Skip to main content Accessibility help

Humoral immunology in normotensive and hypertensive pregnancy

  • Magnus Haeger (a1) and Anders Bengtsson (a1)


The main function of the immune system is to protect the host from both pathogenic (ie. viruses, bacteria and foreign material) and neoplastic invasion. It is composed of both humoral and cellular factors. The humoral factors comprise the antibodies and the complement system, while the cellular factors comprise the lymphocytes and the phagocytes. These immunological factors remain in a relatively inactive state until activated by foreign molecules. Activation of the immune system under normal circumstances is beneficial to the host. In septic, multiply traumatized, critically ill surgical patients or severe preclamptic women, the host response to stress is more extensive and, as a result, extensive activation of immunological factors could create complications in the host like the adult respiratory distress syndrome (ARDS), multisystem organ failure (MOF) or the syndrome of haemolysis, elevated liver enzymes and low platelet count (HELLP) in preeclamptic women. In order to appreciate the later parts of this article regarding immunology and pregnancy, an understanding of the normal immune system is essential.


Corresponding author

Magnus Haeger MD, PhD, Dept of Obstetrics & Gynecology, Sahlgren Hospital, S-41345 Gothenburg, Sweden


Hide All
1Redl, H, Dinges, HP, Schlag, G. Quantitative estimation of leukostasis in the posttraumatic lung-canine and human autopsy data. Prog Clin Biol Res 1987; 236A: 4353.
2Schlag, G, Redl, H. Die Leukostse in der Lunge beim hypovolamisch-traumatischen Schock. Anaesthetist 1980; 29: 606–12.
3Grey, HM, Chesnut, R. Antigen processing and presentation to T cells. Immunol Today 1985; 3: 101106.
4Ashwell, JD, Schwartz, RH. T-cell recognition of antigen and the Ia molecule as a ternary complex. Nature 1986; 320: 176–79.
5Baumhuter, S, Bron, C, Corradin, G. Different antigen-presenting cells differ in their capacity to induce lymphokine production and proliferation of an apocytochrome c-specific T-cell clone. J Immunol 1985; 135: 989–94.
6Miyajama, A, Miyatake, S, Schreurs, J, DeVries, J, Arai, N, Yokota, T et al. Coordinate regulation of immune and inflammatory responses by T-cell-derived lymphokines. FASEB 1988; 2: 2462–73.
7Meuer, SC, Acuto, O, Hercend, T, Schlossman, SF, Reinherz, EL. The human T-cell receptor. Ann Rev Immunol 1984; 2: 2350.
8Copper, MD, Kearney, JF, Gathings, WE, Lawton, AR. Effects of anti-Ig antibodies and the development and differentiation of B cells. In: Moller, G ed, Immunological reviews. Copenhagen: Munkgaard, 1980: 2953.
9Wall, R, Kuehl, M. Biosynthesis and regulation of immunoglobulins. Ann Rev Immunol 1983; 1: 393422.
10Howard, M, Paul, WE. Regulation of B-cell growth and differentiation by soluble factors. Ann Rec Immunol 1983; 1: 307–33.
11Owen, M. Major histocompatibility complex. In: Roitt, I, Brostoff, J, Male, D eds. Immunology, 2nd ed. London: Churchill Livingstone, 1989: 4.14.12.
12Colletti, LM, Remick, DG, Burtch, GD, Kunkel, SL, Strieter, RM, Campbell, DA. Role of tumor necrosis factor alpha in the pathophysiologic alter hepatic ischemia reperfusion injury in the rat. J Clin Invest 1990; 85: 1936–43.
13Redl, H, Schlag, G, Bahrami, S, Schade, U, Ceska, M, Stutz, P. Plasma neutrophil-activating peptide-1/ interleukin-8 and neutrophil elastase in a primate bactermia model. J Inf Dis 1991; 164: 383–88.
14Schlag, G, Redl, H, Dinges, HP, Davies, J, Radmore, K. Bacterial translocation in a baboon model of hypovolemic-traumatic shock. In: Schlag, G, Redl, H, Siegel, JH, Traber, DL eds, Shock, sepsis and organ failure - second Wiggers Bernard conference. Berlin, Heidelberg: Springer-Verlag, 1991: 5383.
15Scuderi, P, Lam, KS, Ryan, KJ. Raised levels of tumor necrosis factor in parasitic infections. Lancet 1986; ii: 1364–65.
16Hesse, DG, Tracey, KJ, Fong, Y, Manogue, KR, Palladino, MA Jr, Cerami, A et al. Cytokine appearance in human endotoxemia and primate bacteremia. Surg Gynecol Obstet 1988; 166: 147–53.
