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Lee SM, Moon JY, Lim BY, Kim SM, Park CW, Kim BJ, Jun JK, Norwitz ER, Choi MH, Park JS. Increased biosynthesis and accumulation of cholesterol in maternal plasma, but not amniotic fluid in pre-eclampsia. Sci Rep 2019; 9:1550. [PMID: 30733456 PMCID: PMC6367404 DOI: 10.1038/s41598-018-37757-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 12/06/2018] [Indexed: 01/14/2023] Open
Abstract
Preeclampsia is one of the most serious complications during pregnancy, defined as development of hypertension during late pregnancy affecting other organ systems (proteinuria, thrombocytopenia, renal insufficiency, liver involvement, cerebral symptoms or pulmonary edema). Preeclampsia is known to be associated with significant dyslipidemia, but the cause or mechanism of this metabolic aberration is not clear. Quantitative analysis of cholesterol precursors and metabolites can reveal metabolic signatures of cholesterol, and provide insight into cholesterol biosynthetic and degradation pathways. We undertook this study to compare the metabolic signatures of cholesterol in serum and amniotic fluid collected from women who delivered in the late preterm period. Matching serum and amniotic fluid samples were collected from women who delivered in the late preterm period (34-0/7–36-6/7 weeks), had undergone amniocentesis within 3 days of delivery, had no evidence of rupture of membranes or intra-amniotic infection/inflammation, and who had not received antenatal corticosteroid prior to amniocentesis. Patients were classified into 3 groups according to the etiology of their preterm birth: Group 1, preeclampsia; Group 2, spontaneous preterm labor; Group 3, other maternal medical indications for iatrogenic preterm birth. Quantitative metabolite profiling of cholesterols was performed using gas chromatography-mass spectrometry. A total of 39 women were included in the analysis (n = 14 in Group 1, n = 16 in Group 2, n = 9 in Group 3). In maternal blood, patients in Group 1 had significantly higher ratios of cholesterol/desmosterol and cholesterol/7-dehydrocholesterol (which represent 24- and 7-reductase enzyme activity, respectively) than those in Group 3 (p < 0.05 for each), which suggests increased cholesterol biosynthesis. In contrast, patients in Group 1 had significantly decreased ratios of individual cholesterol esters/cholesterol and total cholesterol esters/cholesterol than those in Groups 3 (p < 0.01 for each), suggesting increased reverse cholesterol transport. No differences in cholesterol ratios were found in amniotic fluid among the 3 groups. In conclusion, the metabolic signatures of cholesterol suggest increased cholesterol biosynthesis and accumulation in the maternal blood (but not amniotic fluid) of women with preeclampsia.
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Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics & Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Ju-Yeon Moon
- College of Pharmacy, The Catholic University of Korea, Gyeonggi-do, Korea
| | - Byeong-Yun Lim
- Molecular Recognition Research Center, Korea Institute of Science & Technology, Seoul, Korea
| | - Sun Min Kim
- Department of Obstetrics & Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics & Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chan-Wook Park
- Department of Obstetrics & Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Byoung Jae Kim
- Department of Obstetrics & Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics & Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics & Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Errol R Norwitz
- Department of Obstetrics & Gynecology, Tufts University School of Medicine, Boston, MA, USA
| | - Man Ho Choi
- Molecular Recognition Research Center, Korea Institute of Science & Technology, Seoul, Korea.
| | - Joong Shin Park
- Department of Obstetrics & Gynecology, Seoul National University College of Medicine, Seoul, Korea.
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Kasim HH, Masri MA, Noh NA, Mokhtar A, Mokhtar RH. Clinical implications of blood pressure variability (BPV) in pregnancies: a review. Horm Mol Biol Clin Investig 2019; 39:/j/hmbci.ahead-of-print/hmbci-2018-0060/hmbci-2018-0060.xml. [PMID: 30712023 DOI: 10.1515/hmbci-2018-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/13/2018] [Indexed: 11/15/2022]
Abstract
Background Hypertension disorder in pregnancy (HDP) is the second most common contributor to maternal morbidity and mortality worldwide. Blood pressure variability (BPV), with the assistance of ambulatory blood pressure monitoring (ABPM), measures blood pressure readings in pregnant women and has the potential to predict the occurrence of pregnancy-induced hypertension (PIH) or preeclampsia (PE) before any symptoms develop. Methodology Studies involving ABPM among pregnant women were identified using electronic databases such as PubMed, Scopus, Google Scholar, ScienceDirect, Medscape, Ovid and ProQuest. These electronic databases were assessed from 1990 to 2018. Keywords used to search for literatures included a combination of BPV matched with pregnancy, pregnant women and HDP, gestational hypertension and/or PE. Results Out of 21,526 articles identified, a total of 10 studies met the criteria. Seven articles used the spectral analysis method while another two articles used a combination of spectral analysis, time domain and a non-linear method for BPV analysis. The final article described BPV as vagal baroreflex. Four articles agreed that high frequency (HF) BPV was mainly dominant from the second trimester until 4 days postpartum in HDP patients. This reflects the dominant features of parasympathetic activities among these patients. Two articles that used time domain also agreed that standard deviation (SD) BPV increased in PE patients. Conclusions In pregnancy, BPV has a strong impact on the knowledge understanding of the disease in clinical fields, allows a superior ability to predict PIH and PE in mid-pregnancy and offers potential value for addressing hypertension in pregnancy.
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Affiliation(s)
- Hanis Hidayu Kasim
- Medical Sciences (Physiology), Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia, Phone: +603-4289 2400, Fax : +603-4289 2477
| | - Maizatul Azma Masri
- Obstetrics and Gynaecology, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Nor Azila Noh
- Medical Sciences (Physiology), Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Azlina Mokhtar
- Surgical Based Discipline, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Rafidah Hanim Mokhtar
- Medical Sciences (Physiology), Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia, Phone: +603-4289 2400, Fax : +603-4289 2477
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Ortved D, Hawkins TLA, Johnson JA, Hyett J, Metcalfe A. Cost-effectiveness of first-trimester screening with early preventative use of aspirin in women at high risk of early-onset pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:239-244. [PMID: 29700870 DOI: 10.1002/uog.19076] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/30/2018] [Accepted: 04/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Pre-eclampsia (PE) remains a leading cause of maternal and fetal morbidity and mortality. A first-trimester screening algorithm predicting the risk of early-onset PE has been developed and validated. Early prediction coupled with initiation of aspirin at 11-13 weeks in women identified as high risk is effective at reducing the prevalence of early-onset PE. The aim of this study was to evaluate the cost-effectiveness of this first-trimester screening program coupled with early use of low-dose aspirin in women at high risk of developing early-onset PE, in comparison to current practice in Canada. METHODS A decision analysis was performed based on a theoretical population of 387 516 live births in Canada in 1 year. The clinical and financial impact of early preventative screening using the Fetal Medicine Foundation algorithm for prediction of early-onset PE coupled with early (< 16 weeks) use of low-dose aspirin in those at high risk was simulated and compared with current practice using decision-tree analysis. The probabilities at each decision point and associated costs of utilized resources were calculated based on published literature and public databases. RESULTS Of the theoretical 387 516 births per year, the estimated prevalence of early PE based on first-trimester screening and aspirin use was 705 vs 1801 cases based on the current practice. This was associated with an estimated total cost of C$9.52 million with the first-trimester screening program compared with C$23.91 million with current practice for the diagnosis and management of women with early-onset PE. This equals an annual cost saving to the Canadian healthcare system of approximately C$14.39 million. CONCLUSIONS The implementation of a first-trimester screening program for PE and early intervention with aspirin in women identified as high risk for early PE has the potential to prevent a significant number of early-onset PE cases with a substantial associated cost saving to the healthcare system in Canada. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Ortved
- Department of Medicine, Royal Inland Hospital, Kamloops, BC, Canada
| | - T L-A Hawkins
- Department of Medicine and Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - J-A Johnson
- Department of Medicine and Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - J Hyett
- Central Clinical School, Faculty of Medicine, University of Sydney; and Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - A Metcalfe
- Department of Medicine and Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
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Snead CM, Strassberg E, Overcash R, Stark L, Paglia MJ, Schulkin J, Jelin A. Obstetricians' knowledge and practices regarding the management of preeclampsia. J Matern Fetal Neonatal Med 2019; 33:2970-2975. [PMID: 30669908 DOI: 10.1080/14767058.2019.1566311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Preeclampsia affects over 4% of pregnancies in the United States. Management of preeclampsia is dependent on the severity of the condition and can range from expectant management to early delivery and inpatient observation. After publication of the hypertension in Pregnancy Task Force guidelines in 2013, little is known about their implementation and acceptance by practicing obstetricians and maternal-fetal medicine (MFM) specialists.Objective: To evaluate Obstetricians' knowledge and practices regarding the management of preeclampsia.Methods: A prospective survey was administered to ob-gyns at three different hospital systems in the Northeastern United States to assess practices regarding preeclampsia management and prevention.Results: A total of 87 out of 130 providers completed and returned a questionnaire (66.9% response rate). Providers with a subspecialty in MFM made up 44.3% of the sample. 90.7% of respondents agreed that preeclampsia is a common diagnosis in their practice, while 85% agreed that aspirin is useful for reducing a patient's risk of preeclampsia. 68.8% of providers reported not administering magnesium sulfate in labor to reduce seizure risk in patients with preeclampsia without severe features. Only 5.8% of providers reported using a preeclampsia prediction algorithm, all of whom were MFMs. Providers who specialized in MFM were more likely to prescribe aspirin for preeclampsia prevention in patients with chronic hypertension (26, 74.3% vs. 17, 39.5%, p = .002). MFM specialists were also more likely to counsel patients with abnormal biomarkers on the risk of preeclampsia (23, 69.7% vs. 15, 35.7%, p = .005).Conclusion: Efforts to inform practicing ob-gyns about the best practices for preeclampsia management and prevention have been largely successful, though there are still discrepancies between current recommendations and practice. Differences between general OBGYNs and MFM specialists were also significant with regards to practice. Given the acknowledgement of how common diagnoses of preeclampsia are in respondents' practices, better education and distribution of guidelines on management of preeclampsia is needed.
