# A Systematic Review of Telomere Length and Telomerase Activity in Preeclampsia: Maternal, Placental, and Cord Blood Perspectives

## TL;DR

This review examines how telomere length and telomerase activity in maternal, placental, and cord blood relate to preeclampsia, finding inconsistent but suggestive patterns.

## Contribution

The paper provides a systematic review of telomere-related biomarkers in preeclampsia across maternal, placental, and cord blood samples.

## Key findings

- Larger studies report shorter telomere lengths in maternal blood and placental tissue in preeclamptic cases.
- Telomerase levels are elevated in maternal blood leukocytes but reduced in placental tissue in preeclampsia.
- Current evidence remains inconsistent, requiring large-scale prospective studies for clarity.

## Abstract

Background/Objectives: Preeclampsia represents a significant obstetric complication, frequently linked to elevated levels of perinatal morbidity. This review sought to systematically examine the existing literature regarding associations between telomere length in maternal blood, placental tissue, and umbilical cord blood, and the occurrence of preeclampsia. Methods: A comprehensive search of PubMed/MEDLINE and ScienceDirect was conducted to identify studies published up to January 2025 that investigated telomere length in relation to preeclampsia. All observational studies comparing telomere length between women with preeclampsia and healthy pregnant controls were included. Results: A total of 838 studies were assessed. Although findings regarding the association between telomere length in leukocytes in maternal peripheral blood, placental tissue, and cord blood with preeclampsia remain inconsistent, the studies with the largest sample sizes for maternal blood and placental tissue have reported shorter telomere lengths in preeclamptic cases. In cases of preeclampsia, telomerase levels in leukocytes in maternal peripheral blood are elevated, whereas telomerase expression in placental tissue is reduced. Conclusions: Current evidence regarding the role of telomere length in preeclampsia remains inconsistent, precluding definitive conclusions. To clarify its potential as a biomarker, large-scale prospective studies are warranted to longitudinally assess telomere length in leukocytes in maternal peripheral blood, placental tissue, and cord blood, and to establish optimal threshold values.