Metabonomics of serum bile acids in patients with pre-eclampsia

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Pre-eclampsia remains a leading contributor to maternal and perinatal mortality, particularly in resource-limited settings, prompting the urgent search for accessible early biomarkers. Capitalising on growing evidence that bile-acid dysregulation participates in hypertensive disorders of pregnancy, we conducted a case-control study in which fasting serum from 30 women with preeclampsia and 30 gestational-age-matched healthy pregnant controls was subjected to targeted LC-MS/MS quantification of 59 bile-acid subtypes after DMED derivatisation. 30 analytes differed significantly (unpaired t-test, FDR-adjusted q-value < 0.05; fold-change ≥ 2), with glycochenodeoxycholic acid (GCDCA) achieving an AUC of 0.879 (95% CI 0.782-0.946). A two-metabolite panel comprising GCDCA and glycodeoxycholic acid-3-O-β-glucuronide delivered AUCs of 0.856 under support-vector. These data reveal extensive disruption of bile-acid homeostasis in preeclampsia, implicate gut-liver axis perturbation in its pathophysiology, and identify a parsimonious serum signature that merits prospective multi-centre validation.

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