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Affiliation(s)
- Carrie M Snead
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Emmie Strassberg
- Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville,PA, USA
| | - Rachael Overcash
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Lauren Stark
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Michael J Paglia
- Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville,PA, USA
| | - Jay Schulkin
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Angie Jelin
- Department of Gynecology and Obstetrics, Johns Hopkins University Hospital, Baltimore,MD, USA
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Early preterm preeclampsia outcomes by intended mode of delivery. Am J Obstet Gynecol 2019; 220:100.e1-100.e9. [PMID: 30273585 DOI: 10.1016/j.ajog.2018.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/09/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The optimal route of delivery in early-onset preeclampsia before 34 weeks is debated because many clinicians are reluctant to proceed with induction for perceived high risk of failure. OBJECTIVE Our objective was to investigate labor induction success rates and compare maternal and neonatal outcomes by intended mode of delivery in women with early preterm preeclampsia. STUDY DESIGN We identified 914 singleton pregnancies with preeclampsia in the Consortium on Safe Labor study for analysis who delivered between 24 0/7 and 33 6/7 weeks. We excluded fetal anomalies, antepartum stillbirth, or spontaneous preterm labor. Maternal and neonatal outcomes were compared between women undergoing induction of labor (n = 460) and planned cesarean delivery (n = 454) and women with successful induction of labor (n = 214) and unsuccessful induction of labor (n = 246). We calculated relative risks and 95% confidence intervals to determine outcomes by Poisson regression model with propensity score adjustment. The calculation of propensity scores considered covariates such as maternal age, gestational age, parity, body mass index, tobacco use, diabetes mellitus, chronic hypertension, hospital type and site, birthweight, history of cesarean delivery, malpresentation/breech, simplified Bishop score, insurance, marital status, and steroid use. RESULTS Among the 460 women with induction (50%), 47% of deliveries were vaginal. By gestational age, 24 to 27 6/7, 28 to 31 6/7, and 32 to 33 6/7, the induction of labor success rates were 38% (12 of 32), 39% (70 of 180), and 54% (132 of 248), respectively. Induction of labor compared with planned cesarean delivery was less likely to be associated with placental abruption (adjusted relative risk, 0.33; 95% confidence interval, 0.16-0.67), wound infection or separation (adjusted relative risk, 0.23; 95% confidence interval, 0.06-0.85), and neonatal asphyxia (0.12; 95% confidence interval, 0.02-0.78). Women with vaginal delivery compared with those with failed induction of labor had decreased maternal morbidity (adjusted relative risk, 0.27; 95% confidence interval, 0.09-0.82) and no difference in neonatal outcomes. CONCLUSION About half of women with preterm preeclampsia who attempted an induction had a successful vaginal delivery. The rate of successful vaginal delivery increases with gestational age. Successful induction has the benefit of preventing maternal and fetal comorbidities associated with previous cesarean deliveries in subsequent pregnancies. While overall rates of a composite of serious maternal and neonatal morbidity/mortality did not differ between induction of labor and planned cesarean delivery groups, women with failed induction of labor had increased maternal morbidity highlighting the complex route of delivery counseling required in this high-risk population of women.
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Romanowicz L, Gogiel T, Galewska Z, Bruczko M, Bączyk J, Roszkowska-Jakimiec W, Sobolewski K. Divergent changes in the content and activity of MMP-26 and TIMP-4 in human umbilical cord tissues associated with preeclampsia. Eur J Obstet Gynecol Reprod Biol 2018; 231:48-53. [PMID: 30321788 DOI: 10.1016/j.ejogrb.2018.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/06/2018] [Accepted: 10/07/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Preeclampsia is the most common disorder associated with pregnancy. Our earlier findings revealed a substantial increase in the amount of matrix metalloproteinase-26 (matrilysin 2; MMP-26) in preeclamptic umbilical cord blood. The role of MMP-26 in preeclamptic umbilical cord tissue has not been fully elucidated. Some reports have indicated that the expression of matrilysin 2 and tissue inhibitor of matrix metalloproteinase 4 (TIMP-4) is coordinately regulated during progression of various diseases. STUDY DESIGN Therefore, we decided to assess the expression and activity of MMP-26 and TIMP-4 in normal and preeclamptic umbilical cord tissues - umbilical cord arteries (UCA), vein (UCV) and Wharton's jelly (WJ). Tissues obtained from 10 normal (control material) and 10 preeclamptic umbilical cords were assessed using immunoenzymatic assay, Western immunoblotting, reverse transcriptase - polymerase chain reaction and fluorometric determination of the enzyme activity. RESULTS All umbilical cord tissues, both control and preeclamptic, expressed MMP-26 and TIMP-4 in macromolecular complexes. Preeclampsia induced a significant increase in the content and actual activity of MMP-26 in UCV and WJ, as compared to control. The content of TIMP-4 in preeclamptic UCV and WJ was reduced. The content of MMP-26 mRNA was lower in UCA and UCV, whereas higher in WJ in preeclampsia. CONCLUSIONS Divergent changes in MMP-26 mRNA and protein expression suggest a difference in the factors controlling the matrilysin synthesis in healthy and preeclamptic subjects. The decrease in TIMP-4 content in preeclamptic UCV might be the main reason for significantly higher actual activity of MMP-26 in that tissue. Only in preeclamptic Wharton's jelly the changes were compatible in terms of the content and activity of MMP-26 and TIMP-4. It cannot be excluded that similar alterations can be observed for the whole vascular system of newborns delivered by mothers with preeclampsia.
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Affiliation(s)
- Lech Romanowicz
- Department of Medical Biochemistry, Medical University of Białystok, Białystok, Poland.
| | - Tomasz Gogiel
- Department of Medical Biochemistry, Medical University of Białystok, Białystok, Poland
| | - Zofia Galewska
- Department of Medical Biochemistry, Medical University of Białystok, Białystok, Poland
| | - Marta Bruczko
- Department of Medical Biochemistry, Medical University of Białystok, Białystok, Poland
| | - Justyna Bączyk
- Department of Medical Biochemistry, Medical University of Białystok, Białystok, Poland
| | | | - Krzysztof Sobolewski
- Department of Medical Biochemistry, Medical University of Białystok, Białystok, Poland
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Abstract
Hypertensive disorders of pregnancy are a heterogeneous group of conditions that include chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. These disorders account for a significant proportion of perinatal morbidity and mortality nearly 10% of all maternal deaths in the United States. Given the substantial health burden of hypertensive disorders in pregnancy, there is increasing interest in optimizing management of these conditions. This article summarizes the diagnosis and management of each of the disorders in the spectrum of hypertension in pregnancy and highlights recent updates in the field.
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Affiliation(s)
- Amelia L M Sutton
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Women and Infants Center, 1700 6th Avenue South, Birmingham, AL 35249, USA.
| | - Lorie M Harper
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Women and Infants Center, 1700 6th Avenue South, Birmingham, AL 35249, USA
| | - Alan T N Tita
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Women and Infants Center, 1700 6th Avenue South, Birmingham, AL 35249, USA
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Kose S, Tuna G, Nuriyeva G, Altunyurt S, Islekel GH, Doğan OE. A prospective cohort study on the prediction of the diagnosis-to-delivery time in preeclamptic pregnancies: should the sFlt-1/PlGF ratio be added to routine evaluations? Arch Gynecol Obstet 2018; 298:911-920. [DOI: 10.1007/s00404-018-4903-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 09/06/2018] [Indexed: 11/24/2022]
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Weitzner O, Yagur Y, Weissbach T, Man El G, Biron-Shental T. Preeclampsia: risk factors and neonatal outcomes associated with early- versus late-onset diseases. J Matern Fetal Neonatal Med 2018; 33:780-784. [PMID: 30001660 DOI: 10.1080/14767058.2018.1500551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: This study examined the effects of early-onset preeclampsia (EOPE) and late-onset preeclampsia (LOPE) on short-term maternal and neonatal morbidity, as well as risk factors associated with early-onset and late-onset diseases.Method: This retrospective, cohort study included pregnant women who had been diagnosed with PE during pregnancy. Electronic medical records were reviewed for demographics and medical history, laboratory tests, and delivery data. The women were grouped according to EOPE (<34 weeks) and LOPE (≥34 weeks). Power analysis revealed that a sample size of 35 was sufficient for each PE group, under the assumptions of type I error (two-sided) of 5% and at least 80% power to detect a 30% difference in composite outcomes between EOPE and LOPE.Results: Among 101 patients, 35 (34.7%) had EOPE and 66 (65.3%) developed LOPE. Alpha fetoprotein (AFP) and unconjugated estriol (UE3) were higher in the early-onset group (p = .015 and p= .002, respectively) and might be predictors of EOPE. There was a positive correlation between gestational age at PE diagnosis and gestational age at delivery. Patients with EOPE delivered earlier than patients with LOPE did (p<.0001).Conclusions: Patients who developed EOPE had higher of AFP and UE3 values at their second trimester biochemical screening. These parameters might be predictors of EOPE. We found a positive correlation between early gestational age at PE diagnosis and preterm delivery.
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Affiliation(s)
- Omer Weitzner
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Yagur
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Man El
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Odun-Ayo F, Moodley J, Naicker T. Urinary clusterin and glutathione-s-transferase levels in HIV positive normotensive and preeclamptic pregnancies. Hypertens Pregnancy 2018; 37:160-167. [PMID: 30024772 DOI: 10.1080/10641955.2018.1498881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the level and effect of urinary clusterin (CLU) and glutathione-s-transferase (GST) proteins in normotensive and preeclamptic pregnant women with HIV infection. METHODS The urine concentration of CLU and GST in normotensive (n = 38) and preeclamptic pregnant (n = 38) women stratified by HIV status were estimated using the Bio-Plex® ProTM immunoassay. RESULTS Across the group, a significant down-regulation of CLU (p = 0.039) with a reduced trend in GST was shown in HIV positive preeclampsia. CONCLUSION HIV infection affects the activity of urinary CLU protein in HIV positive preeclampsia. However, the cytoprotective role of these proteins neutralizes the oxidative radicals associated with preeclampsia development through complement response in HIV infection.
