Abstract DP104: Biomarkers of Neuronal Injury in Preeclampsia: Implications for Chronic Brain Health

Introduction: Preeclampsia (PreE) is a hypertensive disorder of pregnancy diagnosed after 20 weeks of gestation. While broadly characterized by hypertension (HTN), systemic inflammation, and end-organ injury, PreE varies in severity and presentation, and its impact on maternal brain health remains unclear. Small studies show increased neuronal injury biomarkers in women with PreE, suggesting potential neuronal damage. This study evaluated serum neurofilament light chain (NfL), a marker of axonal injury, and phosphorylated tau-217 (ptau217), a marker elevated in Alzheimer’s disease (AD), to assess brain injury in PreE. Hypothesis: We hypothesized that neuronal injury occurs during PreE and that NfL and ptau217 would be elevated. Methods: A cohort of 184 pregnant patients (32 ± 6 y) were enrolled. Blood samples were collected between 18–40 weeks of gestation. PreE patients (N=85) were compared to non-PreE controls (N=99). Serum concentrations of NfL and ptau217 were measured by ELISA and analyzed by PreE status. Results: NfL was elevated in PreE patients during both the 2nd trimester (p<0.01) and 3rd trimester (p<0.001) versus controls, suggesting axonal injury. Unexpectedly, ptau217 was significantly lower in PreE patients during the 3rd trimester (p<0.001) compared to controls. Conclusion: Women with PreE demonstrated elevated NfL levels, consistent with neuronal injury. However, contrary to our hypothesis, ptau217 levels were decreased. One explanation may be that healthy neonates have high ptau217 levels critical for early brain development, and PreE may disrupt this maternal-fetal transfer. This is the first study to investigate ptau217 in pregnant women. These biomarkers may reflect maternal neuronal damage (NfL) and possible fetal effects (ptau217). Given the growing recognition that hypertensive disorders of pregnancy increase risk for later cognitive decline and vascular dementia, longitudinal studies are critical. Biomarkers may aid in identifying women at higher risk for cerebrovascular and neurodegenerative disease following adverse pregnancy events.