictive value of the sFlt-1: PlGF ratio in women with suspected preeclampsia. N Engl J Med. 2016;374:13-22.
  14. Gathiram P-e, Moodley J. Pre-eclampsia: its pathogenesis and pathophysiolgy: review articles. Cardiovasc J Afr. 2016;27(2):71-8.
  15. Phipps E, Prasanna D, Brima W, Jim B. Preeclampsia: updates in pathogenesis, definitions, and guidelines. Clin J Am Soc Nephrol. 2016;11(6):1102-13.
  16. Mol BW, Roberts CT, Thangaratinam S, Magee LA, De Groot CJ, Hofmeyr GJ. Pre-eclampsia. Lancet. 2016;387(10022):999-1011.
  1. Jim B, Karumanchi SA, editors. Preeclampsia: pathogenesis, prevention, and long-term complications. Seminars in nephrology; 2017: Elsevier.
  2. Than NG, Romero R, Tarca AL, Kekesi KA, Xu Y, Xu Z, et al. Integrated systems biology approach identifies novel maternal and placental pathways of preeclampsia. Front Immunol. 2018;9:1661.
  3. von Dadelszen P, Magee LA, Krajden M, Alasaly K, Popovska V, Devarakonda RM, et al. Levels of antibodies against cytomegalovirus and Chlamydophila pneumoniae are increased in early onset pre-eclampsia. Int J Obstet. Gynaecol. 2003;110(8):725-30.
  4. Mokhtari M, Yaghmaei M, Karimi M, Roodbari M, Koohpaye HR. Comparing serum IgG titers against Chlamydia pneumoniae in patients with early and late-onset pre-eclampsia and healthy individuals. J Reprod Infertil. 2007;7(4).
  5. Zbinden A, van den Brandt S, Østensen M, Villiger PM, Förger F. Risk for adverse pregnancy outcome in axial spondyloarthritis and rheumatoid arthritis: disease activity matters. Rheumatology. 2018;57(7):1235-42.