17Waage, A, Halstensen, A, Espevik, T. Association between tumour necrosis factor in serum and fetal outcome in patients with meningococcal disease. Lancet 1987; i: 355–57.
18Haeffner-Cavaillon, JM, Ciancioni, C, Bacle, F, Delons, S, Kazatchkine, MD. In vivo induction of interleukin-l during hemodialysis. Kidney Int 1989; 35: 1212–18.
19Haeffner-Cavaillon, N, Roussellier, N, Ponzio, O, Carreno, MP, Laude, M, Carpentier, A et al. Induction of interleukin-1 production in patients undergoing cardiopulmonary bypass. J Th Card Surg 1989; 98: 1100–106.
20Beutler, B, Cerami, A. Cachectin: more than a tumor necrosis factor. N Engl J Med 1987; 316: 379–85.
21Debets, JMH, Kampmeijer, R, van der Linden, MPMH, Buurman, WA, van der Linden, CJ. Plasma tumor necrosis factor and mortality in critically ill septic patients. Crit Care Med 1989; 17: 489–94.
22Waage, A, Brandtzaeg, P, Halstensen, A, Kierule, P, Espevik, T. The complex pattern of cytokines in serum from patients with meningococcal septic shock. Association between interleukin 6, interleukin 1 and fatal outcome. J Exp Med 1989; 169: 333–38.
23Marano, MA, Fong, Y, Moldawer, LL, Wei, H, Calvano, SE, Tracey, KJ et al. Serum cachectin/tumor necrosis factor in critically ill patients with burns correlates with infection and mortality. Surg Gynecol Obstet 1990; 170: 3238.
24Cavaillon, JM, Fitting, C, Haeffner-Cavaillon, N. Recombinant C5a enchances interleukin 1 and tumor necrosis factor release by lipopolysaccharide-stimulated monocytes and macrophages. Eur J Immunol 1990; 20: 253–57.
25Scholz, W, McClurg, MR, Cardenas, GJ, Smith, M, Noonan, DJ, Hugli, THE et al. C5a-mediated release of interleukin 6 by human monocytes. Clin Immunol Immunopathol 1990; 57: 297307.
26Lemaire, I. Neurotensin enchances IL-1 production by activated alveolar macrophages. J Immunol 1988; 140: 2983–88.
27Traycey, KJ, Fong, Y, Hesse, DG, Manogue, KR, Lee, AT, Kuo, GC et al. Anti-cachectin/TNF monoclonal antibodies prevent septic shock during lethal bacteraemia. Nature 1987; 330: 662–64.
28Emerson, THE, Lindsey, DC, Jesmok, GJ, Duerr, ML, Fournel, MA. Efficacy of monoclonal antibody against tumor necrosis factor alpha in an endotoxic baboon model. Circ Shock 1992; 38: 3784.
29Kishimoto, T. The biology of interleukin-6. Blood 1989; 74: 110.
30Larsen, CG, Anderson, AO, Appella, E, Oppenheim, JJ, Matsushima, K. The neutrophil activating protein (NAP-1) is also chemotactic for T lymphocytes. Science 1989; 243: 1464–66.
31Turner, M. Molecules which recognize antigen. In: Roitt, I, Brostoff, J, Male, D eds. Immunology, 2nd ed. London: Churchill Livingstone, 1989: 5.1–5.12.
32Ross, SC, Rosenthal, PJ, Berberich, HM, Densen, P. Killing of Neisseria meningtidis by human neutrophils: implications for normal and complement-deficient individuals. J Infect Dis 1987; 155: 1266–75.
33Ghebrehiwet, B, Müller-Eberhard, HJ. C3e: an acidic fragment of human C3 with leukocytosis inducing activity. J Immunol 1979; 123: 616–21.
34Mayer, MM. The complement system. Scientific Am 1973; 229: 5466.
35Densen, P, Weiler, JM, Griffiss, JM, Hoffmann, LG. Familial properdin deficiency and fatal meningococcemia. N Engl J Med 1987; 316: 922–26.
36Molad, Y, Zimran, A, Sidi, Y, Pinkhas, J. Post-traumatic meningococcemia in a patient with deficiency of the C7 complement component. Isr J Med Sci 1990; 26: 9092.
37Alper, CA, Rosen, FG. Inherited deficiencies of complement proteins in man. Springer Semin Immunopathol 1984; 7: 251–61.
38Hugli, TE. Complement anaphylatoxins as plasma mediators, spasmongens and chemotaxins. In: Bing, DH ed, The chemistry and physiology of human plasma proteins. New York: Pergamon Press, 1979: 255–80.
