Pregnancy-Induced Hypertensive Disorders and Cholesterol Crystals in Maternal Decidua Tissue

Cropped shot of a confident female doctor checking the blood pressure of a pregnant patient at a hospital during the day
Researchers examined if post-delivery decidual tissue contained cholesterol crystals in patients that developed a hypertensive disorder during pregnancy.

Cholesterol crystals were found in more maternal decidua tissue samples from women with pre-eclampsia and may be important in the development of hypertensive disorders of pregnancy, according to results of a study presented at the National Lipid Association Scientific Sessions, from June 2nd through 5th, in Scottsdale, AZ.

Investigators from the University of Oklahoma and Michigan State University evaluated whether cholesterol crystals were present in the maternal decidua and whether patients with pre-eclampsia had a greater burden of cholesterol crystals than women without pre-eclampsia. Women (N=10) who were at 37 to 39 weeks’ gestation had maternal decidua tissues dissected from placental tissues and were evaluated for cholesterol crystals using scanning electron microscopy. The women were stratified by pregnancy-induced hypertensive (n=5) or normotensive (n=5) statuses. Crystal density was defined as no crystals, occasional crystals, isolated clusters, and widely distributed clusters.

The pregnancy-induced hypertensive and normotensive cohorts gave birth to babies with birth weights of 3070 to 4380 and 3010 to 4375 g, 2 babies were boys and 3 were girls in each cohort, and 1 baby in each cohort was Black and 4 were White, respectively.

Cholesterol crystals were observed in 4 out of 5 of the hypertensive and 2 out of 5 of the normotensive maternal decidua specimens.

The blind scanning electron microscopy analysis detected both needle and rhomboid cholesterol crystal forms, representing anhydrous and monohydrate cholesterol crystals, respectively.

This study was limited by its small sample size and these findings should be validated among a larger cohort.

“The presence of [cholesterol crystals] in the maternal decidua is a critical finding,” the study authors wrote. “Although preliminary, this is an important finding that could be mechanistically critical in the development of a hypertensive disorder of pregnancy.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Wild R, Salafia CM, Paneth N, et al. Pregnancy-Induced Hypertension: The Potential Role of Cholesterol Crystals in the Maternal Decidua. Presented at: National Lipid Association Scientific Sessions; June 2-5, 2022; Scottsdale, AZ. Abstract #54.