The relationship between trace element imbalance, oxidative stress, and endothelial dysfunction in preeclampsia diagnosis

BACKGROUND: Preeclampsia is a complex and heterogeneous complication during pregnancy, with oxidative stress and endothelial dysfunction also playing a role in its pathogenesis. This prospective case-control study aimed to investigate the roles of trace and toxic element homeostasis, as well as oxidative stress and endothelial dysfunction markers, in the pathophysiology of preeclampsia. METHODS: The study included 100 third-trimester pregnant women (50 with preeclampsia and 50 matched normotensive controls). Trace-Zn, Se, Fe, Cu, V, Mn, Co-and toxic-As, Cd, Pb-elements were measured using inductively coupled plasma mass spectrometry (ICP-MS). To evaluate oxidative stress and endothelial dysfunction, malondialdehyde (MDA), superoxide dismutase (SOD) activity, and asymmetric dimethylarginine (ADMA) levels were measured by ELISA. RESULTS: Fe, Mn, Zn, Co, Cu, Se, As, Cd, and V levels were significantly higher in the preeclampsia group than in controls (all p < 0.001), whereas Pb levels did not differ significantly (p = 0.669). SOD activity decreased (p = 0.027), while MDA (p = 0.005) and ADMA levels (p = 0.039) increased in the preeclampsia group. Compared with healthy controls, the element-correlation network was weaker in preeclampsia, and Cu/Zn, Fe/Zn, and MDA/SOD ratios were significantly altered (all p < 0.05). ROC analyses demonstrated high diagnostic performance for Fe (AUC = 0.891), Mn (AUC = 0.881), Zn (AUC = 0.876), and Se (AUC = 0.856). In binary logistic regression analyses, Zn (OR = 1.11, p < 0.001) and Fe (OR = 1.002, p = 0.004) were positively related to preeclampsia, whereas SOD activity showed an inverse relationship (OR = 0.99, p = 0.025). CONCLUSIONS: These findings indicate that oxidative stress is increased and endothelial function is impaired in preeclampsia in parallel with disruption of elemental balance. The results provide a basis for further investigation into these parameters as supportive clinical assessments and potential biomarkers.