39Grant, JA, Dupree, E, Goldman, AS, Schultz, DR, Jackson, AL. Complement-mediated release of histamine from human leukocytes. J Immunol 1975; 114: 1101–106.
40Hugli, TE, Marceau, F. Effects of the C5a anaphylatoxin and its relationship to cyclo-oxygenase metabolites in rabbit vascular strips. Br J Pharmacol 1985; 84: 725–33.
41Hachfeld del Balzo, U, Levi, R, Polley, MJ. Cardiac dysfunction caused by purified human C3a anaphylatoxin. Proc Natl Acad Sci USA 1985; 82: 886–90.
42Webster, RO, Hong, SR, Johnston, Jr RB, Henson, PM. Biological effects of the human complement fragments C5a and C5a desArg on neutrophil function. Immunopharmac 1980; 2: 201–19.
43Fearon, DT, Collins, LA. Increased expression of C3b receptors on polymorphonuclear leukocytes induced by chemotactic factors and by purification procedures. J Immunol 1983; 130: 370–75.
44Lee, J, Hakim, RM, Fearon, DT. Increased expression of the C3b receptor and complement activation during hemodialysis. Clin Exp Immunol 1984; 56: 205–14.
45Goldstein, IM, Brai, M, Osler, AG, Weissmann, G. Lysosomal enzyme release from human leukocytes: mediation by the alternate pathway of complement activation. J Immunol 1973; 111: 3337.
46Goodman, MG, Chenoweth, DE, Weigle, WO. Induction of interleukin 1 secretion and enchancement of humoral immunity by binding of human C5a to macrophage surface C5a receptors. J Exp Med 1982; 1156: 912–17.
47Henson, PM, Larsen, GL, Webster, RO, Mitchell, BC, Goins, AJ, Henson, JE. Pulmonary microvascular alterations and injury induced by complement fragments: synergistic effect of complement activation, neutrophil sequestration, and prostaglandins. Ann N Y Acad Sci USA 1982; 384: 287300.
48Fein, AM, Lippman, M, Hotzman, H, Eliraz, A, Goldberg, SK. The risk factors, incidence, and prognosis of ARDS following septicemia. Chest 1983; 83: 4042.
49Parker, MM, Parillo, JE. Septic shock. Hemodynamics and pathogenesis. JAMA 1983; 250: 3324–27.
50Lachmann, PJ. Complement and disease. Rec Prog Med 1988; 79: 293–99.
51Dalmasso, AP. Complement in the pathophysiology and diagnosis of human disease. CRC Crit Rev Clin Lab Sci 1986; 24: 123–83.
52Redl, H, Schlag, G. Biochemical analysis in posttraumatic and postoperative organ failure. Prog Clin Biol Res 1989; 308: 649–72.
53Ognibene, FP, Martin, SE, Parker, MM, Schlesinger, T, Roach, P, Burch, C et al. Adult respiratory distress syndrome in patients with severe neutropenia. N Engl J Med 1986; 315: 547–51.
54Maunder, RJ, Hackman, RC, Riff, E, Albert, RK, Springmeyer, SC. Occurrence of the adult respiratory distress syndrome in neutropenic patients. Am Rev Respir Dis 1986; 133: 313–16.
55Laufe, MD, Simon, RH, Flint, A, Keller, JB. Adult respiratory distress syndrome in neutropenic patients. Am J Med 1986; 80: 1022–26.
56Müller-Eberhard, H. The membrane attack complex of complement. Ann Rev Immunol 1986; 4: 503–28.
57Hänsch, GM, Seitz, M, Betz, M. Effects of late acting complement components C5b-9 on human monocytes: release of prostanoids, oxygen radicals and a factor which induced cell proliferation. Int Arch Allergy Appl Immunol 1987; 82: 317–20.
58Hänsch, GM, Seitz, M, Martinotti, G, Betz, M, Rauterberg, EW, Gemsa, D. Macrophages release arachidonic acid, prostaglandin E2, and thromboxane in response to late complement components. J Immunol 1984; 133: 2145–50.
59Langlois, PF, Gawryl, MS. Detection of the terminal complement complex in patient plasma following acute myocardial infarction. Artherosclerosis 1988; 70: 95105.
60Langlois, PF, Sharon, GE, Gawryl, MS. Plasma concentrations of complement-activation complexes correlated with disease activity in patients diagnosed with isolated central nervous system vasculitis. J Allergy Clin Immunol 1989; 83: 1116.
