**4. Results**

Regarding patients' distribution by ethnicity, in **Table 1**, Albanians represented more than half of the women with preeclampsia as 44% of participants with symptoms of medium and 68% with symptoms of severe PE. Pregnant Albanians (68%) dominate in the group with normal tension.

The average body mass index (BMI) in the group of pregnant women with preeclampsia was 34.33 ± 4.5—that was not significantly higher than tile average body mass of the control group (32.88 ± 3.8) (p = 0.09). The difference between the average BMI of pregnant women with moderate and severe PE and normotensive patients was significant (F = 3.8, p = 0.026). Namely, pregnant women with severe PE had significant higher average BMI than normotensive pregnant women (35.57 ± 4.11 vs. 32.88 ± 3.8, p = 0.025).

Statistical analysis is showed, not significant differences in the levels of interleukin 10 in serum between pregnant women with preeclampsia and healthy pregnant women (p = 0.5), but the difference between moderate preeclampsia, severe preeclampsia, and control group was highly significant (p < 0.01) due to the lower levels of this interleukin in the severe preeclampsia group comparing moderate preeclampsia in relation to the control and due to the significant lower values when comparing control in relation to the moderate preeclampsia


**Variable B S.E. Wald Sig. Exp(B) 95.0% CI for Exp(B)** Age 0.2 0.086 5.350 0.021 1.221 1.031 1.446 Nulliparity (present) 1.816 1.114 2.657 0.103 6.145 0.692 54.534

Proteinuria (present) 3.081 1.307 5.56 0.018 21.785 1.682 282.123 LDH ≥ 450 (U/L) 2.066 0.915 5.102 0.024 7.896 1.314 47.433 Albumin (serum) (g/L) −0.239 0.125 3.66 0.056 0.787 0.616 1.006 Creatinine (serum) (umol/L) −0.067 0.035 3.696 0.055 0.935 0.873 1.001

IL-10 (pg/ml) −2.324 1.051 4.888 0.027 0.098 0.012 0.768

**Table 2.** Multivariate logistic regression analysis for the factors predictors of severe preeclampsia.

3.711 1.053 12.412 0.000 40.900 5.189 322.371

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2.414 0.843 8.192 0.004 11.176 2.140 58.360

−0.006 0.013 0.236 0.627 0.994 0.97 1.019

Systolic blood pressure (≥160 mmHg)

Diastolic blood pressure

Dependent variable: severe preeclampsia.

**Figure 1.** Correlation IL-10/LDH: r = −0.215 and p = 0.134.

(≥100 mmHg)

Platelets (≤150)

**Table 1.** Age, gestational week, BMI, and IL-10 serum concentration in women with moderate and severe preeclampsia, and women with normal blood pressure (control group).

group. Average concentrations of lL-10 in serum were 23.2 ± 40.7 pg/ml in the total group of preeclampsia patients, 45.5 ± 48.4 pg/ml in the group with moderate preeclampsia, and 0.8 ± 0.4 pg/ml in the group with severe preeclampsia. In patients with normal tension, the average serum concentration of interleukin 10 was 4.2 ± 6.7 pg/ml.

Study data demonstrated that in pregnant women with pregnancy complicated by preeclampsia, the serum concentration of anti-inflammatory interleukin 10 is confirmed as a significant predictor of the occurrence of severe preeclampsia (**Table 2**). Increased serum concentrations of interleukin 10 (in pg/ml) reduced the likelihood of the development of severe preeclampsia by 89.6% (95% CI 0.016–0.678).

**Figures 1**–**3** show that the results of bivariate analysis are of the relationships between serum maternal concentration of IL-10 and serum enzyme LDH, creatinine, platelets, proteinuria, and uric acid.

The obtained values of Pearson's coefficients indicate negative correlations of interleukin 10 with LOH and proteinuria, whereas the correlations of lL-10 with creatinine platelets and uric acid were positive. However significant correlations were confined between interleukin 10 and platelets as well as between IL-10 and proteinuria. The correlation with the platelet count was positive which means that significantly higher concentration of interleukin 10 was confirmed in patients with higher number of platelets in the blood and vice versa. The correlation between interleukin


**Table 2.** Multivariate logistic regression analysis for the factors predictors of severe preeclampsia.

**Figure 1.** Correlation IL-10/LDH: r = −0.215 and p = 0.134.

group. Average concentrations of lL-10 in serum were 23.2 ± 40.7 pg/ml in the total group of preeclampsia patients, 45.5 ± 48.4 pg/ml in the group with moderate preeclampsia, and 0.8 ± 0.4 pg/ml in the group with severe preeclampsia. In patients with normal tension, the

**Table 1.** Age, gestational week, BMI, and IL-10 serum concentration in women with moderate and severe preeclampsia,

**Moderate PE N = 25**

*Gestational week,* mean ± SD 34.99 ± 3.5 35.5 ± 3.4 34.4 ± 3.6 34.8 ± 3.6

Macedonian 18 (36%) 10 (40%) 8 (32%) 15 (30%) Albanian 28 (56%) 11 (44%) 17 (68%) 34 (68%) Romani 4 (8%) 4 (16%) 0 1 (2%)

