Bilirubin influences the clinical presentation of pre-eclampsia.

Pre-eclampsia is a placental, inflammatory disease modified by maternal anti-oxidant status to give a syndrome. In its most severe forms pre-eclampsia is followed by maternal and neonatal mortality and morbidity. Bilirubin is a known antioxidant and as such is associated with a reduced risk of cardiovascular and respiratory disease. Hence we aimed to find an association between maternal bilirubin levels and the clinical severity of the disease.A retrospective observational study of 50,712 pregnancies, 925 of which had pre-eclampsia (1999-2010), to examine the association between bilirubin level and perinatal outcome.In women with pre-eclampsia, those with bilirubin levels in the lowest quintile were more likely to require caesarean section (p=0.001, aOR 2.59 (1.52-5.72)). The lowest quintile of bilirubin levels is associated with an increased risk of poor maternal (p=0.002, aOR 3.52 (95%CI 1.6-7.7)) and infant/fetal (p=0.001, OR=3.05 (95%CI=1.63-5.72)) outcome.Low levels of bilirubin were associated with poor maternal and infant outcomes in women diagnosed with pre-eclampsia. Bilirubin may act as an anti-oxidant in this condition and thus modify the disease.