61Haeger, M, Bengtsson, A, Karlsson, K, Heideman, M. Complement activation and anaphylatoxin (C3a and C5a) formation in preeclampsia and by amniotic fluid. Obstet Gynecol 1989; 73: 551–56.
62Kapp, A, Meske-Brand, S, Maly, FE, Müller, W. Komplement-aktiverung bei Patienten mit chronischer Polyartritis gemessenanhand des Komplement Bruckstuckes C3a im Plasma. Z Rheumatol 1984; 43: 103105.
63Zilow, G, Sturm, JA, Rother, U, Kirschfink, M. Complement activation and the prognostic value of C3a in patients at risk of adult respiratory distress syndrome. Clin Exp Immunol 1990; 79: 151–57.
64Roxvall, L, Bengtsson, A, Heideman, M. Anaphylatoxin generation in acute pancreatitis. J Surg Res 1989; 47: 138–43.
65Chenoweth, DE, Cooper, SW, Hugli, THE, Stewart, RW, Blackstone, EH, Kirklin, JW. Complement activation during cardiopulmonary bypass. Evidence for generation of C3a and C5a anaphylatoxins. N Engl J Med 1981; 304: 497503.
66Colomb, MG, Arlaud, GJ, Villiers, CL. Structure and activation of CI: current concepts. Complement 1984; 1: 6980.
67Cooper, NR, Morrison, DC. Binding and activation of the first component of human complement by the lipid A region of lipopolysaccharides. J Immunol 1978; 120: 1862–68.
68Porter, RR, Reid, KBM. Activation of the complement system by antibody-antigen complexes: the classical pathway. Adv Protein Chem 1979; 33: 164.
69Tenner, AJ, Ziccardi, RJ, Cooper, NR. Antibody-independent Cl activation by E coli. J Immunol 1984; 133: 886–91.
70Ziccardi, RJ. The role of immune complexes in the activation of the first component of human complement. J Immunol 1984; 132: 283–88.
71Pangburn, MK. Activation of complement via the alternative pathway. Fed Proc 1983; 42: 139–43.
72Gelfand, JA, Donelan, M, Burke, JF. Preferential activation and depletion of the alternative complement pathway by burn injury. Ann Surg 1983; 198: 5862.
73Joiner, KA. Role of complement in infectious disease. In: Ross, GD ed, Immunbiology of the complement system. New York: Academic Press, 1986; 183–95.
74Pangburn, MK, Schreiber, RD, Müller-Eberhard, HJ. C3b deposition during activation of the alternative complement pathway and the effect of deposition on the activating surface. J Immunol 1983; 131: 1930–35.
75Hack, CE, Nuijens, JH, Felt-Bersma, RJF, Schreuder, WO, Eerenberg-Belmer, AJM, Paardekooper, J et al. Elevated plasma levels of the anaphylatoxins C3a and C4a are associated with a fatal outcome in sepsis. Am J Med 1989; 86: 2026.
76Weinburg, PF, Matthay, MA, Webster, RO, Roskos, KV, Goldstein, IM, Murray, JF. Biologically active products of complement and acute lung injury in patients with the sepsis syndrome. Am Rev Respir Dis 1984; 130: 791–96.
77Slotman, GJ, Burchard, KW, Williams, JJ, D’Arrezzo, A, Yellin, SA. Interaction of prostaglandins, activated complement and granulocytes in clinical sepsis and hypotension. Surgery 1986; 99: 744–50.
78Langlois, PF, Gawryl, MS. Accentuated formation of the terminal C5b-9 complement complex in patient plasma precedes development of the adult respiratory distress syndrome. Am Rev Respir Dis 1988; 138: 368–75.
79Glassman, AB, Bennett, CE, Christopher, JB, Self, S. Immunity during pregnancy: lymphocyte subpopulations and mitogen responsiveness. Ann Clin Lab Sci 1985; 15: 357–62.
80Coulam, CB, Silverfield, JC, Kazmar, RE, Fathman, CG. T lymphocyte subsets during pregnancy and the menstrual cycle. Am J Reprod Immunol 1983; 4: 8890.
81Bach, JF. Transplantation immunity and cytotoxicity phenomena. In: Bach, JF, Schwartz, RS eds, Immunology, 2nd ed. New York: John Wiley and Sons, 1982: 399.
82Taylor, PV, Gowland, G, Hancock, KW, Scott, JS. Effect of length of gestation on maternal cellular immunity to human trophoblast antigens. Am J Obstet Gynecol 1976; 125: 528–31.
83Youtananukorn, V, Matangkasombut, P. Specific plasma factors blocking human maternal cell-mediated immune reaction to placental antigens. Nature New Biol 1973; 242: 110–11.