> 33.1 ± 4.7 24.2–41

32.06 ± 4.8 29.9 ± 4.7 34.2 ± 3.85 31.8 ± 4.8

**Severe PE N = 25**

35.57 ± 4.1 27–44

**Control (C) N = 50**

32.88 ± 3.8 27–43.9

Study data demonstrated that in pregnant women with pregnancy complicated by preeclampsia, the serum concentration of anti-inflammatory interleukin 10 is confirmed as a significant predictor of the occurrence of severe preeclampsia (**Table 2**). Increased serum concentrations of interleukin 10 (in pg/ml) reduced the likelihood of the development of severe preeclampsia

**Figures 1**–**3** show that the results of bivariate analysis are of the relationships between serum maternal concentration of IL-10 and serum enzyme LDH, creatinine, platelets, proteinuria,

The obtained values of Pearson's coefficients indicate negative correlations of interleukin 10 with LOH and proteinuria, whereas the correlations of lL-10 with creatinine platelets and uric acid were positive. However significant correlations were confined between interleukin 10 and platelets as well as between IL-10 and proteinuria. The correlation with the platelet count was positive which means that significantly higher concentration of interleukin 10 was confirmed in patients with higher number of platelets in the blood and vice versa. The correlation between interleukin

average serum concentration of interleukin 10 was 4.2 ± 6.7 pg/ml.

by 89.6% (95% CI 0.016–0.678).

**Variable Groups**

*BMI* mean ± SD, range 34.33 ± 4.5

and women with normal blood pressure (control group).

*Age (years)* mean ± SD

All PE/C t = 0.27 p = 0.8

150 Autoantibodies and Cytokines

All PE/C; t = 0.2; p = 0.8 mPE/sPE/C F = 0.6 p = 0.5

All PE/C; t = 1.7; p = 0.09

*Ethnicity n %*

**All PE N = 50**

**mPE/sPE/C; F = 5.5; p = 0.005 post hoc mPE/sPE p = 0.004**

24.2–44

and uric acid.

10 and proteinuria was negative showing that the serum concentration of interleukin 10 was significantly lower in patients with higher amount of proteins in the urine and vice versa.

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This study demonstrates differences in IL-10 levels in women with preeclampsia compared to

We found that in pregnant women with preeclampsia the increased serum concentrations of

Longitudinal studies in mice demonstrate a sequential change in the cytokine profile in serum including interleukin 10 in peripheral blood and release from spleen elements as pregnancy

In the second half of pregnancy, IL-10 inhibition in mice is related with fetal growth retardation [16]. Progesterone has been shown to increase Th2-type responses in T cells [17]. This study demonstrated that there is a significant alteration in the serum concentration of lL-10 in severe preeclampsia compared with normal pregnancy and in moderate preeclampsia groups of patients.

The regression analysis applied in this study showed diastolic blood pressure of 100 mmHg or higher, systolic blood pressure of 160 mmHg or higher, persistent proteinuria in pregnancy, the serum LDH concentration of 450 U/L or higher, and reduced serum concentrations of IL-10 in maternal serum as significant predictors of severe preeclampsia. While other variables predicted the development of severe preeclampsia, IL-10 decreased such likelihood. IL-10 was also found to be negatively correlated with proteinuria and positively correlated with blood platelets. Significantly higher concentration of IL-10 was confirmed in patients with higher number of platelets in the blood. The serum concentration of IL-10 was signifi-

This study demonstrated platelet count and proteinuria as significant predictors of serum IL-10 concentration—urine proteins predicting lower serum IL-10 while platelets count pre-

Other studies suggest a proportional link between the level of proteinuria and adverse clinical outcomes. In recent study 13,000 pregnant women found significant proteinuria, defined as 21 or more on dipstick analysis, and it was associated with an increase in prematurity rates, intrauterine fetal growth restriction, and increased neonatal morbidity and mortality when associated with hypertension [18]. Other studies suggest that it is the presence of proteinuria rather than the severity, which is associated with poorer outcomes in these complications for mother and stillbirth. There is evidence that even the finding of trace proteinuria in pregnant women with hypertension is associated with an increase in adverse outcomes.

Taking into consideration changes of anti-inflammatory cytokine concentrations in severe preeclampsia, the moderate phase can be analyzed as a critical stage in complicated

IL-10 predicted lower likelihood for the development of severe preeclampsia.

cantly lower in patients with higher amount of proteins in the urine.

dicting higher serum concentration of interleukin 10.

the levels in women with a normal pregnancy outcome.

**5. Discussion**

advances.

pregnancy.

**Figure 2.** Correlation IL-10/creatinine: r = 0.134 and p = 0.355.

**Figure 3.** Correlation IL-10/platelets.

10 and proteinuria was negative showing that the serum concentration of interleukin 10 was significantly lower in patients with higher amount of proteins in the urine and vice versa.
