Immune and angiogenic disturbance in fetal compartment and its effect on fetal blood gas parameters in cord blood in late onset Preeclampsia.

OBJECTIVE: Late-Onset Preeclampsia (LoPE) results in T regulatory cell (Treg) disturbance in the maternal compartment but its effect on the fetal Treg population is not completely understood. The study investigates the fetal aspect of LoPE by analysing cord blood and gene expression profiles of Treg-related (FOXP3, CTLA4, GATA3) and angiogenesis-related genes (VEGF, MMP2, MMP9), alongside assessing the blood gas parameters of the foetus. STUDY DESIGN: This is a prospective case-control study conducted at BLDE(DU), Vijayapura, with 48 consenting mothers following inclusion and exclusion criteria. MAIN OUTCOME MEASURES: Umbilical cord venous and arterial blood were subjected to arterial blood gas analysis (ABG). RT-qPCR was performed in umbilical venous blood. RESULTS: A significant reduction was seen in FOXP3 (2.09 ± 2.94, 5.45 ± 12.73, p = 0.05), CTLA4 (0.85 ± 0.48, 1.26 ± 0.68, p = 0.01) and VEGF (1.80 ± 2.18, 2.77 ± 2.83, p = 0.03) with reduced expression of GATA3, MMP2, MMP9 in the study group. Arterial and venous ABG values showed haemoconcentration, exposure to hypoxia in the study group. Statistically significant increased hematocrit, Haemoglobin, Methhaemoglobin, glucose and lactate was found in the study group in venous ABG and increased hematocrit, glucose and lactate in the study group in arterial ABG. No significant correlation was found between gene expression values and pH, pCO2 and base excess. CONCLUSION: This evidence supports the possibility of Treg disturbance leading to deranged angiogenesis in the fetus, leading to hypoxic exposure in the baby and the development of LoPE in the mother.