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Affiliation(s)
- Frederick Odun-Ayo
- a Optics and Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Jagidesa Moodley
- b Women's Health and HIV Research Unit, Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa
| | - Thajasvarie Naicker
- a Optics and Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa
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Sak S, Barut M, Çelik H, Incebiyik A, Ağaçayak E, Uyanikoglu H, Kirmit A, Sak M. Copper and ceruloplasmin levels are closely related to the severity of preeclampsia. J Matern Fetal Neonatal Med 2018; 33:96-102. [PMID: 29886772 DOI: 10.1080/14767058.2018.1487934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: The aim of this study was to investigate the maternal serum concentrations of copper (Cu) and ceruloplasmin (CP) in patients with mild preeclampsia, severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and to determine their association with the severity of the disease.Methods: This study was carried out at the largest tertiary care health center in the southeast region in Turkey and Department of Obstetrics and Gynecology, Dicle University Hospital. A total of 179 pregnant women, including 58 healthy pregnant women and 71 mild preeclampsia, 26 severe preeclampsia, and 24 HELLP syndrome cases classified according to the American College of Obstetricians and Gynecologists' 2013 guidelines were included in this prospective study. Blood samples were taken from all the pregnant women to evaluate the serum Cu and CP levels. The Cu level was determined via atomic absorption/emission spectroscopy, while the serum CP level was assessed with a nephelometric assay using an automatic image analyzer. Spearman's rank correlation tests were used to determine the correlations between the serum levels of the antioxidative markers and the preeclampsia severity.Results: The mean ± SD of the Cu was 81.2 ± 11.84 µg/dl in the mild preeclampsia cases and 160.2 ± 20.89 µg/dl in the severe preeclampsia cases (p < .001). The mean ± SD of the CP was 33.0 ± 4.81 mg/dl in the mild preeclampsia cases and 65.3 ± 9.17 mg/dl in the severe preeclampsia cases (p < .001). The Cu and CP levels were significantly higher in the patients with HELLP syndrome, which is an advanced and more severe form of severe preeclampsia, than in the mild and severe preeclampsia patients (p < .001 and p < .001, respectively). Therefore, the serum Cu and CP levels were correlated with the severity of preeclampsia (r = 859, p < .001 and r = 786, p < .001, respectively). In addition, there was a positive correlation between the serum Cu and CP levels and the systolic and diastolic blood pressure values and aspartate amino transferase levels (AST), and a negative correlation between the serum Cu and CP levels and the platelet count.Conclusion: This was the first study in which the ceruloplasmin and Cu levels were investigated in HELLP syndrome patients. When considering the results obtained in the present study, there were significant relationships between the Cu, CP levels which are the markers of oxidative stress and the preeclampsia severity.
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Affiliation(s)
- Sibel Sak
- Harran University School of Medicine, Sanliurfa, Turkey
| | - Mert Barut
- Harran University School of Medicine, Sanliurfa, Turkey
| | - Hakim Çelik
- Harran University School of Medicine, Sanliurfa, Turkey
| | | | - Elif Ağaçayak
- Department of Obstetrics and Gynecology, School of Medicine, Dicle University, Diyarbakir, Turkey
| | | | - Adnan Kirmit
- Harran University School of Medicine, Sanliurfa, Turkey
| | - Muhammet Sak
- Harran University School of Medicine, Sanliurfa, Turkey
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Kongwattanakul K, Saksiriwuttho P, Chaiyarach S, Thepsuthammarat K. Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome. Int J Womens Health 2018; 10:371-377. [PMID: 30046254 PMCID: PMC6054275 DOI: 10.2147/ijwh.s168569] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine the incidence of preeclampsia with severe features among pregnant women and evaluate the characteristics, maternal complications, and perinatal outcomes between nonsevere preeclampsia versus preeclampsia with severe features and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. MATERIALS AND METHODS A retrospective descriptive study was conducted at Khon Kaen University's Srinagarind Hospital, a tertiary care facility in northeast Thailand. The pregnant women who had been diagnosed with preeclampsia according to American College of Obstetricians and Gynecologists guidelines from January 1, 2012 to December 31, 2016 were identified and their medical records were reviewed. Various characteristics were examined to compare maternal complications and perinatal outcomes. RESULTS There was a total of 11,199 deliveries during the study period, out of which 213 preeclamptic women were identified. One hundred and seven women (9.6 per 1,000 deliveries) were diagnosed with nonsevere preeclampsia, 90 (8 per 1,000 deliveries) had preeclampsia with severe features, and 16 (1.4 per 1,000 deliveries) had HELLP syndrome. Twenty-one women (9.9%) experienced postpartum hemorrhage; 11 (10.3%) in the nonsevere features preeclampsia group and 10 (9.4%) in the preeclampsia with severe features and HELLP syndrome group. Placental abruption (3 women; 1.4%) and heart failure (1 women; 0.4%) only occurred among women in the preeclampsia with severe features group. Neonatal complications were significantly higher in the preeclampsia with severe features and HELLP syndrome group (low birth weight =35.1% versus 74.3%, p<0.001; birth asphyxia =4.4% versus 18.2%, p=0.001; neonatal intensive care unit admission =7.0% versus 30.9%, p<0.001; neonatal resuscitation =15.8% versus 42.7%, p<0.001). Stillbirths only occurred in cases of preeclampsia with severe features and HELLP syndrome (3 cases, 1.4%). Intrapartum death was higher in cases of preeclampsia with severe features and HELLP syndrome, but without statistical significance (2.6% versus 6.4%, p=0.190). CONCLUSION The incidence of preeclampsia with severe features and HELLP syndrome was 9.5 per 1,000 deliveries. Severe maternal and perinatal outcomes were more commonly observed.
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Affiliation(s)
- Kiattisak Kongwattanakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,
| | - Piyamas Saksiriwuttho
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,
| | - Sukanya Chaiyarach
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,
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Role of endogenous digitalis-like factors in the clinical manifestations of severe preeclampsia: a sytematic review. Clin Sci (Lond) 2018; 132:1215-1242. [PMID: 29930141 DOI: 10.1042/cs20171499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/26/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
Endogenous digitalis-like factor(s), originally proposed as a vasoconstrictor natriuretic hormone, was discovered in fetal and neonatal blood accidentally because it cross-reacts with antidigoxin antibodies (ADAs). Early studies using immunoassays with ADA identified the digoxin-like immuno-reactive factor(s) (EDLF) in maternal blood as well, and suggested it originated in the feto-placental unit. Mammalian digoxin-like factors have recently been identified as at least two classes of steroid compounds, plant derived ouabain (O), and several toad derived bufodienolides, most prominent being marinobufagenin (MBG). A synthetic pathway for MBG has been identified in mammalian placental tissue. Elevated maternal and fetal EDLF, O and MBG have been demonstrated in preeclampsia (PE), and inhibition of red cell membrane sodium, potassium ATPase (Na, K ATPase (NKA)) by EDLF is reversed by ADA fragments (ADA-FAB). Accordingly, maternal administration of a commercial ADA-antibody fragment (FAB) was tested in several anecdotal cases of PE, and two, small randomized, prospective, double-blind clinical trials. In the first randomized trial, ADA-FAB was administered post-partum, in the second antepartum. In the post-partum trial, ADA-FAB reduced use of antihypertensive drugs. In the second trial, there was no effect of ADA-FAB on blood pressure, but the fall in maternal creatinine clearance (CrCl) was prevented. In a secondary analysis using the pre-treatment maternal level of circulating Na, K ATPase (NKA) inhibitory activity (NKAI), ADA-FAB reduced the incidence of pulmonary edema and, unexpectedly, that of severe neonatal intraventricular hemorrhage (IVH). The fall in CrCl in patients given placebo was proportional to the circulating level of NKAI. The implications of these findings on the pathophysiology of the clinical manifestations PE are discussed, and a new model of the respective roles of placenta derived anti-angiogenic (AAG) factors (AAGFs) and EDLF is proposed.
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Reduced placental protein 13 (PP13) in placental derived syncytiotrophoblast extracellular vesicles in preeclampsia – A novel tool to study the impaired cargo transmission of the placenta to the maternal organs. Placenta 2018; 66:17-25. [DOI: 10.1016/j.placenta.2018.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022]
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Goldman BG, Hehir MP, Yambasu S, O'Donnell EM. The presentation and management of platelet disorders in pregnancy. Eur J Haematol 2018; 100:560-566. [DOI: 10.1111/ejh.13049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Bernardus G. Goldman
- Department of Obstetrics and Gynaecology; University Hospital Waterford; Waterford Ireland
| | - Mark P. Hehir
- Department of Obstetrics and Gynaecology; University Hospital Waterford; Waterford Ireland
| | | | - Edward M. O'Donnell
- Department of Obstetrics and Gynaecology; University Hospital Waterford; Waterford Ireland
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Cavaignac-Vitalis M, Vidal F, Simon-Toulza C, Boulot P, Guerby P, Chantalat E, Parant O. Conservative versus active management in HELLP syndrome: results from a cohort study. J Matern Fetal Neonatal Med 2017; 32:1769-1775. [PMID: 29228827 DOI: 10.1080/14767058.2017.1416604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE HELLP syndrome exposes to severe maternal and fetal complications. Prompt delivery is thus recommended after 34 weeks of gestation, or earlier in case of nonreassuring maternofetal conditions. However, no consensus has been raised in the treatment of HELLP syndrome occurring before 34 weeks of gestation, when both maternal and fetal conditions are stable: it remains still unclear whether an active attitude should be prioritized over expectant management. Herein, we aimed to compare mother and child outcomes according to the type of obstetrical management, either active or conservative. STUDY DESIGN Retrospective and multicenter study involving two tertiary care units. In Center A, obstetrical attitude consisted in expectant management: all women received full antenatal betamethasone therapy and pregnancy was prolonged until maternal or fetal follow up indicated delivery. In Center B, management was active: all deliveries were initiated within 48 hours following diagnosis. RESULTS From 2003 to 2011, 118 patients were included (87 in Center A, 31 in Center B). Both groups of patients were similar regarding maternal and fetal features at baseline. Active management led to increased risks of post-partum hemorrhage (relative risks (RR) = 5.38, 95%CI: 1.2-24.06) and neonatal morbidity including respiratory distress syndrome (RR = 3.1, 95%CI: 1.4-7.1), sepsis (RR = 2.5, 95%CI: 1.1-6.0), necrotizing enterocolitis (RR = 4.8, 95%CI: 1.1-21.2), intracerebral hemorrhage (RR = 5.4, 95%CI: 2.1-13.6), and blood transfusion (RR = 6.1, 95%CI: 1.7-21.7). CONCLUSIONS Conservative management may be beneficial for both mother and newborn in patients with stable HELLP syndrome. Identification of maternal and fetal specific prognostic factors would allow a better stratification of women with HELLP syndrome according to illness progressive potential, resulting in a more personalized management.
