Integration of vitamin d status, inflammatory biomarkers, and oxidative stress markers in assessing the clinical severity of preeclampsia: A narrative review

Preeclampsia is a pregnancy-specific hypertensive disorder associated with substantial maternal and perinatal morbidity and mortality. Its pathophysiology involves placental dysfunction, systemic inflammation, oxidative stress, and endothelial injury. Vitamin D has attracted increasing attention because of its potential immunomodulatory, antioxidant, and vascular regulatory effects. However, the relationships between maternal vitamin D status, inflammatory biomarkers, oxidative stress markers, and the clinical severity of preeclampsia remain incompletely understood. This narrative review aims to synthesize current evidence regarding the associations of vitamin D status, inflammatory biomarkers, and oxidative stress markers with preeclampsia severity and to explore their potential integration in clinical assessment. The review focuses on serum 25-hydroxyvitamin D [25(OH)D], proinflammatory cytokines including tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), the anti-inflammatory cytokine interleukin-10 (IL-10), and oxidative stress indicators including malondialdehyde (MDA) and superoxide dismutase (SOD). Available evidence suggests that preeclampsia is frequently associated with lower maternal vitamin D concentrations, increased proinflammatory activity, enhanced lipid peroxidation, and altered antioxidant defenses. These biological disturbances may contribute to endothelial dysfunction and the development of severe clinical manifestations. Nevertheless, variations in study design, gestational age, biomarker measurement, and definitions of disease severity limit the consistency and clinical interpretation of existing findings. Integrating vitamin D status with inflammatory and oxidative stress biomarkers may provide a more comprehensive understanding of preeclampsia severity than evaluating individual biomarkers independently. Further prospective studies are required to determine their combined predictive performance and clinical applicability.