From the Department of Obstetrics and Gynecology, University of Colorado, School of Medicine, Aurora, Colorado.
Obstet Gynecol. 2011 Jan;117(1):75-83. doi: 10.1097/AOG.0b013e3181fc3afa.
To estimate whether elevations of complement C3a early in pregnancy are predictive of the subsequent development of adverse pregnancy outcomes.
A plasma sample was obtained from each enrolled pregnant woman before 20 weeks of gestation. The cohort (n=1,002) was evaluated for the development of adverse pregnancy outcomes defined as hypertensive diseases of pregnancy (gestational hypertension or preeclampsia), preterm birth (before 37 weeks of gestation), premature rupture of the membranes, pregnancy loss (during the embryonic and fetal period), intrauterine growth restriction, and the composite outcome of any adverse outcome.
One or more adverse pregnancy outcomes occurred in 211 (21%) of the cohort. The mean levels (ng/mL) of C3a in early pregnancy were significantly (P=<.001) higher among women with one or more adverse outcomes (858±435) compared with women with an uncomplicated pregnancy (741±407). Adjusted for parity and prepregnancy body mass index, women with levels of C3a in the upper quartile in early pregnancy were three times more likely to have an adverse outcome later in pregnancy compared with women in the lowest quartile (95% confidence interval, 1.8-4.8; P<.001). The link between early elevated C3a levels and adverse pregnancy outcomes was driven primarily by individual significant (P<.05) associations of C3a with hypertensive diseases of pregnancy, preterm birth, and premature rupture of the membranes.
Elevated C3a as early as the first trimester of pregnancy is an independent predictive factor for adverse pregnancy outcomes, suggesting that complement-related inflammatory events in pregnancy contribute to the subsequent development of poor outcomes at later stages of pregnancy.
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评估妊娠早期补体 C3a 升高是否与不良妊娠结局的发生相关。
在妊娠 20 周前采集每位入组孕妇的血浆样本。本队列（n=1002）评估了不良妊娠结局的发生情况，定义为妊娠高血压疾病（妊娠期高血压或子痫前期）、早产（<37 孕周）、胎膜早破、妊娠丢失（胚胎和胎儿期）、胎儿生长受限以及任意不良结局的复合结局。
在该队列中，211 名（21%）孕妇发生了 1 种或多种不良妊娠结局。妊娠早期 C3a 水平（ng/mL）在发生 1 种或多种不良结局的孕妇中显著升高（P<0.001）[（858±435）ng/mL]，而在妊娠结局无异常的孕妇中则显著降低（P<0.001）[（741±407）ng/mL]。经产次和孕前体质量指数校正后，妊娠早期 C3a 水平处于上四分位数的女性发生妊娠晚期不良结局的风险是处于下四分位数女性的 3 倍（95%置信区间，1.8-4.8；P<0.001）。妊娠早期 C3a 水平升高与不良妊娠结局之间的关联主要是由于 C3a 与妊娠高血压疾病、早产和胎膜早破之间存在显著的独立相关性（P<0.05）。
妊娠早期 C3a 升高，早在妊娠 1 trimester 即可作为不良妊娠结局的独立预测因素，提示妊娠期间补体相关炎症事件可能导致妊娠晚期不良结局的发生。
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