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Affiliation(s)
- Marie Cavaignac-Vitalis
- a Université de Toulouse III, UMR1027 , Toulouse , France.,b CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier , Toulouse , France
| | - Fabien Vidal
- b CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier , Toulouse , France
| | - Caroline Simon-Toulza
- b CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier , Toulouse , France
| | - Pierre Boulot
- c CHU Montpellier, Pôle de Gynécologie Obstétrique , Montpellier , France
| | - Paul Guerby
- a Université de Toulouse III, UMR1027 , Toulouse , France.,b CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier , Toulouse , France
| | - Elodie Chantalat
- a Université de Toulouse III, UMR1027 , Toulouse , France.,b CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier , Toulouse , France
| | - Olivier Parant
- a Université de Toulouse III, UMR1027 , Toulouse , France.,b CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier , Toulouse , France.,d Inserm, UMR1027 , Toulouse , France
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Zhang W, Chen X, Yan Z, Chen Y, Cui Y, Chen B, Huang C, Zhang W, Yin X, He QY, He F, Wang T. Detergent-Insoluble Proteome Analysis Revealed Aberrantly Aggregated Proteins in Human Preeclampsia Placentas. J Proteome Res 2017; 16:4468-4480. [PMID: 28965414 DOI: 10.1021/acs.jproteome.7b00352] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Preeclampsia (PE) is a placenta disease, featured by hypertension, proteinuria, and other multiorgan dysfunctions, and its etiology is unclear. We and others have shown that intensive endoplasmic reticulum (ER) stress and unfolded protein response (UPR) occur in the PE placenta. In this study, we isolated detergent-insoluble proteins (DIPs) from human placenta tissues, which were enriched with protein aggregates, to characterize the placenta UPR in PE. With data-independent acquisition (DIA) mass spectrometry, we identified 2066 DIPs across all normal (n = 10) and PE (n = 10) placenta samples, among which 110 and 108 DIPs were significantly up- and down-regulated in PE, respectively. Per clustering analysis, differential DIPs could generally distinguish PE from normal placentas. We verified the MS quantitation of endoglin and vimentin by immunoblotting. In addition, we observed that PE placenta tissues have remarkably more endoglin in the cytoplasm. Furthermore, we found that DIPs were evenly distributed across different chromosomes and could be enriched in diversified gene ontology terms, while differential DIPs avoided to distribute on X-chromosome. Significantly up-regulated DIPs in PE were focused on the top functions of lipid metabolism, while 23 of these DIPs could form the top network regulating cellular movement, development, growth, and proliferation. Our results implicate that human PE placentas have disease-relevant differential DIPs, which reflect aberrantly aggregated proteins of placental tissues. The mass spectrometry proteomics data have been deposited to ProteomeXchange consortium with the data set identifier PXD006654, and iProX database (accession number: IPX0000948000).
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Affiliation(s)
- Wanling Zhang
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University , 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Xing Chen
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University , 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Ziqi Yan
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University , 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Yang Chen
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University , 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Yizhi Cui
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University , 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | | | | | | | - Xingfeng Yin
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University , 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Qing-Yu He
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University , 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | | | - Tong Wang
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University , 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
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69
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Meiri H, Osol G, Cetin I, Gizurarson S, Huppertz B. Personalized Therapy Against Preeclampsia by Replenishing Placental Protein 13 (PP13) Targeted to Patients With Impaired PP13 Molecule or Function. Comput Struct Biotechnol J 2017; 15:433-446. [PMID: 29034064 PMCID: PMC5633742 DOI: 10.1016/j.csbj.2017.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/27/2017] [Accepted: 09/12/2017] [Indexed: 12/16/2022] Open
Abstract
Hypertensive disorders affect about one third of all people aged 20 and above, and are treated with anti-hypertensive drugs. Preeclampsia (PE) is one form of such disorders that only develops during pregnancy. It affects ten million pregnant women globally and additionally causes fetal loss and major newborn disabilities. The syndrome's origin is multifactorial, and anti-hypertensive drugs are ineffective in treating it. Biomarkers are helpful for predict its development. Generic drugs, such as low dose aspirin, were proven effective in preventing preterm PE. However, it does not cure the majority of cases and many studies are underway for fighting PE with extended use of additional generic drugs, or through new drug development programs. This review focuses on placental protein 13 (PP13). This protein is only expressed in the placenta. Impaired PP13 DNA structure and/or its reduced mRNA expression leads to lower blood PP13 level that predict a higher risk of developing PE. Two polymorphic PP13 variants have been identified: (1) The promoter PP13 variant with an "A/A" genotype in the -98 position (versus "A/C" or "C/C"). Having the "A/A" genotype is coupled to lower PP13 expression, mainly during placental syncytiotrophoblast differentiation and, if associated with obesity and history of previous preeclampsia, it accurately predicts higher risk for developing the disorder. (2) A thymidine deletion at position 221 causes a frame shift in the open reading frame, and the formation of an early stop codon resulting in the formation of DelT221, a truncated variant of PP13. In pregnant rodents, both short- and long- term replenishment of PP13 causes reversible hypotension and vasodilation of uterine vessels. Long-term exposure is also accompanied by the development of larger placentas and newborns. Also, only w/t PP13 is capable of inducing leukocyte apoptosis, providing maternal immune tolerance to pregnancy. Based on published data, we propose a targeted PP13 therapy to fight PE, and consider the design and conduct of animal studies to explore this hypothesis. Accordingly, a new targeted therapy can be implemented in humans combining prediction and prevention.
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Affiliation(s)
- Hamutal Meiri
- Hy Laboratories, Rehovot, and TeleMarpe, Tel Aviv, Israel
| | - George Osol
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Irene Cetin
- Department of Obstetrics and Gynecology, University of Milano, Italy
- Department of Mother and Child, Hospital Luigi Sacco, and Center for Fetal Research “Giorgio Pardi”, Milano, Italy
| | - Sveinbjörn Gizurarson
- Faculty of Pharmaceutical Sciences, School of Health Science, University of Iceland, Reykjavik, Iceland
| | - Berthold Huppertz
- Institute of Cell Biology, Histology and Embryology & Biobank Graz, Medical University of Graz, Graz, Austria
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Zhao Y, Lin L, Lai A. Expression and significance of aquaporin-2 and serum hormones in placenta of patients with preeclampsia. J OBSTET GYNAECOL 2017; 38:42-48. [PMID: 28764583 DOI: 10.1080/01443615.2017.1327516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yurong Zhao
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li Lin
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ailuan Lai
- Department of Obstetrics and Gynecology, Fuxing Hospital, Capital Medical University, Beijing, China
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Sarmiento-Piña M, Reyna-Villasmil E, Mejia-Montilla J, Santos-Bolívar J, Torres-Cepeda D, Reyna-Villasmil N. Valor predictivo de la proteinuria en 24 horas en la resultante neonatal de las preeclámpsicas. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Joung KE, Cataltepe SU, Michael Z, Christou H, Mantzoros CS. Cord Blood Adipocyte Fatty Acid-Binding Protein Levels Correlate With Gestational Age and Birth Weight in Neonates. J Clin Endocrinol Metab 2017; 102:1606-1613. [PMID: 28324040 PMCID: PMC5443332 DOI: 10.1210/jc.2016-3831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/26/2017] [Indexed: 02/08/2023]
Abstract
CONTEXT Infants born small for gestational age (SGA) have increased risk for obesity and metabolic syndrome, but the underlying mechanisms are not fully elucidated. Adipocyte fatty acid-binding protein (AFABP) is an adipokine that has been implicated in modulation of insulin sensitivity and lipid metabolism. Higher plasma AFABP levels are associated with increased risk of metabolic syndrome and cardiovascular morbidity in adults. Alterations in AFABP levels during fetal growth have not been characterized. OBJECTIVE To examine AFABP levels in neonatal cord blood in relation to gestational age and birth weight. DESIGN A cross-sectional study of 361 neonates born at a tertiary academic center. OUTCOME MEASURES Plasma AFABP levels were measured by enzyme-linked immunosorbent assay. For comparison, venous samples from 26 adults were analyzed. RESULTS AFABP levels were higher in neonates compared with adults (P < 0.01). Preterm infants had higher AFABP levels [48.2 (31.2 to 73.3) ng/mL] compared with full-term infants [35.8 (25.1 to 51.5)] ng/mL, P < 0.01). There was a negative correlation between AFABP and gestational age (r = 0.28, P = 0.02). Among full-term infants, AFABP levels in SGA infants were lower [28.6 (24.2 to 37.3) ng/mL], compared with appropriate for gestational age [36.1 (25.5 to 50.4) ng/mL] and large for gestational age infants [45.0 (24.6 to 62.4) ng/mL, P < 0.05]. CONCLUSIONS These associations may reflect the higher metabolic activity during fetal development. AFABP may also be involved in fetal growth and the association between SGA status and obesity and metabolic syndrome in later life.
