C-reactive protein (CRP) is an acute-phase protein that produced by liver tissues in response to tissue injury, infection and inﬂammation (1). Also tumor necrosis factor alpha (TNF-α) is an acute-phase protein that produced by macrophages and adipose tissues in response to inﬂammation (2-3). Pregnancy is associated with enhanced production of pro-inflammatory indices due to increase of biosynthesis pro-inflammatory factors including TNF-α and C-reactive protein by adipose tissue (4) and placenta especially in third trimester (5). It has been reported that the association between body mass index (BMI) and serum CRP level might be resulted from cytokines such as serum interleukin-6 (IL-6) and TNF-α, which are both expressed in adipose tissue (1, 6). In fact, serum CRP is synthesized by the liver (7) in response to factors released by fat cells including IL-6 and TNF-α (8).
Increased of pro-inflammatory indices serum TNF-α and CRP levels have been associated with insulin resistance, aging, sepsis, muscle damage and pre-eclampsia during pregnancy (4, 9-10). It may also play a role in insulin resistance among normal pregnant women and gestational diabetes mellitus (GDM) (4-5, 11-12).
Patients who develop pre-eclampsia during pregnancy are at increased risk of long-term cardiovascular diseases (CVD), such as ischemic cardiovascular disease, thromboembolic disease and chronic hypertension (13-14). These diseases appear to be associated with increased of inflammatory cytokines (15). This suggests a common thread of underlying physiologic factors that may predispose patients to the development of these diseases.
Yet, there are a few studies about serum inflammatory indices levels and the affecting factors in the seventh month. Also a marker of serum inflammatory indices in maternal may be the prediction of the development of pre-eclampsia. Therefore, we assessed serum hs-CRP and TNF-α levels and other relevant factors (including: maternal age, weight and BMI in pre-pregnanDiscussion
In this cross-sectional study of apparently pregnant women, two factors- weight and BMI in pre-pregnancy, 13 weeks of gestation and the seventh month of pregnancy were found to be the most powerful predictors of serum hs-CRP and TNF-α levels. It is worth noting that subjects with major risk factors of CVD, GDM and pre-eclampsia, which are associated with higher levels of serum hs-CRP and TNF-α, were not enrolled in the study. The clinical and pathophysiological relevance of our ﬁndings result from a series of epidemiological data.
Present results confirm with the results a number of previous studies. In a study by Kac et al. reported that there is a significant relation between overweight in pregnant women and serum hs-CRP level in the tenth week (18). In another study by Ertas et al. reported that the group with BMI ≥ 25 compared to the group with normal BMI, between 28 and 33 weeks of gestation had significantly higher serum hs-CRP levels (19). Also...