84Toder, V, Nebel, L, Gleicher, N. Studies of natural killer cells in pregnancy. I. Analysis at the single cell level. J Clin Lab Immunol 1984; 14: 123–27.
85Gregory, CD, Shah, LP, Lee, H, Scott, IV, Golding, PR. Gytotoxic reactivity of human natural killer (NK) cells during normal pregnancy: a longitudinal study. J Clin Lab Immunol 1985; 18: 175–81.
86Pitkin, RM, Witte, DL. Platelet and leukocyte counts in pregnancy. JAMA 1979; 242: 2696–98.
87Plum, J, Thierry, M, Sabre, L. Distribution of mononuclear cells during pregnancy. Clin Exp Immunol 1978; 31: 4549.
88Krause, PJ, Ingardia, CJ, Pontius, LT, Malech, HL, LoBello, TM, Maderazo, EG. Host defence during pregnancy: neutrophil chemotaxis and adherence. Am J Obstet Gynecol 1987; 157: 274–80.
89Greer, IA, Haddad, NG, Dawes, J, Johnstone, FD, Calder, AA. Neutrophil activation in pregnancy-induced hypertension. Br J Obstet Gynaecol 1989; 96: 978–82.
90Haeger, M, Unander, M, Norder-Hansson, B, Tylman, M, Bengtsson, A. Complement, neutrophil and macrophage activation in women with severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 1992; 79: 1926.
91Schröksnadel, H, Herold, M, Steckel-Berger, G, Fuchs, D, Wachter, H, Dapunt, O. Zellvermittelte Immunitätbei schwangerschaftsinduzierten Hochdruckerkrankungen (Cell-mediated immunity in hypertensive disorders of pregnancy). Geburtsh u Frauenheilk 1992; 52: 592–95.
92Hunt, JS, Fishback, JL. Amniochorion: immunological aspects - a review. Am J Reprod Immunol 1989; 21: 114–18.
93Ellis, S. HLA-G: at the interface. Am J Reprod Immunol 1990; 23: 8486.
94Opsjön, S-L, Wathen, NC, Tingulstad, S, Wiedswang, G, Sundan, A, Waage, A et al. Tumor necrosis factor, interleukin-1, and interleukin-6 in normal human pregnancy. Am J Obstet Gynecol 1993; 169: 397404.
95Marolis, GB, Buckley, RH, Younger, JB. Serum immunoglobulin concentrations during normal pregnancy. Am J Obstet Gynecol 1971; 109: 971–76.
96Studd, JWW. Immunoglobulins in normal pregnancy, pre-eclampsia and pregnancy complicated by nephrotic syndrome. J Obstet Gynaecol Br Commonwlth 1971; 78: 786–90.
97Dodson, MG, Kerman, RH, Lange, CF, Stefani, SS, O’Leary, JA. T and B cells in pregnancy. Obstet Gynecol 1977; 49: 299302.
98Gleicher, N. Autoantibodies in normal and abnormal pregnancy. Am J Reprod Immunol 1992; 28: 269–73.
99Massobrio, M, Benedetto, C, Bertini, E, Tetta, C, Camussi, G. Immune complexes in preeclampsia and normal pregnancy. Am J Obstet Gynecol 1985; 152: 578–83.
100Jain, A, Rohatgi, P, Singh, VK, Sharma, MK. Circulating immune complexes in preeclampsia. J Indian Med Assoc 1991; 89: 251–53.
101Faulk, WP, Hunt, JS. Human trophoblast antigens. In: Rubin, JM, Gleicher, N eds, Immunology and allergy clinics of North America, reproductive immunology. Philadelphia: WB Saunders Co, 1990: 2748.
102Hsi, B-L, Hunt, JS, Atkinson, JP. Differential expression of complement regulatory proteins on subpopulations of human trophoblast cells. J Repr Immunol 1991; 19: 209–23.
103Holmes, CH, Simpson, KL, Okada, H, Okada, N, Wainwright, SD, Purcell, DF et al. Complement regulatory proteins at the feto-maternal interface during human placental development: distribution of CD59 by comparison with membrane cofactor protein (CD46) and decay accelerating factor (CD55). Eur J Immunol 1992; 22: 1579–85.
104Kovar, IZ, Riches, PG. C3 and C4 complement components and acute phase proteins in late pregnancy and parturition. J Clin Pathol 1988; 41: 650–52.
105Johnson, U, Gustavii, B. Complement components in normal pregnancy. Acta Pathol Microbiol Immunol Scand (C) 1987; 95: 9799.