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Affiliation(s)
- Kyoung Eun Joung
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
| | - Sule Umit Cataltepe
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
| | - Zoe Michael
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
| | - Helen Christou
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, Massachusetts 02115
| | - Christos S. Mantzoros
- Harvard Medical School, Boston, Massachusetts 02115
- Division of Endocrinology and Metabolism, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215
- Section of Endocrinology, Boston VA Healthcare System, Division of Endocrinology, Jamaica Plain, Massachusetts 02130
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Pitfalls With the New American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy. Clin Obstet Gynecol 2017; 60:141-152. [DOI: 10.1097/grf.0000000000000247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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BALOGUN OLAIDEAASHIMI, SIBAI BAHAM. Counseling, Management, and Outcome in Women With Severe Preeclampsia at 23 to 28 Weeks’ Gestation. Clin Obstet Gynecol 2017; 60:183-189. [DOI: 10.1097/grf.0000000000000250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Sakae C, Sato Y, Kanbayashi S, Taga A, Emoto I, Maruyama S, Mise H, Kim T. Introduction of management protocol for early-onset severe pre-eclampsia. J Obstet Gynaecol Res 2017; 43:644-652. [PMID: 28150368 DOI: 10.1111/jog.13265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/31/2016] [Accepted: 11/20/2016] [Indexed: 11/30/2022]
Abstract
AIM This quality Improvement study evaluated the applicability of our protocol for early-onset severe pre-eclampsia, prepared in April 2013. METHODS We collected data from all women with early-onset severe pre-eclampsia treated at our hospital between March 2008 and August 2015. Neonatal and maternal outcomes were compared between protocol-based (n = 17) and non-protocol-based management groups (n = 28). RESULTS The latency period was significantly longer in the protocol-based than in the non-protocol-based group (21.9 ± 3.7 vs 11.0 ± 2.9 days). Gestational age at delivery was significantly more advanced in the protocol-based than in the non-protocol-based group (31.4 ± 0.6 vs 29.8 ± 0.4 weeks). Serious neonatal complications were significantly less prevalent in the protocol-based than in the non-protocol-based group (26% vs 79%). Among the protocol components, magnesium sulfate use was the only independent factor contributing to the absence of serious neonatal complications. The percentages of women exhibiting persistent proteinuria or hypertension at one, two and three months post-partum were similar between the groups. CONCLUSIONS Strict adherence to our protocol improved neonatal outcomes without affecting maternal prognosis. Routine use of magnesium sulfate could be the most important component of the protocol.
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Affiliation(s)
- Chieko Sakae
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan
| | - Yukiyasu Sato
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan
| | - Shota Kanbayashi
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan
| | - Atsuko Taga
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan
| | - Ikuko Emoto
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan
| | - Shunsuke Maruyama
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan
| | - Hiroko Mise
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan
| | - Tomoko Kim
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan
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Mateus J, Newman R, Sibai BM, Li Q, Barton JR, Combs CA, Guzman E, Boggess KA, Gyamfi C, von Dadelszen P, Woelkers D. Massive Urinary Protein Excretion Associated with Greater Neonatal Risk in Preeclampsia. AJP Rep 2017; 7:e49-e58. [PMID: 28348923 PMCID: PMC5365400 DOI: 10.1055/s-0037-1601866] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective The objective of this study was to compare clinical outcomes of preeclamptic pregnancies according to the proteinuria level. Study Design Secondary analysis of a multicenter prospective cohort study of women with preeclampsia (PE) symptomatology. Nonproteinuria, mild-proteinuria, and massive-proteinuria PEs were defined as: < 165 mg in 12 hours or < 300 mg in 24 hours, 165 mg to 2.69 g in 12 hours or 300 mg to 4.99 g in 24 hours, and ≥ 2.7 g in 12 hours or ≥ 5.0 g in 24 hours, respectively. Individual and composite maternal, fetal, and neonatal outcomes were compared among the PE groups. Results Of the 406 analyzed pregnancies, 36 (8.8%) had massive-proteinuria PE, 268 (66.0%) mild-proteinuria PE, and 102 (25.1%) nonproteinuria PE. Compared with the other groups, massive-proteinuria PE women had significantly higher blood pressures (p < 0.001), epigastric pain (p = 0.007), and uric acid serum levels (p < 0.001) prior to delivery. Composite maternal morbidity was similar across the groups. Delivery < 340/7 weeks occurred in 80.6, 49.3, and 22.5% of massive-proteinuria, mild-proteinuria, and nonproteinuria PE groups, respectively (p < 0.0001). Composite adverse neonatal outcomes were significantly higher in the massive-proteinuria PE compared with the other groups (p = 0.001). Conclusion While potentially not important diagnostically, massive proteinuria is associated with more severe clinical manifestations of PE prompting earlier delivery.
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Affiliation(s)
- Julio Mateus
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Roger Newman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Baha M Sibai
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Qing Li
- Center of Behavioral Epidemiology and Community Health (CBEACH), San Diego State University, San Diego, California
| | - John R Barton
- Department of Obstetrics and Gynecology, Central Baptist Hospital, Lexington, Kentucky
| | | | - Edwin Guzman
- Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Kim A Boggess
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Cynthia Gyamfi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St Geroge's, University of London, London, United Kingdom
| | - Doug Woelkers
- Department of Reproductive Medicine, University of California San Diego, La Jolla, California
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Abstract
The incidence of acute kidney injury in pregnancy (P-AKI) has declined significantly over the last three decades in developing countries. However, it is still associated with significant fetomaternal mortality and morbidity. The diagnosis of P-AKI is based on the serum creatinine increase. The usual formulas for estimating glomerular filtration rate (GFR) are not validated in this population. The incidence of P-AKI with respect to total AKI cases has decreased in the last three decades from 25% in 1980s to 9% in 2000s at our centre. During the first trimester of gestation, AKI develops most often due to septic abortion or hyperemesis gravidarum. Septic abortion related AKI with respect to total AKI decreased from 9% to 5% in our study. Prevention of unwanted pregnancy and avoidance of septic abortion are keys to eliminate abortion associated AKI in early pregnancy. However, we have not seen AKI on account of hyperemesis gravidarum over a period of 33 years at our center. In the third trimester, the differential diagnosis of AKI in association with pregnancy specific conditions namely preeclampsia/HELLP syndrome, acute fatty liver of pregnancy and thrombotic microangiopathies of pregnancy (P-TMA) is more challenging, because these 3 conditions share several clinical features of thrombotic microangiopathy which makes the diagnosis very difficult on clinical grounds. It is imperative to distinguish these conditions to make appropriate therapeutic decisions. Typically, AFLP and HELLP syndrome improve after delivery of the fetus, whereas plasma exchange is the first-line treatment for pregnancy associated thrombotic microangioathies (P-TMA). We observed that preclampsia/eclampsia is the most common cause of AKI in late third trimester and postpartum periods followed by puerperal sepsis and postpartum hemorrhage. Pregnancy-associated thrombotic microangiopathies (aHUS/TTP) and AFLP are rare causes of AKI during pregnancy in developing countries.
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Affiliation(s)
- J Prakash
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - V C Ganiger
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Svirsky R, Maymon R, Melcer Y, Klog E, Cuckle H. First and second trimester maternal serum inhibin A levels in twins with pre-eclampsia. Prenat Diagn 2016; 36:1071-1074. [DOI: 10.1002/pd.4937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Ran Svirsky
- Institute of Ultrasound, Department of Obstetrics and Gynecology; Assaf Harofeh Medical Centre, affiliated with the Sackler School of Medicine; Tel Aviv Israel
- Tel Aviv University; Tel Aviv Israel
| | - Ron Maymon
- Institute of Ultrasound, Department of Obstetrics and Gynecology; Assaf Harofeh Medical Centre, affiliated with the Sackler School of Medicine; Tel Aviv Israel
- Tel Aviv University; Tel Aviv Israel
| | - Yaakov Melcer
- Institute of Ultrasound, Department of Obstetrics and Gynecology; Assaf Harofeh Medical Centre, affiliated with the Sackler School of Medicine; Tel Aviv Israel
- Tel Aviv University; Tel Aviv Israel
| | - Esther Klog
- Institute of Ultrasound, Department of Obstetrics and Gynecology; Assaf Harofeh Medical Centre, affiliated with the Sackler School of Medicine; Tel Aviv Israel
- Tel Aviv University; Tel Aviv Israel
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79
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Assessing progression from mild to severe preeclampsia in expectantly managed preterm parturients. Pregnancy Hypertens 2016; 6:340-343. [DOI: 10.1016/j.preghy.2016.08.230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022]
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Cain MA, Salemi JL, Tanner JP, Kirby RS, Salihu HM, Louis JM. Pregnancy as a window to future health: maternal placental syndromes and short-term cardiovascular outcomes. Am J Obstet Gynecol 2016; 215:484.e1-484.e14. [PMID: 27263996 DOI: 10.1016/j.ajog.2016.05.047] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/27/2016] [Accepted: 05/26/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death among women. Identifying risk factors for future cardiovascular disease may lead to earlier lifestyle modifications and disease prevention. Additionally, interpregnancy development of cardiovascular disease can lead to increased perinatal morbidity in subsequent pregnancies. Identification and implementation of interventions in the short term (within 5 years of first pregnancy) may decrease morbidity in subsequent pregnancies. OBJECTIVE We identified the short-term risk (within 5 years of first pregnancy) of cardiovascular disease among women who experienced a maternal placental syndrome, as well as preterm birth and/or delivered a small-for-gestational-age infant. STUDY DESIGN We conducted a retrospective cohort study using a population-based, clinically enhanced database of women in the state of Florida. Nulliparous women and girls aged 15-49 years experiencing their first delivery during the study time period with no prepregnancy history of diabetes mellitus, hypertension, or heart or renal disease were included in the study. The risk of subsequent cardiovascular disease was compared among women who did and did not experience a placental syndrome during their first pregnancy. Risk was then reassessed among women with placental syndrome and preterm birth or delivering a small-for-gestational-age infant vs those without these adverse pregnancy outcomes. RESULTS The final study population was 302,686 women and girls. Median follow-up time for each patient was 4.9 years. The unadjusted rate of subsequent cardiovascular disease among women and girls with any placental syndrome (11.8 per 1000 women) was 39% higher than the rate among women and girls without a placental syndrome (8.5 per 1000 women). Even after adjusting for sociodemographic factors, preexisting conditions, and clinical and behavioral conditions associated with the current pregnancy, women and girls with any placental syndrome experienced a 19% increased risk of cardiovascular disease (hazard ratio, 1.19; 95% confidence interval, 1.07-1.32). Women and girls with >1 placental syndrome had the highest cardiovascular disease risk (hazard ratio, 1.43; 95% confidence interval, 1.20-1.70), followed by those with eclampsia/preeclampsia alone (hazard ratio, 1.42; 95% confidence interval, 1.14-1.76). When placental syndrome was combined with preterm birth and/or small for gestational age, the adjusted risk of cardiovascular disease increased 45% (95% confidence interval, 1.24-1.71). Women and girls with placental syndrome who then developed cardiovascular disease experienced a 5-fold increase in health care-related costs during follow-up, compared to those who did not develop cardiovascular disease. CONCLUSION Women and girls experiencing placental syndromes and preterm birth or small-for-gestational-age infant are at increased risk of subsequent cardiovascular disease in short-term follow-up. Strategies to identify and improve cardiovascular disease risk in the postpartum period may improve future heart disease outcomes.
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Affiliation(s)
- Mary Ashley Cain
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, FL.
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Jean Paul Tanner
- Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL
| | - Russell S Kirby
- Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Judette M Louis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, FL
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81
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Preterm preeclampsia in relation to country of birth. J Perinatol 2016; 36:718-22. [PMID: 27149056 PMCID: PMC5007604 DOI: 10.1038/jp.2016.73] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the association between maternal country of birth and the risk of preeclampsia+preterm birth (PTB). STUDY DESIGN We completed a population-based study in the entire province of Ontario, where there is universal access to obstetrical care. We included 881 700 singleton livebirths among Canadian-born mothers and 305 547 births among immigrant mothers. Adjusted risk ratios (aRRs) were adjusted for maternal age, parity and income quintile. RESULTS Compared with a rate of preeclampsia+PTB of 4.0 per 1000 among Canadian-born mothers, the aRR of preeclampsia+PTB at 24 to 36 weeks was significantly higher for immigrant women from Nigeria (1.79, 95% confidence interval (CI) 1.12 to 2.84), the Philippines (1.54, 95% CI 1.30 to 1.86), Colombia (1.68, 95% CI 1.04 to 2.73), Jamaica (2.06, 95% CI 1.66 to 2.57) and Ghana (2.12, 95% CI 1.40 to 3.21). The aRRs generally followed a similar pattern for secondary outcomes. Specifically, women from Ghana were at highest risk of preeclampsia+very PTB (4.55, 95% CI 2.57 to 8.06), and women from Jamaica at the highest risk of preeclampsia+indicated PTB (1.89, 95% CI 1.43 to 2.50). CONCLUSION The risk of preeclampsia+PTB is highest among women from a select number of countries. This information can enhance initiatives aimed at reducing the risk of PTB related to preeclampsia.
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Ecker JL, Kaimal A, Mercer BM, Blackwell SC, deRegnier RAO, Farrell RM, Grobman WA, Resnik JL, Sciscione AC, Sciscione AC. Periviable birth: Interim update. Am J Obstet Gynecol 2016; 215:B2-B12.e1. [PMID: 27103153 DOI: 10.1016/j.ajog.2016.04.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including declining and accepting interventions and therapies, based on individual circumstances and patient values.
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83
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Total oxidative and anti-oxidative status, and ADAMTS-12 levels in placenta previa and early-onset severe preeclampsia. Pregnancy Hypertens 2016; 6:295-299. [PMID: 27939472 DOI: 10.1016/j.preghy.2016.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/05/2016] [Indexed: 12/27/2022]
Abstract
AIM This study was carried out due to the discussions in the literature stating that the inverse association between placenta previa (PP) and preeclampsia (PE). The aim of this study was to determine whether total antioxidant status (TAS), and total oxidant status (TOS) and ADAMTS-12 levels differ among early-onset (<34th gestational week) severe PE (EOS-PE), PP and uncomplicated pregnancies. METHODS In this case-control study, serum samples obtained from 26 pregnant with EOS-PE, 31 pregnant with PP, and 32 healthy patients with uncomplicated pregnancies (control group). RESULTS TOS levels were significantly higher in the EOS-PE than in the control group and PP groups (p=0.002, p=0.05, respectively). TAS levels were significantly lower in the EOS-PE than in the control (p<0.001). Although TAS levels were lower in the EOS-PE group than in the PP group, the differences were not statistically significant (p=0.09). There were no significant differences in the ADAMTS-12 levels of the groups. DISCUSSION The data in this study suggested that the balance between oxidative and anti-oxidative substances were comparable and normal in pregnancies complicated by PP when compared to normal pregnancies without placentation abnormality. In support of this, we encountered no case with PE and fetal growth restriction in our study groups suggesting normal placental angiogenesis. Contrarily, EOS-PE was associated with decreased TAS and increased TOS levels in the maternal serum.
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85
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Svirsky R, Levinsohn-Tavor O, Feldman N, Klog E, Cuckle H, Maymon R. First- and second-trimester maternal serum markers of pre-eclampsia in twin pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:560-564. [PMID: 25865365 DOI: 10.1002/uog.14873] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/30/2015] [Accepted: 04/05/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the distribution of first- and second-trimester maternal serum markers in twin pregnancy with and without pre-eclampsia. METHODS One-hundred and forty-four twin and 109 unaffected singleton pregnancies were recruited from the same institution. First- and second-trimester maternal blood samples were stored and measured retrospectively for serum placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (β-hCG) and α-fetoprotein (AFP). All had measurement of first-trimester serum markers, and 167 (66%) had second-trimester tests. Values were expressed in multiples of the gestation-specific median (MoMs) in singletons, adjusted for maternal weight, as appropriate. RESULTS Pre-eclampsia was diagnosed in 12 (9.0%) twin pregnancies of 133 continuing beyond 22 weeks. In unaffected twin pregnancies, all serum markers were statistically significantly increased (P < 0.0001), consistent with a doubling of concentration. Among twin pregnancies, those with pre-eclampsia had a significantly reduced median PlGF compared with surviving unaffected twin pregnancies (0.96 MoM vs 1.46 MoM; P < 0.0002, two-tailed), whilst median PAPP-A, which is known to be reduced in affected singleton pregnancies, was increased (3.91 MoM vs 2.43 MoM; P < 0.0005, two-tailed). The levels of free β-hCG (P < 0.02) and AFP (P < 0.05) were also significantly raised, but to a lesser extent than was the level of PAPP-A. Using a logistic regression algorithm based on first- and second-trimester PlGF and PAPP-A, together with previously published uterine artery Doppler and mean arterial pressure measurements in the same series, the predicted pre-eclampsia detection rate was 65% for a 10% false-positive rate. CONCLUSIONS In twin pregnancy, the predicted detection rate of pre-eclampsia using first- and second-trimester maternal serum and biophysical markers is good. In contrast to singleton pregnancy, PAPP-A levels are raised in the first trimester of twin pregnancies destined to develop pre-eclampsia and therefore a different prediction algorithm is needed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Svirsky
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Levinsohn-Tavor
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Feldman
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Klog
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Cuckle
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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86
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Staff ACA, Andersgaard AB, Henriksen T, Langesæter E, Magnussen E, Michelsen TM, Thomsen LC, Øian P. Chapter 28 Hypertensive disorders of pregnancy and eclampsia. Eur J Obstet Gynecol Reprod Biol 2016; 201:171-8. [PMID: 27160502 DOI: 10.1016/j.ejogrb.2016.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Anne Cathrine Annetine Staff
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway; University of Oslo, The Medical Faculty, Oslo, Norway.
| | | | - Tore Henriksen
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway; University of Oslo, The Medical Faculty, Oslo, Norway
| | - Eldrid Langesæter
- Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Magnussen
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim, Norway
| | | | - Liv Cecilie Thomsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, Tromsø University Hospital, Tromsø, Norway
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87
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Abstract
Preeclampsia is a hypertensive disorder that affects 4% of pregnancies and has a high risk of maternal, fetal, and neonatal morbidity and mortality, as well as long-term cardiovascular risk. Recent updates in the definition, diagnosis, and management guidelines for preeclampsia warrant review by general obstetrician-gynecologists. Screening and prevention algorithms for preeclampsia are available, but ultimately the cure remains delivery of the fetus and placenta. Close monitoring for the development and worsening of preeclampsia during pregnancy is essential to optimize both maternal and fetal/neonatal outcomes.