106Haeger, M, Unander, M, Bengtsson, A. Complement activation in relation to development of preeclampsia. Obstet Gynecol 1991; 78: 4649.
107Chesley, LC. A short history of eclampsia. Obstet Gynecol 1974; 43: 599602.
108Mauriceau, F. Traite des maladies des femmes grosses, et celles qui sont accouchées. Paris: d’Houry, 1964.
109Lindheimer, MD, Katz, AI. Hypertension in pregnancy. N Engl J Med 1985; 313: 675–80.
110Montan, S, Sjöberg, N-O, Svenningsen, N. Hypertension in pregnancy - fetal and infant outcome. A cohort study. Clin Exp Hypertens 1987; B6: 337–48.
111MacGillivray, I. Pre-eclampsia: the hypertensive disease of pregnancy. Philadelphia: WB Saunders, 1983.
112De Wolf, F, Robertson, WB, Brosens, I. The ultrastructure of acute atherosis in hypertensive pregnancy. Am J Obstet Gynecol 1975; 123: 164–74.
113Ferris, TF. Toxemia and hypertension. In: Burrow, GN, Ferris, TF eds, Medical complications during pregnancy. 3rd ed. Philadelphia: WB Saunders, 1988: 133.
114Pritchard, JA. Hypertensive disorders in pregnancy. In: Pritchard, JA, MacDonald, PC, Gant, NF eds, Williams obstetrics. 17th ed. Connecticut: Appleton-Century-Crofts, 1985: 525–60.
115Kitzmiller, JL, Benirschke, K. Immunofluorescent study of placental bed vessels in pre-eclampsia of pregnancy. Am J Obstet Gynecol 1973; 115: 248–51.
116Petrucco, OM, Thomson, NM, Lawrence, JR, Weldon, MW. Immunofluorescent studies in renal biopsies in pre-eclampsia. Br Med J 1974; 1: 473–76.
117Tedesco, F, Radillo, O, Candussi, G, Nazzaro, A, Mollnes, TE, Pecorari, D. Immunohistochemical detection of terminal complement complex and S protein in normal and pre-eclamptic placentae. Clin Exp Immunol 1990; 80: 236–40.
118Faulk, WP, Temple, A, Lovins, RE, Smith, N. Antigens of human trophoblast: a working hypothesis for their role in normal and abnormal pregnancies. Proc Natl Acad Sci USA 1978; 75: 1947–51.
119Campbell, DM, MacGillivray, I, Carr-Hill, R. Pre-eclampsia in second pregnancy. Br J Obstet Gynaecol 1985; 92: 131–40.
120Feeney, JG, Scott, JS. Pre-eclampsia and changed paternity. Eur J Obstet Gynecol Repr Biol 1980; 11: 3538.
121Ikedife, D. Eclampsia in multiparae. Br Med J 1980; 280: 985–86.
122Herrman, U, Marti, JJ. Immunogestosis: a new etiologic concept of essential EPH gestosis, with special consideration of the primigravid patient; preliminary report of a clinical study. Am J Obstet Gynecol 1977; 128: 489–93.
123Klonoff-Cohen, HS, Savitz, DA, Cefalo, RC, McCann, MF. An epidemiologic study of contraception and preeclampsia. JAMA 1989; 262: 3143–47.
124Need, JA, Bell, B, Meffin, E, Jones, WR. Pre-eclampsia in pregnancies from donor inseminations. J Reprod Immunol 1983; 5: 329–38.
125Serhal, PF, Craft, I. Immune basis for preeclampsia: evidence from oocyte recipients. Lancet 1987; 1: 744.
126Strickland, DM, Guzicks, DS, Cox, K, Gant, NF, Rosenfeld, CR. The relationship between abortion in the first pregnancy and development of pregnancy-induced hypertension in the subsequent pregnancy. Am J Obstet Gynecol 1986; 154: 146–48.
127Seidman, DS, Ever-Hadani, P, Stevenson, DK, Gale, R. The effect of abortion on the incidence of preeclampsia. Eur J Obstet Gynecol Repr Biol 1989; 33: 109–14.
128Toivanen, P, Hirvonen, T. Sex ratio of newborns: preponderance of males in toxemia of pregnancy. Science 1970; 170: 187–88.
129James, WH. The human sex ratio. Part 1: a review of the literature. Hum Biol 1987; 59: 721–52.
130Feeney, JG, Tovey, LAD, Scott, JS. Influence of previous blood-transfusion on incidence of pre-eclampsia. Lancet 1977; 1: 874–75.