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Affiliation(s)
- Jaimey M Pauli
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA.
| | - John T Repke
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
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Daglar K, Kirbas A, Timur H, Ozturk Inal Z, Danisman N. Placental levels of total oxidative and anti-oxidative status, ADAMTS-12 and decorin in early- and late-onset severe preeclampsia. J Matern Fetal Neonatal Med 2016; 29:4059-64. [PMID: 26953866 DOI: 10.3109/14767058.2016.1154942] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Preeclampsia (PE), can be classified according to the timing of disease onset: early-onset PE occurs before the 34th gestational week and late-onset PE occurs in the 34th gestational week or later. The aim of this study was to determine whether total antioxidant status (TAS), and total oxidant status (TOS), ADAMTS-12 and decorin levels differ among early-onset severe PE (EOS-PE), late-onset severe PE (LOS-PE) and uncomplicated pregnancies. METHODS In this case-control study, placental samples obtained from 25 pregnant patients with EOS-PE, 26 pregnant patients with LOS-PE and 28 healthy patients with uncomplicated pregnancies (control group). RESULTS Placenta levels of decorin and TOS were significantly higher and TAS was significantly lower in the EOS-PE and LOS-PE groups than in the control group. These alterations were more prominent in patients with EOS-PE than in patients with LOS-PE. There were no significant differences in the ADAMTS-12 levels of the groups. CONCLUSION The distinctly higher rate of negative perinatal outcomes in both EOS-PE and LOS-PE patients is well evidenced. However, the main questions that need to be answered are whether the only difference between these two diseases is the time of their onset and whether the only difference between them with respect to fetal morbidity and mortality is prematurity.
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Affiliation(s)
- Korkut Daglar
- a Department of Perinatology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey and
| | - Ayse Kirbas
- a Department of Perinatology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey and
| | - Hakan Timur
- a Department of Perinatology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey and
| | - Zeynep Ozturk Inal
- b Department of Obstetrics and Gynecology , Konya Education and Research Hospital , Konya , Turkey
| | - Nuri Danisman
- a Department of Perinatology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey and
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89
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Mooney SS, Lee RM, Tong S, Brownfoot FC. Expectant management of severe preterm preeclampsia: a comparison of maternal and fetal indications for delivery. J Matern Fetal Neonatal Med 2016; 29:3821-6. [DOI: 10.3109/14767058.2016.1147555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Samantha S. Mooney
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia and
| | - Rilka M. Lee
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia and
| | - Stephen Tong
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Fiona C. Brownfoot
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Fuchs F, Zaki D, Morin F, Audibert F. Resolution of HELLP syndrome after selective feticide for trisomy 21 in discordant twins – A case report. J OBSTET GYNAECOL 2016; 36:663-4. [DOI: 10.3109/01443615.2015.1133576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Florent Fuchs
- Department of Obstetrics and Gynecology, CHU Sainte Justine, Université de Montréal, Montréal, QC, Canada,
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux De Paris (APHP), Le Kremlin-Bicêtre, France,
- U1018, Reproduction and Child Development, Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France, and
| | - Dina Zaki
- Department of Obstetrics and Gynecology, CHU Sainte Justine, Université de Montréal, Montréal, QC, Canada,
| | - Francine Morin
- Division of Internal Medicine, Department of Obstetrics and Gynecology, CHU Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, CHU Sainte Justine, Université de Montréal, Montréal, QC, Canada,
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Ueda A, Kondoh E, Kawasaki K, Mogami H, Chigusa Y, Konishi I. Magnesium sulphate can prolong pregnancy in patients with severe early-onset preeclampsia. J Matern Fetal Neonatal Med 2016; 29:3115-20. [PMID: 26513699 DOI: 10.3109/14767058.2015.1114091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess whether long-term use of magnesium sulphate prolongs pregnancy in patients with severe early-onset preeclampsia. METHODS Retrospective cohort study included all singleton pregnancies with severe early-onset preeclampsia, expectantly managed in our institution between 2005 and 2013. Obstetric and perinatal outcomes were compared between patients managed using a current protocol that tolerates long-term (over 48 h) use of magnesium sulphate (long-term group, n = 26) and a historical control group (control group, n = 15) that underwent conventional treatment (up to 48 h use of magnesium sulphate). RESULTS Long-term group showed significant prolongation of pregnancy compared with the control group (9.2 ± 7.9 versus 16.6 ± 9.3 d, log-rank test, p = 0.021), which was also observed in patients with severe preeclampsia occurring before 28 weeks' gestation (n = 11, 4.5 ± 5.2 versus 13.2 ± 6.8 d, log-rank test, p = 0.035). In contrast to a progressive decrease of platelet count in patients managed without magnesium sulphate, administration of magnesium sulphate for 7 d prevented the decrease of platelet count (p = 0.001). Thirty two percent of patients (13/41) experienced a major complication irrespective of duration of magnesium sulphate use. CONCLUSIONS Long-term use of magnesium sulphate prolonged pregnancy in patients with severe early-onset preeclampsia and can help alleviate progression of preeclampsia.
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Affiliation(s)
- Akihiko Ueda
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Eiji Kondoh
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Kaoru Kawasaki
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Haruta Mogami
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Yoshitsugu Chigusa
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Ikuo Konishi
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
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Maternal clinical disease characteristics and maternal and neonatal outcomes in twin and singleton pregnancies with severe preeclampsia. Eur J Obstet Gynecol Reprod Biol 2015; 201:36-41. [PMID: 27054964 DOI: 10.1016/j.ejogrb.2015.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/03/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Based on anecdotal observations, there is concern that severe preeclampsia leads to greater morbidity and mortality for mothers and neonates of twin pregnancies than for mothers and neonates of singleton pregnancies. Because few studies have been done, this study compared maternal disease characteristics and maternal/neonatal clinical outcomes of twin and singleton pregnancies complicated by severe preeclampsia. STUDY DESIGN An historical cohort study of patients hospitalized at the Mount Sinai Hospital in New York City, NY, USA, from 2006 to 2010, compared 63 twin and 339 singleton pregnancies complicated by severe preeclampsia via chart review. Women were analyzed in two groups: hospitalized ≤34 weeks gestational age (GA) and hospitalized >34 weeks GA. Univariable analysis (using Chi-square test, Fisher's Exact test, Student's t-test, or Wilcoxon Rank-Sum test, as appropriate) then multivariable analysis (using multivariable linear regression or multivariable logistic regression, as appropriate) compared maternal disease characteristics and maternal/neonatal clinical outcomes in twin and singleton pregnancies. RESULTS Women with twins were older [mean age 34.9 years (standard deviation (SD) 7.9 years) vs. 29.4 years (SD 7.4 years), P-value<.001] and women with singletons had a higher prevalence of chronic hypertension (21% vs. 8%, P=.02) and higher prevalence of history of preeclampsia (13% vs. 2%, P=.006). Women with twins were admitted for severe preeclampsia at an earlier gestational age (GA) [median twin 34.9 weeks GA (interquartile range, IQR, 32.7, 36.1) vs. median singleton 37.1 weeks GA (IQR 35.0, 38.9), P<.001]. Among women presenting ≤34 weeks GA (27 twins; 108 singletons), women with singletons had a higher mean systolic blood pressure (BP) (181.1 vs. 163.5, P<.001), higher mean diastolic BP (108.4 vs. 100.1, P=.002), and higher prevalence of headache (56% vs. 30%, P=.02). Among women presenting >34 weeks GA (36 twins; 231 singletons), women with singletons had a higher prevalence of headache (54% vs. 28%, P=.004). CONCLUSION Mothers and neonates of twin pregnancies complicated by severe preeclampsia do not appear to have greater morbidity and mortality compared to mothers and neonates of singleton pregnancies complicated by severe preeclampsia.
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Joung KE, Park KH, Filippaios A, Dincer F, Christou H, Mantzoros CS. Cord blood irisin levels are positively correlated with birth weight in newborn infants. Metabolism 2015; 64:1507-14. [PMID: 26303870 PMCID: PMC5348079 DOI: 10.1016/j.metabol.2015.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 07/20/2015] [Accepted: 07/23/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Irisin is a novel myokine, secreted from skeletal muscle after exercise. Irisin mediates exercise-related energy expenditure by turning white adipose tissue (WAT) into brown adipose tissue (BAT). Thus, irisin is considered as a potential biomarker for obesity and metabolic syndrome. Infants born small for gestational age (SGA) have increased risk for metabolic syndrome. However, the physiologic role of irisin in neonates remains to be studied. OBJECTIVE To evaluate the association of umbilical cord blood irisin levels with gestational age and birth weight categories in neonates. METHODS A cross-sectional study of 341 newborns, from 26 to 41weeks' gestation. We collected umbilical cord blood and analyzed plasma for irisin by ELISA. RESULTS Plasma irisin levels were positively correlated with gestational age (r=0.21, p<0.001), and birth weight Z-score (r=0.18, p<0.001). SGA infants had significantly lower irisin (median [interquartile range] 55.38 [46.56-65.72]ng/mL) compared to appropriate for gestational age infants (64.41 [53.87-76.76]ng/mL) and large for gestational age infants (68.70 [54.78-79.09]ng/mL, p<0.01). The association between SGA and lower irisin remained significant in multivariate analysis independent of gestational age, maternal age, maternal BMI, and gestational diabetes (p=0.03). In singleton infants, irisin was also significantly negatively associated with maternal preeclampsia (p=0.01). CONCLUSIONS Our results support the notion that irisin may have a physiologic role in neonates. We speculate that decreased levels of irisin in SGA infants may contribute to the development of catch-up growth and metabolic syndrome later in life.
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Affiliation(s)
- Kyoung Eun Joung
- Division of Newborn Medicine, Boston Children's Hospital, 300 Brookline Ave, Boston, MA, 02115, USA; Department of Pediatrics, Division of Neonatology, Goryeb Children's Hospital, 100 Madison Ave, Morristown, NJ, 07960, USA; Division of Endocrinology and Metabolism, Beth Israel Deaconess Medical Center, 300 Brookline Ave, Boston, MA, 02215, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Kyung-Hee Park
- Division of Endocrinology and Metabolism, Beth Israel Deaconess Medical Center, 300 Brookline Ave, Boston, MA, 02215, USA; Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, 431-070, Republic of Korea
| | - Andreas Filippaios
- Division of Endocrinology and Metabolism, Beth Israel Deaconess Medical Center, 300 Brookline Ave, Boston, MA, 02215, USA
| | - Fadime Dincer
- Division of Endocrinology and Metabolism, Beth Israel Deaconess Medical Center, 300 Brookline Ave, Boston, MA, 02215, USA
| | - Helen Christou
- Division of Newborn Medicine, Boston Children's Hospital, 300 Brookline Ave, Boston, MA, 02115, USA; Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Christos S Mantzoros
- Division of Endocrinology and Metabolism, Beth Israel Deaconess Medical Center, 300 Brookline Ave, Boston, MA, 02215, USA; Section of Endocrinology, Division of Endocrinology, Boston VA Healthcare System, Jamaica Plain, MA, 02130, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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Ecker JL, Kaimal A, Mercer BM, Blackwell SC, deRegnier RAO, Farrell RM, Grobman WA, Resnik JL, Sciscione AC, Sciscione AC. #3: Periviable birth. Am J Obstet Gynecol 2015; 213:604-14. [PMID: 26506448 DOI: 10.1016/j.ajog.2015.08.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including declining and accepting interventions and therapies, based on individual circumstances and patient values.
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Is It Possible to Differentiate Chronic Kidney Disease and Preeclampsia by means of New and Old Biomarkers? A Prospective Study. DISEASE MARKERS 2015; 2015:127083. [PMID: 26557728 PMCID: PMC4618113 DOI: 10.1155/2015/127083] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/09/2015] [Indexed: 01/06/2023]
Abstract
Objective. Chronic kidney disease (CKD) and preeclampsia (PE) may both present with hypertension and proteinuria in pregnancy. Our objective is to test the possibility of distinguishing CKD from PE by means of uteroplacental flows and maternal circulating sFlt-1/PlGF ratio. Design. Prospective analysis. Population. Seventy-six patients (35 CKD, 24 PE, and 17 other hypertensive disorders), with at least one sFlt-1/PlGF and Doppler evaluation after the 20th gestational week. Methods. Maternal sFlt-1-PlGF were determined by immunoassays. Abnormal uterine artery Doppler was defined as resistance index ≥ 0.58. Umbilical Doppler was defined with gestational-age-adjusted Pulsatility Index. Clinical diagnosis was considered as reference. Performance of Doppler study was assessed by sensitivity analysis; sFlt-1/PlGF cut-off values were determined by ROC curves. Results. The lowest sFlt-1/PlGF ratio (8.29) was detected in CKD, the highest in PE (317.32) (P < 0.001). Uteroplacental flows were mostly preserved in CKD patients in contrast to PE (P < 0.001). ROC analysis suggested two cut-points: sFlt-1/PlGF ≥ 32.81 (sensitivity 82.93%; specificity 91.43%) and sFlt-1/PlGF ≥ 78.75 (sensitivity 62.89%, specificity 97.14%). Specificity reached 100% at sFlt-1/PlGF ≥ 142.21 (sensitivity: 48.8%). Early-preterm delivery was associated with higher sFlt-1/PlGF ratio and abnormal uteroplacental flows relative to late-preterm and term deliveries. Conclusions. sFlt-1/PlGF ratio and uteroplacental flows significantly correlated with PE or CKD and preterm delivery.
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Stepan H, Kuse-Föhl S, Klockenbusch W, Rath W, Schauf B, Walther T, Schlembach D. Diagnosis and Treatment of Hypertensive Pregnancy Disorders. Guideline of DGGG (S1-Level, AWMF Registry No. 015/018, December 2013). Geburtshilfe Frauenheilkd 2015; 75:900-914. [PMID: 28435172 PMCID: PMC5396549 DOI: 10.1055/s-0035-1557924] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Hypertensive pregnancy disorders contribute significantly to perinatal as well as maternal morbidity and mortality worldwide. Also in Germany these diseases are a major course for hospitalization during pregnancy, iatrogenic preterm birth and long-term cardiovascular morbidity. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. Recommendations: This guideline summarizes the state-of-art for classification, risk stratification, diagnostic, treatment of hypertensive pregnancy disorders.
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Affiliation(s)
- H. Stepan
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig,
Leipzig
| | - S. Kuse-Föhl
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig,
Leipzig
| | - W. Klockenbusch
- Universitätsklinikum Münster, Klinik und Poliklinik für Frauenheilkunde und
Geburtshilfe, Abt. für Geburtshilfe, Münster
| | - W. Rath
- Frauenklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum RWTH
Aachen, Aachen
| | - B. Schauf
- Frauenklinik Sozialstiftung Bamberg, Bamberg
| | - T. Walther
- Department of Pharmacology and Therapeutics, University College Cork, Cork,
Ireland
| | - D. Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin
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Rahgozar S, Amirian T, Qi M, Shahshahan Z, Entezar-E-Ghaem M, Ghasemi Tehrani H, Miroliaei M, Krilis SA, Giannakopoulos B. Improved Assay for Quantifying a Redox Form of Angiotensinogen as a Biomarker for Pre-Eclampsia: A Case-Control Study. PLoS One 2015; 10:e0135905. [PMID: 26312482 PMCID: PMC4552422 DOI: 10.1371/journal.pone.0135905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/28/2015] [Indexed: 01/13/2023] Open
Abstract
Objective Angiotensinogen exists in two distinct redox forms in plasma, the oxidized sulfhydryl-bridge form and the reduced, unbridged, free thiol form. The oxidized form of angiotensinogen compared to the free thiol form preferentially interacts with renin resulting in increased generation of angiotensin. The predictive potential of the ratio of free-thiol to oxidized angiotensinogen in the plasma for pre-eclampsia was first suggested by the Read group in ref 10. We propose an improved method for determining the ratio and validate the method in a larger cohort of pregnant women. Methods Plasma samples from 115 individuals with pre-eclampsia and from 55 healthy pregnant control subjects were collected sequentially over a 2 year period. Using two distinct enzyme-linked immunosorbent assays (ELISAs) the plasma levels of total and free thiol angiotensinogen were quantified. The oxidized angiotensinogen plasma level is derived by subtracting the level of free thiol, reduced angiotensinogen from the total angiotensinogen levels in the plasma. Results The relative proportion of free thiol angiotensinogen, expressed as a percentage of that observed with an in-house standard, is significantly decreased in pre-eclamptic patients (70.85% ± 29.49%) (mean ± SD) as compared to healthy pregnant controls (92.98 ± 24.93%) (mean ± SD) p ≤ 0.0001. The levels of total angiotensinogen did not differ between the two groups. Conclusion Patients with pre-eclampsia had substantially lower levels of free thiol angiotensinogen compared to healthy pregnant controls, whilst maintaining similar total angiotensinogen levels in the plasma. Hence, elevated levels of plasma oxidized angiotensinogen may be a contributing factor to hypertension in the setting of pre-eclampsia.
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Affiliation(s)
- Soheila Rahgozar
- Department of Biology, Faculty of Science, University of Isfahan, Isfahan, Iran
| | - Tayebeh Amirian
- Department of Biology, Faculty of Science, University of Isfahan, Isfahan, Iran
| | - Miao Qi
- Department of Infectious Diseases, Immunology and Sexual Health and Department of Medicine, St George Hospital, University of New South Wales, Sydney, Australia
| | - Zahra Shahshahan
- Department of Obstetrics and Gynaecology, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Hatav Ghasemi Tehrani
- Department of Obstetrics and Gynaecology, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Miroliaei
- Department of Biology, Faculty of Science, University of Isfahan, Isfahan, Iran
| | - Steven A. Krilis
- Department of Infectious Diseases, Immunology and Sexual Health and Department of Medicine, St George Hospital, University of New South Wales, Sydney, Australia
| | - Bill Giannakopoulos
- Department of Infectious Diseases, Immunology and Sexual Health and Department of Medicine, St George Hospital, University of New South Wales, Sydney, Australia
- * E-mail:
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Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth. Epidemiology 2015; 26:17-26. [PMID: 25437315 DOI: 10.1097/ede.0000000000000213] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preeclampsia is characterized by alterations in angiogenic factors that may increase neonatal morbidity independent of preterm birth. METHODS We estimated the controlled direct effect of preeclampsia on neonatal outcomes independent of preterm birth among 200,103 normotensive and 10,507 preeclamptic singleton pregnancies in the Consortium on Safe Labor (2002-2008). Marginal structural models with stabilized inverse probability weights accounted for potential confounders in the pathway from preeclampsia to preterm birth to neonatal outcomes, including mediator-outcome confounders related to preeclampsia status, such as cesarean delivery. Controlled direct effects of preeclampsia on perinatal mortality, small for gestational age (SGA), neonatal intensive care unit (NICU) admission, respiratory distress syndrome, transient tachypnea of the newborn, anemia, apnea, asphyxia, peri- or intraventricular hemorrhage, and cardiomyopathy were estimated for the hypothesized intervention of term delivery for all infants. RESULTS When delivery was set at ≥37 weeks, preeclampsia increased the odds of perinatal mortality (odds ratio = 2.2 [95% confidence interval = 1.1-4.5], SGA = (1.9 [1.8-2.1]), NICU admission (1.9 [1.7-2.1]), respiratory distress syndrome (2.8 [2.0-3.7], transient tachypnea of the newborn (1.6 [1.3-1.9]), apnea (2.2 [1.6-3.1]), asphyxia (2.7 [1.5-4.9]), and peri- or intraventricular hemorrhage (3.2 [1.4-7.7]). No direct effect of preeclampsia at term was observed for anemia or cardiomyopathy. Our results appear robust in the presence of moderate confounding, and restriction to severe preeclampsia yielded similar findings. CONCLUSION Preeclampsia was directly associated with adverse neonatal outcomes beyond morbidity mediated by preterm birth. Although severe neonatal outcomes were less common at later gestational ages, marginal structural models suggested elevated neonatal risk due to preeclampsia even if it was possible to deliver all infants at term.
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Pre-eclampsia causes adverse maternal outcomes across the gestational spectrum. Pregnancy Hypertens 2015; 5:198-204. [DOI: 10.1016/j.preghy.2015.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/03/2015] [Accepted: 02/14/2015] [Indexed: 11/19/2022]
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