131Arngrimsson, R, Bjornsson, S, Geirsson, RT, Bjornsson, H, Walker, JJ, Snaedal, G. Genetic and familial predisposition to eclampsia and pre-eclampsia in a defined population. Br J Obstet Gynaecol 1990; 97: 762–69.
132Robertson, WB, Brosens, I, Dixon, HG. The pathological response of the vessels of the placental bed to hypertensive pregnancy. J Pathol Bacteriol 1967; 93: 581–92.
133Cignetti, M, Garzetti, GG, Marchegiani, F, Fabris, N, Romanini, C. Natural killer cells and Tac antigen in the hypertension of pregnancy. Clin Exp Obstet Gynecol 1990; 17: 1315.
134Bardeguez, AD, McNerney, R, Frieri, M, Verma, UL, Tejani, N. Cellular immunity in preeclampsia: alterations in T-lymphocyte subpopulations during early pregnancy. Obstet Gynecol 1991; 77: 859–62.
135Schroksnadel, H, Fuchs, D, Herold, D, Wachter, H, Dapunt, O. Activated macrophages in preeclampsia. Pteridines 1993; 4: 144–48.
136Pacher, R, Redl, H, Frass, M, Petzl, DH, Schuster, E, Woloszczuk, W. Relationship between neopterin and granulocyte elastase plasma levels and the severity of multiple organ failure. Crit Care Med 1989; 17: 221–26.
137Strohmaier, W, Redl, H, Schlag, G, Inthorn, D. D-erythro-neopterin plasma levels in intensive care patients with and without septic complications. Crit Care Med 1987; 15: 757–60.
138Haeger, M, Unander, M, Bengtsson, A. Neopterin PMN elastase, and complement components as monitoring parameters in women with the syndrome of hemolysis, elevated liver enzymes and low platelet count. Pteridines 1993; 4: 138–43.
139Goris, RJA. Multiple organ failure: whole body inflammation? Schweiz med Wochenschr 1989; 119: 347–53.
140Jenkins, DM, Need, JA, Scott, JS, Morris, H, Pepper, M. Human leukocyte antigens and mixed lymphocyte reaction in severe preeclampsia. Br Med J 1978; 1: 542–44.
141Johnson, N, Moodley, J, Hammond, MG. Human leukocyte antigen status in African women with eclampsia. Br J Obstet Gynaecol 1988; 95: 877–79.
142Redman, CWG, Bodmer, WF, Bodmer, JG, Beilin, LJ, Bonnar, J. HLA antigens in severe preeclampsia. Lancet 1978; 2: 397–99.
143Kilpatrick, DC, Liston, WA, Gibson, F, Livingstone, J. Association between susceptibility to preeclampsia within families and HLA-DR4. Lancet 1989; 2: 1063–65.
144Hoff, C, Stevens, RG, Mendenhall, H, Peterson, RDA, Spinnato, JA. Association between risk for preeclampsia and HLA-DR4. Lancet 1990; 1: 660–61.
145Wilton, AN, Cooper, DW, Brennecke, SP, Bishop, SM, Marshall, P. Absence of close linkage between maternal genes for susceptibility to preeclampsia/eclampsia and HLA-DR beta. Lancet 1990; 336: 653–57.
146Houwert-de Jong, MH, Claas, FHJ, Gmelig-Meyling, FHJ, Kalsbeek, GL, Valentijn, RM, the Velde, ER et al. Humoral immunity in normal and complicated pregnancy. Eur J Obstet Gynecol Reprod Biol 1985; 19: 205–14.
147Kaku, M. Placental polysaccharide and the aetiology of the toxaemia of pregnancy. J Obstet Gynaecol Br Emp 1957; 60: 148–56.
148Hulka, JF, Brinton, V. Antibody to trophoblast during early postpartum period in toxemic pregnancy. Am J Obstet Gynecol 1963; 86: 130–34.
149Gaugas, JM, Curzen, P. Complement fixing antibody against solubilized placental microsomal fraction in pre-eclampsia sera. Br J Pathol 1974; 55: 570–73.
150Thiry, L, Yane, F, Sprecher-Goldberger, S, Cappel, R, Bossens, M, Neuray, F. Expression of retrovirus related antigen in pregnancy. II. Cytotoxic and blocking specificities in immunoglobulins eluted from the placenta. J Reprod Immunol 1981; 2: 323–30.
151Bieglmayer, C, Rudelstorfer, R, Bartl, W, Janisch, H. Detection of antibodies in pregnancy serum reacting with isolated placental basement membrane collagen. Br J Obstet Gynaecol 1986; 93: 815–22.
152Branch, DW, Andres, R, Digre, KB, Rote, NS, Scott, JR. The association of antiphospholipid antibodies with severe preeclampsia. Obstet Gynecol 1989; 73 541–45.
153Alanen, A. Serum IgE and smooth muscle antibodies in preeclampsia. Ada Obstet Gynecol Scand 1984; 63: 581–82.
154Foidart, JM, Hunt, J, Lapiere, C-M, Nusgens, B, De Rycker, C, Bruwier, M et al. Antibodies to laminin in preeclampsia. Kidney Int 1986; 29: 1050–57.
155Samuels, P, Main, EK, Tomaski, A, Mennuti, MT, Gabbe, SG, Cines, DB. Abnormalities in platelet antiglobulin tests in preeclamptic mothers and their neonates. Am J Obstet Gynecol 1987; 157: 109–13.
156Rapaport, VJ, Hirata, G, Yap, HK, Jordan, SC. Anti-vascular endothelial cell antibodies in severe preeclampsia. Am J Obstet Gynecol 1990; 162: 138–46.
157Haeger, M, Unander, AM, Bengtsson, A. Enhanced anaphylatoxin and terminal C5b-9 complement formation in patients with the syndrome of hemolysis, elevated liver enzymes and low platelet count. Obstet Gynecol 1990; 76: 698702.
158Loke, YW, Joysey, VG, Borland, R. HL-A antigens on human trophoblast cells. Nature 1971; 232: 403405.
159Bengtsson, A, Heideman, M. Altered anaphylatoxin activity during induced hypoperfusion in acute and elective abdominal aortic surgery. J Trauma 1986; 26: 631–37.
160Bengtsson, A, Haljamae, H. Complement activation and organ function in critically ill surgical patients. Acute Care 19881989; 14–15: 111–37.
161Bengtsson, A, Holmberg, P, Heideman, M. The ischaemic leg as a source of complement activation. BrJSurg 1987; 74: 697700.
162Chenoweth, DE, Hugli, TE. Demonstration of specific C5a receptor on intact human polymorphonuclear leukocytes. Proc Natl Acad Sci USA 1978; 75: 3943–47.
163Walport, M. Complement. In: Roitt, I, Brostoff, J, Male, D eds, Immunology, 2nd ed. London: Churchill Livingstone, 1989: 13.113.16.
164Hangen, DH, Stevens, JG, Satoh, PS, Hall, EW, O'Hanley, PT, Raffin, TA. Complement levels in septic primates treated with anti-C5a antibodies. J Surg Res 1989; 46: 195–99.
165Greer, IA, Haddad, NG, Dawes, J, Johnston, TA, Johnstone, FD, Steel, JM. Increased neutrophil activation in diabetic pregnancy and in nonpregnant diabetic women. Obstet Gynecol 1989; 74: 878–81.
166Sunder-Plassmann, G, Stockenhuber, F, Balcke, P. Serum interleukin 2 activity in renal graft recipients. Transplant Proc 1988; 20: 387–89.
167Sunder-Plassmann, G, Derfler, K, Wagner, L, Stockenhuber, F, Endler, M, Nowotny, C et al. Increased serum activity of interleukin-2 in patients with pre-eclampsia. J Autoimmun 1989; 2: 203205.
168Weisman, HF, Bartow, T, Leppo, MK, March, HC Jr, Carson, GR, Concino, MF et al. Soluble human complement receptor type 1: in vivo inhibitor of complement suppressing postischemic myocardial inflammation and necrosis. Science 1990; 249: 146–51.
169Yeh, CG, Marsh, HC Jr, Carson, GR, Berman, L, Concino, MF, Scesney, SM et al. Recombinant soluble human complement receptor type 1 inhibits inflammation in the reversed passive Arthus reaction in rats. J Immunol 1991; 146: 250–56.
170Gerard, NP, Gerard, C. The chemotactic receptor for human C5a anaphylatoxin. Nature 1991; 349: 614–17.
171Exley, AR, Cohen, J, Buurman, W, Owen, R, Hanson, G, Lumley, J et al. Monoclonal antibody to TNF in severe septic shock. Lancet 1990; 1: 1275–76.
172Manning, PJ, Watson, RM, Margolskee, DJ, Williams, VC, Schwartz, JI, O'Byrne, PM. Inhibition of exercise-induced bronchoconstriction by MK-571, a potent leukotriene D4-receptor antagonist. N Engl J Med 1990; 323: 1736–39.
173Mandell, GL. ARDS, neutrophils, and pentoxifylline. Am Rev Respir Dis 1988; 138: 1103–105.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed