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Torkhovskaya TI, Zakharova TS, Korotkevich EI, Kasum-zade NK, Shalina RI, Markin SS. Blood Plasma Lipidome: Opportunities in the Early Diagnostics of Preeclampsia. RUSSIAN JOURNAL OF BIOORGANIC CHEMISTRY 2020. [DOI: 10.1134/s1068162020030206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Jiang L, Lin J, Yan J, Lin X, Han Q, Zhang H. Prepregnancy body mass indexes are associated with perinatal outcomes in females with preeclampsia. Exp Ther Med 2020; 20:500-504. [PMID: 32509020 PMCID: PMC7271714 DOI: 10.3892/etm.2020.8677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/04/2020] [Indexed: 11/30/2022] Open
Abstract
The present study aimed to determine the clinical characteristics and perinatal outcomes of females with severe preeclampsia according to their pre-pregnancy body mass index (BMI). Data from 233 patients with severe preeclampsia were reviewed from the Inpatient Obstetrics Department. The data were divided into 3 groups according to the patients' pre-pregnancy BMI: Normal (BMI of 18-25 kg/m2; n=134); underweight (BMI <18 kg/m2; n=15); and overweight and obese (BMI >25 kg/m2; n=84). The incidence of dyslipidemia, amniotic fluid abnormalities and neonatal hospitalizations in the group of females who were overweight or obese before pregnancy were higher than those in the other groups (all P<0.05). In conclusion, the presence of dyslipidemia, excessive weight and obesity prior to pregnancy in patients with severe preeclampsia was associated with maternal and perinatal outcomes.
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Affiliation(s)
- Lingling Jiang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Juan Lin
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Jianying Yan
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Xiaoqian Lin
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Qing Han
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Huale Zhang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
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Wernz C, S Mkuu R, Leal N, Stegall R, Wekullo C, Woldu D, Shevon Harvey I. Prevalence and predictors of receipt of weight loss advice among a nationally representative sample of overweight and obese Kenyans. Afr Health Sci 2020; 20:903-911. [PMID: 33163058 PMCID: PMC7609077 DOI: 10.4314/ahs.v20i2.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: As Kenya continues to experience rapid development and urbanization, growing evidence shows an increasing prevalence of non-communicable diseases (NCDs) and overweight and obese citizens. Objectives: This study sought to explore the extent to which Kenyan overweight and obese participants reported receiving advice from physicians or health care providers to lose weight and to identify demographic characteristics associated with receipt of weight loss advice. Methods: Descriptive statistics analyzed sociodemographic characteristics and weight loss advice from the 2015 Kenya WHO STEPwise survey (n = 1335). A bivariate logistic regression model estimated the association between socio-demographic characteristics and weight loss advice reported from a physician or health care provider. Results: The prevalence of weight loss advice from health professionals among overweight and obese participants was 19%. Model results indicated that obese individuals [odds ratio (OR) = 2.11, 95% confidence interval (CI) (1.36, 3.26)], individuals with higher than a secondary education [OR = 2.26, 95% CI (1.39, 3.68)], urban dwellers [OR = 2.38, 95% CI (1.29, 4.39)], and women [OR = 3.13, 95% CI (1.60, 6.12)] were significantly more likely to receive weight loss advice from their physician or health care provider. Conclusion: This study found low levels of report of physician or health care provider advice for weight loss among overweight individuals. Advice was primarily reported by obese patients. Weight loss advice differed significantly based on educational attainment, geographical location, and gender thus calling for targeted interventions to increase equitable NCD prevention services from physicians.
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Manrique-Acevedo C, Chinnakotla B, Padilla J, Martinez-Lemus LA, Gozal D. Obesity and cardiovascular disease in women. Int J Obes (Lond) 2020; 44:1210-1226. [PMID: 32066824 PMCID: PMC7478041 DOI: 10.1038/s41366-020-0548-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
Abstract
As the prevalence of obesity continues to grow worldwide, the health and financial burden of obesity-related comorbidities grows too. Cardiovascular disease (CVD) is clearly associated with increased adiposity. Importantly, women are at higher risk of CVD when obese and insulin resistant, in particular at higher risk of developing heart failure with preserved ejection fraction and ischemic heart disease. Increased aldosterone and mineralocorticoid receptor activation, aberrant estrogenic signaling and elevated levels of androgens are among some of the proposed mechanisms explaining the heightened CVD risk. In addition to traditional cardiovascular risk factors, understanding nontraditional risk factors specific to women, like excess weight gain during pregnancy, preeclampsia, gestational diabetes, and menopause are central to designing personalized interventions aimed to curb the epidemic of CVD. In the present review, we examine the available evidence supporting a differential cardiovascular impact of increased adiposity in women compared with men and the proposed pathophysiological mechanisms behind these differences. We also discuss women-specific cardiovascular risk factors associated with obesity and insulin resistance.
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Affiliation(s)
- Camila Manrique-Acevedo
- Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri, Columbia, MO, USA
- Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
| | - Bhavana Chinnakotla
- Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Jaume Padilla
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Luis A Martinez-Lemus
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA
| | - David Gozal
- Department of Child Health, University of Missouri, Columbia, MO, USA.
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Antwi E, Amoakoh-Coleman M, Vieira DL, Madhavaram S, Koram KA, Grobbee DE, Agyepong IA, Klipstein-Grobusch K. Systematic review of prediction models for gestational hypertension and preeclampsia. PLoS One 2020; 15:e0230955. [PMID: 32315307 PMCID: PMC7173928 DOI: 10.1371/journal.pone.0230955] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Prediction models for gestational hypertension and preeclampsia have been developed with data and assumptions from developed countries. Their suitability and application for low resource settings have not been tested. This review aimed to identify and assess the methodological quality of prediction models for gestational hypertension and pre-eclampsia with reference to their application in low resource settings. METHODS Using combinations of keywords for gestational hypertension, preeclampsia and prediction models seven databases were searched to identify prediction models developed with maternal data obtained before 20 weeks of pregnancy and including at least three predictors (Prospero registration CRD 42017078786). Prediction model characteristics and performance measures were extracted using the CHARMS, STROBE and TRIPOD checklists. The National Institute of Health quality assessment tools for observational cohort and cross-sectional studies were used for study quality appraisal. RESULTS We retrieved 8,309 articles out of which 40 articles were eligible for review. Seventy-seven percent of all the prediction models combined biomarkers with maternal clinical characteristics. Biomarkers used as predictors in most models were pregnancy associated plasma protein-A (PAPP-A) and placental growth factor (PlGF). Only five studies were conducted in a low-and middle income country. CONCLUSIONS Most of the studies evaluated did not completely follow the CHARMS, TRIPOD and STROBE guidelines in prediction model development and reporting. Adherence to these guidelines will improve prediction modelling studies and subsequent application of prediction models in clinical practice. Prediction models using maternal characteristics, with good discrimination and calibration, should be externally validated for use in low and middle income countries where biomarker assays are not routinely available.
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Affiliation(s)
- Edward Antwi
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Ghana Health Service, Accra, Ghana
| | - Mary Amoakoh-Coleman
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Dorice L. Vieira
- New York University Health Sciences Library, New York University School of Medicine, New York, NY, United States of America
| | - Shreya Madhavaram
- New York University Health Sciences Library, New York University School of Medicine, New York, NY, United States of America
| | - Kwadwo A. Koram
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Lopes Perdigao J, Hirshberg A, Koelper N, Srinivas SK, Sammel MD, Levine LD. Postpartum blood pressure trends are impacted by race and BMI. Pregnancy Hypertens 2020; 20:14-18. [PMID: 32143061 DOI: 10.1016/j.preghy.2020.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/12/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Our objective was to evaluate postpartum blood pressure trends, and time to resolution of hypertension among women with hypertensive disorders of pregnancy, specifically focusing on impact of race and BMI on these trends. METHODS We performed a secondary analysis of a randomized trial that utilized a text-message based home blood pressure monitoring system. BPs for this study included both inpatient postpartum BPs as well as home BPs obtained from the text-based program. Women were followed from 12 h of delivery to 16 days postpartum. Outcomes were: (1) postpartum BP trend summaries from a linear mixed-effects regression model and (2) time to resolution of hypertension (defined as ≥ 48 h of BPs < 140/90) depicted using Kaplan Meier survival curves with hazard ratio estimates of association using Cox models. RESULTS Eighty-four women were included, of which 63% were black. Non-black women with a BMI < 35 kg/m2 had steady decreases in systolic BP whereas other groups peaked around 6.5 days postpartum. BPs for women in the BMI < 35 group, regardless of race, remained in the normotensive range. Conversely, women with a BMI ≥ 35 had a systolic BP peak into the hypertensive range prior to declining. Diastolic BP peaked at an average of 8.5 days postpartum. Time to resolution of BPs differed by race and BMI groups (p = 0.012). Non-black women with a BMI < 35 had the shortest time to resolution and 81% of these women had resolution of hypertension. Only 49% of black women with a BMI < 35 had resolution of hypertension and approximately 40% of both black and non-black women with BMI ≥ 35 had resolution of hypertension. CONCLUSION We identified race and BMI to be determinants of postpartum BP trends and hypertension resolution. Further study is needed to determine if race and BMI targeted postpartum hypertension interventions may lead to faster blood pressure recovery and lower maternal morbidity postpartum.
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Affiliation(s)
- Joana Lopes Perdigao
- Maternal and Child Health Research Center, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Adi Hirshberg
- Maternal and Child Health Research Center, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Nathanael Koelper
- Center for Research on Reproduction and Women's Health, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Sindhu K Srinivas
- Maternal and Child Health Research Center, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Mary D Sammel
- Center for Clinical Epidemiology and Biostatistics & Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA, United States
| | - Lisa D Levine
- Maternal and Child Health Research Center, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Chen CN, Chen HS, Hsu HC. Maternal Prepregnancy Body Mass Index, Gestational Weight Gain, and Risk of Adverse Perinatal Outcomes in Taiwan: A Population-Based Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041221. [PMID: 32074959 PMCID: PMC7068269 DOI: 10.3390/ijerph17041221] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 01/01/2023]
Abstract
Epidemiological studies have shown that maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) are associated with increased risk of perinatal outcomes. However, the evidence of such associations in Asian populations is limited. We conducted a secondary data analysis to investigate the relationships of prepregnancy BMI and GWG with the risks of adverse perinatal outcomes, including gestational diabetes (GDM), gestational hypertension (GHTN), preeclampsia, cesarean delivery, preterm birth, low birth weight (LBW), and macrosomia. We categorized prepregnancy BMI by the WHO classification and GWG by the Institute of Medicine guidelines. We performed adjusted logistic regression models to estimate the odds ratios of adverse perinatal outcomes. A total of 19,052 women were included; prepregnancy overweight and obesity were associated with a greater risk of GDM, GHTN, preeclampsia, cesarean delivery, preterm birth, and macrosomia. Women with excessive GWG had a greater risk of GHTN, preeclampsia, cesarean delivery, and macrosomia. In conclusion, regardless of the range of GWG during pregnancy, maternal prepregnancy BMI is significantly associated with the risk of adverse perinatal outcomes in Taiwan. Public health attention regarding obesity reduction before conception and prenatal counseling for optimal GWG is needed to mitigate the risk of poor perinatal outcomes.
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Affiliation(s)
- Chi-Nien Chen
- Department of Pediatrics, National Taiwan University Hospital Hsinchu Branch, Hsinchu 30059, Taiwan
- Correspondence:
| | - Ho-Sheng Chen
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei 10041, Taiwan;
- Department of Emergency, National Taiwan University Hospital, Taipei 10048, Taiwan
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsinchu Branch, Hsinchu 30059, Taiwan;
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 10048, Taiwan
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Sutton EF, Gemmel M, Powers RW. Nitric oxide signaling in pregnancy and preeclampsia. Nitric Oxide 2020; 95:55-62. [DOI: 10.1016/j.niox.2019.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/10/2019] [Accepted: 11/22/2019] [Indexed: 01/08/2023]
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Oxidative stress in pregnancy complicated by preeclampsia. Arch Biochem Biophys 2020; 681:108255. [PMID: 31904364 DOI: 10.1016/j.abb.2020.108255] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/28/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
Preeclampsia is a multisystemic disorder of pregnancy that causes perinatal morbidity and mortality. Studies published in the last decade have contributed to a better understanding of physiopathogenesis through key mechanisms involved, such as altered immune response, endothelial dysfunction, oxidative stress and systemic inflammatory response, as well as genetic susceptibility. Oxidative stress (OS) plays an important role in the development of preeclampsia, since it alters placental remodeling and placental vascular endothelial dysfunction, resulting in an ischemia/reperfusion injury with an increase in xanthine oxidase activity that produces high levels of reactive oxygen species (ROS). ROS can be generated through many pathways within cells, mitochondria, endoplasmic reticulum (ER) and enzymes such as NADPH oxidase are the most important sources, causing widespread and indiscriminate damage to cells and tissues, which leads to an intravascular inflammatory response and maternal systemic endothelial dysfunction characteristic of this prenatal syndrome. Therefore, the following review aims to identify the main risk factors and the role of OS as a pathophysiological mechanism in the development of preeclampsia.
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Wang J, Gu X, Yang J, Wei Y, Zhao Y. Gut Microbiota Dysbiosis and Increased Plasma LPS and TMAO Levels in Patients With Preeclampsia. Front Cell Infect Microbiol 2019; 9:409. [PMID: 31850241 PMCID: PMC6901393 DOI: 10.3389/fcimb.2019.00409] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: To characterize the gut microbiota in patients with preeclampsia (PE) compared with healthy controls. Methods: We analyzed and compared the microbiota communities in the feces of 48 PE patients with 48 age-, gestational weeks-, and pre-pregnancy body mass index-matched healthy controls using 16S rRNA gene sequencing, and also we tested fecal and plasma lipopolysaccharide (LPS) and plasma trimethylamine-N-oxide (TMAO) concentration levels in the two groups. Results: Compared with the control group, microbial alpha diversity was lower in the PE group, but there was no statistically significant difference between the two groups. At the phylum level, Firmicutes (51.64% PE vs. 59.62% Control, P < 0.05), Bacteroidetes (40.51% PE vs. 34.81% Control, P< 0.05), Proteobacteria (4.51% PE vs. 2.56% Control, P < 0.05), and Actinobacteria (2.90% PE vs. 1.77% Control, P < 0.05), exhibited significant differences between the PE group and the control group. LEfSe analysis found 17 differentially abundant taxa between the two groups. PICRUSt analysis found that in the KEGG pathways, the microbial gene functions related to LPS biosynthesis were higher in the fecal microbiome of the PE group. The fecal and plasma LPS concentrations and plasma TMAO concentrations of PE patients were higher than those of the healthy controls. Conclusion: PE patients had gut microbiota dysbiosis and increased plasma LPS and TMAO levels, which will lead to a better understanding of the relationship between the gut microbiota and PE.
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Affiliation(s)
- Jing Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Xunke Gu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Jing Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
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Increased BMI has a linear association with late-onset preeclampsia: A population-based study. PLoS One 2019; 14:e0223888. [PMID: 31622409 PMCID: PMC6797165 DOI: 10.1371/journal.pone.0223888] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022] Open
Abstract
Background To investigate the ongoing controversy on the effect of BMI (body mass index) on EOP (early onset preeclampsia) vs LOP (late onset), especially focusing on diabetes and maternal booking/pre-pregnancy BMI as possible independent variables. Methods 18 year-observational cohort study (2001–2018). The study population consisted of all consecutive births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity (ap. 4,300 birth per year, only level 3 maternity in the south of Reunion Island, sole allowed to follow and deliver all preeclampsia cases of the area). History of pregnancies, deliveries and neonatal outcomes have been collected in standardized fashion into an epidemiological perinatal data base. Results Chronic hypertension and, history of preeclampsia in multigravidas, were the strongest risk factors for EOP. Primiparity, age over 35 years and BMI ≥ 35 kg/m² were rather associated with LOP. In a multivariate analysis with EOP or LOP as outcome variables compared with controls (normotensive), maternal age and pre-pregnancy BMI were independent risk factors for both EOP and LOP (p < 0.001). However, analyzing by increment of 5 (years of age, kg/m² for BMI) rising maternal ages and incidence of preeclampsia were strictly parallel for EOP and LOP, while increment of BMI was only associated with LOP. Controlling for maternal ages and booking/pre-pregnancy BMI, diabetes was not an independent risk factor neither for EOP or LOP. Conclusions Metabolic factors, other than diabetes, associated with pre-pregnancy maternal corpulence are specifically associated with LOP. This may be a direction for future researches on the maternal preeclamptic syndrome. This may explain the discrepancy we are facing nowadays where high-income countries report 90% of their preeclampsia being LOP, while it is only 60–70% in medium-low income countries.
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Delivery-to-Delivery Weight Gain and Risk of Hypertensive Disorders in a Subsequent Pregnancy. Obstet Gynecol 2019; 132:868-874. [PMID: 30204702 DOI: 10.1097/aog.0000000000002874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate whether weight gain between deliveries is associated with an increased risk of hypertensive disorders in a subsequent pregnancy. METHODS This is a case-control study of women who had two live singleton births of at least 24 weeks of gestation at a single maternity hospital from January 1, 2005, to December 31, 2015, with no hypertensive disorder documented in the index pregnancy. Maternal weight gain between deliveries was measured as the change in body mass index (BMI) at delivery. Women who were diagnosed with any hypertensive disorder in the subsequent pregnancy were compared with those who experienced no hypertensive disorder in the subsequent pregnancy using χ statistics for categorical variables and t tests for continuous variables. Logistic regression was used to determine whether weight gain remained independently associated with hypertensive disorders after adjusting for potential confounders. RESULTS Of 1,033 women, 188 (18.2%) were diagnosed with a hypertensive disorder in the subsequent pregnancy. Of these, 166 (88.3%) had a hypertensive disorder specific to pregnancy (gestational hypertension; preeclampsia; superimposed preeclampsia; or hemolysis, elevated liver enzymes, and low platelet count syndrome), and 22 (11.7%) had chronic hypertension only. Greater weight gain between deliveries was significantly associated with a higher frequency of hypertensive disorders, which remained significant for a BMI increase of at least 2 kg/m in multivariable analyses (adjusted odds ratio [OR] 1.76, 95% CI 1.14-2.74 for 2 to less than 4 kg/m, adjusted OR 3.19, 95% CI 1.86-5.47 for 4 kg/m or more). Conversely, weight loss of 2 kg/m or more was associated with a decreased risk of a hypertensive disorder (adjusted OR 0.41, 95% CI 0.21-0.81). CONCLUSION Among women with no hypertensive disorder noted in an index pregnancy, an increase in BMI of at least 2 kg/m between deliveries was independently associated with an increased risk of a hypertensive disorder in a subsequent pregnancy.
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Pan L, Fu Z, Yin P, Chen D. Pre-existing medical disorders as risk factors for preeclampsia: an exploratory case-control study. Hypertens Pregnancy 2019; 38:245-251. [PMID: 31530202 DOI: 10.1080/10641955.2019.1667381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: We sought to explore pre-existing medical disorders as risk factors for preeclampsia as thoroughly as possible. Methods: A case-control design. A group of 1,652 patients were identified as the preeclampsia group, and another randomly selected 4,500 patients were identified as the non-preeclampsia group. Results: Mature ovarian teratoma (adjusted odds ratio [OR] 7.69, 95% CI 1.58-37.53), uterine fibroids (adjusted OR 2.24, 95% CI 1.28-3.92) and pregestational hypothyroidism (adjusted OR 5.17, 95% CI 2.43-11.00), were significantly correlated with preeclampsia. Conclusions: Mature ovarian teratoma, uterine fibroids and pregestational hypothyroidism may also contribute to the incidence of preeclampsia.
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Affiliation(s)
- Linglan Pan
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Zhen Fu
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, , China
| | - Ping Yin
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, , China
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
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Motedayen M, Rafiei M, Rezaei Tavirani M, Sayehmiri K, Dousti M. The relationship between body mass index and preeclampsia: A systematic review and meta-analysis. Int J Reprod Biomed 2019; 17:463-472. [PMID: 31508571 PMCID: PMC6718883 DOI: 10.18502/ijrm.v17i7.4857] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 11/28/2018] [Accepted: 12/26/2018] [Indexed: 01/22/2023] Open
Abstract
Background One of the causes of maternal and fetal mortality and morbidity is pregnancy-induced hypertension, the most common form of which is preeclampsia that causes many complications for mother and fetus. Objective The aim of this systematic review and meta-analysis was to determine the relationship between body mass index (BMI) and preeclampsia in Iran. Materials and Methods Using valid keywords in the SID database, PubMed, Scopus, data obtained from all the articles, which were reviewed in Iran between 2000 and 2016, were combined using the meta-analysis method (random-effects model) and analyzed using STATA version 11.1. Results A total number of 5,946 samples were enrolled in 16 studies with the mean BMI values of 25.13, 27.42, and 26.33 kg /m2 in the healthy, mild, and severe preeclamptic groups, respectively. Conclusion The results of this study revealed that there is a significant relationship between BMI and the risk of preeclampsia, so it can be said that BMI may be one of the ways to diagnose preeclampsia.
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Affiliation(s)
- Morteza Motedayen
- Department of Cardiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad Rafiei
- Department of Biostatistics and Epidemiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | | | - Kourosh Sayehmiri
- Psychosocial Injuries Research Center, Department of Biostatistics, School of Public Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Majid Dousti
- Psychosocial Injuries Research Center, Department of Biostatistics, School of Public Health, Ilam University of Medical Sciences, Ilam, Iran
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Faulkner JL, Kennard S, Huby AC, Antonova G, Lu Q, Jaffe IZ, Patel VS, Fulton DJR, Belin de Chantemèle EJ. Progesterone Predisposes Females to Obesity-Associated Leptin-Mediated Endothelial Dysfunction via Upregulating Endothelial MR (Mineralocorticoid Receptor) Expression. Hypertension 2019; 74:678-686. [PMID: 31327274 DOI: 10.1161/hypertensionaha.119.12802] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Compelling clinical evidence indicates that obesity and its associated metabolic abnormalities supersede the protective effects of female sex-hormones and predisposes premenopausal women to cardiovascular disease. The underlying mechanisms remain poorly defined; however, recent studies have implicated overactivation of the aldosterone-MR (mineralocorticoid receptor) axis as a cause of sex-specific cardiovascular risk in obese females. Experimental evidence indicates that the MR on endothelial cells contributes to obesity-associated, leptin-induced endothelial dysfunction in female experimental models, however, the vascular-specific mechanisms via which females are predisposed to heightened endothelial MR activation remain unknown. Therefore, we hypothesized that endogenous expression of endothelial MR is higher in females than males, which predisposes them to obesity-associated, leptin-mediated endothelial dysfunction. We found that endothelial MR expression is higher in blood vessels from female mice and humans compared with those of males, and further, that PrR (progesterone receptor) activation in endothelial cells is the driving mechanism for sex-dependent increases in endothelial MR expression in females. In addition, we show that genetic deletion of either the endothelial MR or PrR in female mice prevents leptin-induced endothelial dysfunction, providing direct evidence that interaction between the PrR and MR mediates obesity-associated endothelial impairment in females. Collectively, these novel findings suggest that progesterone drives sex-differences in endothelial MR expression and predisposes female mice to leptin-induced endothelial dysfunction, which indicates that MR antagonists may be a promising sex-specific therapy to reduce the risk of cardiovascular diseases in obese premenopausal women.
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Affiliation(s)
- Jessica L Faulkner
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
| | - Simone Kennard
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
| | - Anne-Cecile Huby
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
| | - Galina Antonova
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
| | - Qing Lu
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (Q.L., I.Z.J.)
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (Q.L., I.Z.J.)
| | - Vijay S Patel
- Department of Surgery, Section of Cardiothoracic Surgery (V.S.P.), Medical College of Georgia, Augusta University, GA
| | - David J R Fulton
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
| | - Eric J Belin de Chantemèle
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA.,Department of Medicine, Section of Cardiology (E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
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67
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Georgiadou D, Afink GB, van Dijk M. The apelinergic-axis in human preeclamptic pregnancies: A systematic review. Pregnancy Hypertens 2019; 17:148-157. [DOI: 10.1016/j.preghy.2019.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 11/16/2022]
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68
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Wang J, Wen D, Liu X, Liu Y. Impact of exercise on maternal gestational weight gain: An updated meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e16199. [PMID: 31277127 PMCID: PMC6635273 DOI: 10.1097/md.0000000000016199] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Clinical evidence indicates that women will benefit from regular physical activity during pregnancy. This study aimed to summarize and update the evidence on the effect of exercise on maternal gestational weight gain (GWG). METHODS We conducted a systematic literature search of Pubmed, Embase, and Cochrane Library from inception until July, 2018 for randomized controlled trials (RCTs) that investigate the effect of physical exercises on the maternal GWG compared with that of no physical exercises or conventional medical care. We extracted data from eligible trials for study characteristics, interventions, patients' baseline characteristics and outcomes for the study populations of interest. We conducted meta-analyses using random effects models. RESULTS From 844 citations, 23 RCTs including 4462 pregnant women met the inclusion criteria. Meta-analysis indicated that compared with that in women having conventional medical care, GWG was significantly decreased in pregnant women with physical exercise [weighted mean difference (WMD) -1.02, 95% CI -1.35 to -0.70; P < .01; I = 48.4%]. Women appeared to benefit more for gestational weight control for exercise frequency of 3 times per week (WMD -1.22, 95% CI -1.55 to -0.90; I = 40.3%) and exercise duration of 30 to 45 minutes each time (WMD -1.32, 95% CI -1.79 to -0.85; I = 1.5%). CONCLUSION This meta-analysis provides indications that exercise intervention can reduce maternal GWG for pregnant women, especially for those with exercise frequency of 3 times per week and duration of 30 to 45 minutes each time.
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Affiliation(s)
- Jianying Wang
- Department of Gynecology and Obstetrics, Northwest Women's and Children's Hospital, Xi’ an, Shaanxi Province
| | - Danting Wen
- Department of Gynecology, Second Affiliated Hospital of Guangzhou University of Chinese Medicine
- Postdoctoral Research Station, Guangzhou University of Chinese Medicine
- Department of Gynecology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Xiaofei Liu
- Department of Gynecology and Obstetrics, Northwest Women's and Children's Hospital, Xi’ an, Shaanxi Province
| | - Yingjie Liu
- Department of Gynecology and Obstetrics, Northwest Women's and Children's Hospital, Xi’ an, Shaanxi Province
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69
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Leavitt K, Običan S, Yankowitz J. Treatment and Prevention of Hypertensive Disorders During Pregnancy. Clin Perinatol 2019; 46:173-185. [PMID: 31010554 DOI: 10.1016/j.clp.2019.02.002] [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] [Indexed: 10/27/2022]
Abstract
This article reviews the pharmacology of the most commonly used antihypertensive medications during pregnancy; their mechanism of action; and the effects on the mother, the fetus, and lactation. Each class of antihypertensive pharmacologic agents have specific mechanisms of action by which they exert their antihypertensive effect. β-Adrenoreceptor antagonists block these receptors in the peripheral circulation. Calcium channel blockers result in arterial vasodilation. α-Agonists inhibit vasoconstriction. Methyldopa is a centrally acting adrenoreceptor antagonist. Vasodilators have a direct effect on vascular smooth muscle. Diuretics decrease intravascular volume. Medications acting on the angiotensin pathway are avoided during pregnancy because of fetotoxic effects.
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Affiliation(s)
- Karla Leavitt
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, 6th Floor, Tampa, FL 33606, USA.
| | - Sarah Običan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, 6th Floor, Tampa, FL 33606, USA
| | - Jerome Yankowitz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, 6th Floor, Tampa, FL 33606, USA
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70
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Wang D, Liu N, Tian Y, Li Y, Shen X, Chen Y, Wu F. Expression profile of Let-7s in peripheral blood mononuclear cells of normal and severe preeclampsia pregnant women. Exp Mol Pathol 2019; 110:104263. [PMID: 31128089 DOI: 10.1016/j.yexmp.2019.104263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022]
Abstract
HEADINGS AIM We aimed to investigate if the let-7 s expression level in the serum of peripheral blood from pregnant women with severe pre-eclampsia and normal pregnant women is related to the incidence of severe pre-eclampsia. METHODS Total RNA was extracted from collected peripheral blood mononuclear cells from 20 or over weeks pregnant women diagnosed with severe pre-eclampsia (age: 31.57 ± 4.94) and normal pregnant women (age: 29.75 ± 4.6) respectively, followed by real-time PCR to examine the expression of let-7 s. Correlation between let-7 s expression level and maternal age or body mass index of the normal pregnant women were also analyzed using SPSS21.0 software. RESULTS Let-7a and let-7 g were significantly increased in pregnant women with severe pre-eclampsia by 4.67 fold and 2.37 fold respectively compared to the normal pregnant women, whereas there was no significant difference in let-7b and let-7i. Moreover, there was no correlation between maternal age or body mass index and the expression level of let-7a, let-7b, let-7 g, and let-7i. CONCLUSIONS In conclusion, let-7a and let-7 g were significantly increased in the PBMCs of severe pre-eclampsia women compared to normal controls. Moreover, their expression level was not correlated to the maternal age or body mass of patients. Our data indicated that let-7a and let-7 g may be considered as predictive markers for SPE.
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Affiliation(s)
- Dandan Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin Province 130041, China; Department of Obstetrics and Gynecology, Longnan Hospital of Daqing, Daqing, Heilongjiang Province 163458, China
| | - Ning Liu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin Province 130041, China
| | - Yuan Tian
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin Province 130041, China
| | - Yang Li
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin Province 130041, China
| | - Xinyang Shen
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin Province 130041, China
| | - Yang Chen
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin Province 130041, China
| | - Fuju Wu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin Province 130041, China.
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71
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Reijnders D, Olson KN, Liu CC, Beckers KF, Ghosh S, Redman LM, Sones JL. Dyslipidemia and the role of adipose tissue in early pregnancy in the BPH/5 mouse model for preeclampsia. Am J Physiol Regul Integr Comp Physiol 2019; 317:R49-R58. [PMID: 30995083 DOI: 10.1152/ajpregu.00334.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The hypertensive pregnancy disorder preeclampsia (PE) is a leading cause of fetal and maternal morbidity/mortality. Obesity increases the risk to develop PE, presumably via the release of inflammatory mediators from the adipose tissue, but the exact etiology remains largely unknown. Using obese PE-like blood pressure high subline 5 (BPH/5) and lean gestational age-matched C57Bl6 mice, we aimed to obtain insight into differential reproductive white adipose tissue (rWAT) gene expression, circulating lipids and inflammation at the maternal-fetal interface during early pregnancy. In addition, we investigated the effect of 7 days 25% calorie restriction (CR) in early pregnancy on gene expression in rWAT and implantation sites. Compared with C57Bl6, female BPH/5 are dyslipidemic before pregnancy and show an amplification of rWAT mass, circulating cholesterol, free fatty acids, and triacylglycerol levels throughout pregnancy. RNA sequencing showed that pregnant BPH/5 mice have elevated gene enrichment in pathways related to inflammation and cholesterol biosynthesis at embryonic day (e) 7.5. Expression of cholesterol-related HMGCS1, MVD, Cyp51a1, and DHCR was validated by quantitative reverse-transcription-polymerase chain reaction. CR during the first 7 days of pregnancy restored the relative mRNA expression of these genes to a level comparable to C57Bl6 pregnant females and reduced the expression of circulating leptin and proinflammatory prostaglandin synthase 2 in both rWAT and implantation sites in BPH/5 mice at e7.5. Our data suggest a possible role for rWAT in the dyslipidemic state and inflammatory uterine milieu that might underlie the pathogenesis of PE. Future studies should further address the physiological functioning of the adipose tissue in relation to PE-related pregnancy outcomes.
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Affiliation(s)
- Dorien Reijnders
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University , Baton Rouge, Louisiana.,Reproductive Endocrinology & Women's Health Lab, Pennington Biomedical Research Center , Baton Rouge, Louisiana
| | - Kelsey N Olson
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University , Baton Rouge, Louisiana.,Reproductive Endocrinology & Women's Health Lab, Pennington Biomedical Research Center , Baton Rouge, Louisiana
| | - Chin-Chi Liu
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University , Baton Rouge, Louisiana
| | - Kalie F Beckers
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University , Baton Rouge, Louisiana
| | - Sujoy Ghosh
- Center for Computational Biology, Duke-National University of Singapore Medical School, Singapore.,Nutrient Sensing and Adipocyte Signaling Laboratory, Pennington Biomedical Research Center , Baton Rouge, Louisiana
| | - Leanne M Redman
- Reproductive Endocrinology & Women's Health Lab, Pennington Biomedical Research Center , Baton Rouge, Louisiana
| | - Jenny L Sones
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University , Baton Rouge, Louisiana
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72
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Embryonic programming of heart disease in response to obesity during pregnancy. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165402. [PMID: 30759362 DOI: 10.1016/j.bbadis.2019.01.028] [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] [Received: 11/10/2018] [Revised: 01/19/2019] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
Obesity during pregnancy programs adult-onset heart disease in the offspring. Clinical studies indicate that exposure to an adverse environment in utero during early, as compared to late, gestation leads to a higher prevalence of adult-onset heart disease. This suggests that the early developing heart is particularly sensitive to an adverse environment. Accordingly, growing evidence from clinical studies and animal models demonstrates that obesity during pregnancy alters the function of the fetal heart, programming a higher risk of cardiovascular disease later in life. Moreover, gene expression patterns and signaling pathways that promote initiation and progression of cardiovascular disease are altered in the hearts in offspring born to obese mothers. However, the mechanisms mediating the long-term effects of an adverse environment in utero on the developing heart leading to adult-onset disease are not clear. Here, we review clinical and experimental evidence documenting the effects of maternal obesity during pregnancy on the fetal and post-natal heart and emphasize on the potential mechanisms of disease programming.
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Abstract
Preeclampsia (PE) is a devastating adverse outcome of pregnancy. Characterized by maternal hypertension, PE, when left untreated, can result in death of both mother and baby. The cause of PE remains unknown, and there is no way to predict which women will develop PE during pregnancy. The only known treatment is delivery of both the fetus and placenta; therefore, an abnormal placenta is thought to play a causal role. Women with obesity before pregnancy have an increased chance of developing PE. Increased adiposity results in a heightened state of systemic inflammation that can influence placental development. Adipose tissue is a rich source of proinflammatory cytokines and complement proteins, which have been implicated in the pathogenesis of PE by promoting the expression of antiangiogenic factors in the mother. Because an aggravated inflammatory response, angiogenic imbalance, and abnormal placentation are observed in PE, we hypothesize that maternal obesity and complement proteins derived from adipose tissue play an important role in the development of PE.
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Affiliation(s)
- Kelsey N Olson
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University , Baton Rouge, Louisiana.,Reproductive Endocrinology & Women's Health Lab, Pennington Biomedical Research Center , Baton Rouge, Louisiana
| | - Leanne M Redman
- Reproductive Endocrinology & Women's Health Lab, Pennington Biomedical Research Center , Baton Rouge, Louisiana
| | - Jenny L Sones
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University , Baton Rouge, Louisiana
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74
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Davis S, Dylewski J, Shah PB, Holmen J, You Z, Chonchol M, Kendrick J. Risk of adverse maternal and fetal outcomes during pregnancy in living kidney donors: A matched cohort study. Clin Transplant 2019; 33:e13453. [PMID: 30472740 PMCID: PMC6342653 DOI: 10.1111/ctr.13453] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/30/2018] [Accepted: 11/16/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND We examined the risk of adverse pregnancy outcomes in primiparous kidney donors compared to matched controls. METHODS Fifty-nine women with a history of kidney donation prior to their first pregnancy with normal renal function and no history of kidney disease, diabetes or chronic hypertension were matched 1:4 by age (within 2 years) and race to women with two kidneys using data from an integrated healthcare delivery system. Adverse pregnancy outcomes were defined as preterm delivery (delivery <37 weeks), delivery via cesarean section, gestational hypertension, preeclampsia/eclampsia, gestational diabetes, length of stay in the hospital >3 days, infant death/transfer to acute facility and low birthweight (<2500 g). RESULTS Living kidney donors did not have a higher risk of adverse outcomes compared to matched controls. There was a trend toward an increased risk of preeclampsia/eclampsia in kidney donors but it did not reach statistical significance (Odds ratio [OR]: 2.96, 95% CI: 0.98-8.94, P = 0.06). However, in kidney donors ≤30 years of age, there was a fourfold increased risk of preeclampsia/eclampsia (OR: 4.09, 95% CI: 1.07-15.59, P = 0.04). CONCLUSION Overall, the risk of pregnancy-associated complications following kidney donation is small but potential female kidney donors should be counseled on the possible increased risk of preeclampsia.
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Affiliation(s)
- Scott Davis
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - James Dylewski
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - Pratik B Shah
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - John Holmen
- Homer Warner Center, Intermountain Health Care, Salt Lake City, UT
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
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Lopez-Jaramillo P, Barajas J, Rueda-Quijano SM, Lopez-Lopez C, Felix C. Obesity and Preeclampsia: Common Pathophysiological Mechanisms. Front Physiol 2018; 9:1838. [PMID: 30618843 PMCID: PMC6305943 DOI: 10.3389/fphys.2018.01838] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/06/2018] [Indexed: 01/25/2023] Open
Abstract
Preeclampsia is a disorder specific of the human being that appears after 20 weeks of pregnancy, characterized by new onset of hypertension and proteinuria. Abnormal placentation and reduced placental perfusion associated to impaired trophoblast invasion and alteration in the compliance of uterine spiral arteries are the early pathological findings that are present before the clinical manifestations of preeclampsia. Later on, the endothelial and vascular dysfunction responsible of the characteristic vasoconstriction of preeclampsia appear. Different nutritional risk factors such as a maternal deficit in the intake of calcium, protein, vitamins and essential fatty acids, have been shown to play a role in the genesis of preeclampsia, but also an excess of weight gain during pregnancy or a pre-pregnancy state of obesity and overweight, which are associated to hyperinsulinism, insulin resistance and maternal systemic inflammation, are proposed as one of the mechanism that conduce to endothelial dysfunction, hypertension, proteinuria, thrombotic responses, multi-organ damage, and high maternal mortality and morbidity. Moreover, it has been demonstrated that pregnant women that suffer preeclampsia will have an increased risk of future cardiovascular disease and related mortality in their later life. In this article we will discuss the results of studies performed in different populations that have shown an interrelationship between obesity and overweight with the presence of preeclampsia. Moreover, we will review some of the common mechanisms that explain this interrelationship, particularly the alterations in the L-arginine/nitric oxide pathway as a crucial mechanism that is common to obesity, preeclampsia and cardiovascular diseases.
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Affiliation(s)
- Patricio Lopez-Jaramillo
- Clinic of Metabolic Syndrome, Prediabetes, and Diabetes, Research Department, FOSCAL, Floridablanca, Colombia.,Masira Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia.,Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnologica Equinoccial, Quito, Ecuador
| | - Juan Barajas
- Clinic of Metabolic Syndrome, Prediabetes, and Diabetes, Research Department, FOSCAL, Floridablanca, Colombia
| | - Sandra M Rueda-Quijano
- Clinic of Metabolic Syndrome, Prediabetes, and Diabetes, Research Department, FOSCAL, Floridablanca, Colombia
| | | | - Camilo Felix
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnologica Equinoccial, Quito, Ecuador
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Nathan HL, Seed PT, Hezelgrave NL, De Greeff A, Lawley E, Conti-Ramsden F, Anthony J, Steyn W, Hall DR, Chappell LC, Shennan AH. Maternal and perinatal adverse outcomes in women with pre-eclampsia cared for at facility-level in South Africa: a prospective cohort study. J Glob Health 2018; 8:020401. [DOI: 10.7189/jogh.08.020401] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lokki AI, Heikkinen-Eloranta JK, Laivuori H. The Immunogenetic Conundrum of Preeclampsia. Front Immunol 2018; 9:2630. [PMID: 30483272 PMCID: PMC6243043 DOI: 10.3389/fimmu.2018.02630] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/25/2018] [Indexed: 12/12/2022] Open
Abstract
Pregnancy is an immunological challenge to the mother. The fetal tissues including the placenta must be protected from activation of the maternal immune system. On the other hand, the placental tissue sheds into the maternal circulation and must be adequately identified and phagocytized by the maternal immune system. During a healthy pregnancy, numerous immunosuppressive processes take place that allow the allograft fetus to thrive under exposure to humoral and cellular components of the maternal immune system. Breakdown of immune tolerance may result in sterile inflammation and cause adverse pregnancy outcomes such as preeclampsia, a vascular disease of the pregnancy with unpredictable course and symptoms from several organs. Immunological incompatibility between mother and fetus is strongly indicated in preeclampsia. Recently, genetic factors linking immunological pathways to predisposition to preeclampsia have been identified. In this mini-review genetic variation in immunological factors are discussed in the context of preeclampsia. Specifically, we explore immunogenetic and immunomodulary mechanisms contributing to loss of tolerance, inflammation, and autoimmunity in preeclampsia.
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Affiliation(s)
- A Inkeri Lokki
- Research Programs Unit, Immunobiology Research Program, University of Helsinki, Helsinki, Finland.,Bacteriology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Hannele Laivuori
- Medical and Clinical genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
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Alemu A, Abebe M, Biadgo B, Terefe B, Baynes HW. Biochemical Profiles of Pregnant and Non-pregnant Women Attending at the University of Gondar Hospital, Northwest Ethiopia: A Comparative Cross-sectional Study. Ethiop J Health Sci 2018; 28:331-340. [PMID: 29983533 PMCID: PMC6016350 DOI: 10.4314/ejhs.v28i3.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Pregnancy is a natural physiological statement with hormonal and metabolic changes that helps the growth and survival of the fetus. However, biochemical profiles derangement may lead to pregnancy complications. Therefore, there is a need for determining biochemical profiles among pregnant women. Methods A comparative cross-sectional study was conducted among pregnant and non-pregnant women at the University of Gondar Hospital, from February to April, 2015. Fasting blood sample was collected from 139 pregnant and 139 age matched non-pregnant women using systematic random sampling technique. Interviewer-administered questionnaire was used to collect socio-demographic and clinical data. Fasting blood glucose and lipid profile were measured by A25 Biosytemchemistry analyzer using enzymatic calorimetric methods. Data analysis was done using SPSS version 20. Level of significance between groups was analyzed using independent student t-test and Mann-Whitney U test. A p-value of <0.05 was considered as statistically significant. Result Pregnant women as compared to non-pregnant had significantly increased glucose (96.35±14.45 and 81.12±9.86 mg/dl), total cholesterol (211.9±40.88 and 172.40±29.64 mg/dl) [p<0.05], respectively. It had also significantly high triglycerides (190.81±81.04 and 107.43±45.80 mg/dl) and low-density lipoprotein cholesterol (116.03±37.26 and 86.12±27.29mg/dl) [p<05] in pregnant as compared to non-pregnant women. The level of high-density lipoprotein cholesterol was significantly lower in pregnant women (59.58±14.26) than control (63.63±11.4, P <0.05). Conclusion There were statistically significant increment in glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol and decrement in high-density lipoprote in cholesterol levels among pregnant women compared with non-pregnant women. Therefore, pregnant women have to be monitored closely for their biochemical profiles to avoid adverse pregnancy outcomes.
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Affiliation(s)
- Aynadis Alemu
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia.,Department of Hematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia
| | - Molla Abebe
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia.,Department of Hematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia
| | - Belete Biadgo
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia.,Department of Hematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia
| | - Betelihem Terefe
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia.,Department of Hematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia
| | - Habtamu Wondifraw Baynes
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia.,Department of Hematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia
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Lassek WD, Gaulin SJC. Do the Low WHRs and BMIs Judged Most Attractive Indicate Better Health? EVOLUTIONARY PSYCHOLOGY 2018; 16:1474704918803998. [PMID: 30296849 PMCID: PMC10367492 DOI: 10.1177/1474704918803998] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 09/10/2018] [Indexed: 01/01/2023] Open
Abstract
It is widely claimed that in well-nourished populations, very low female waist-hip ratios (WHRs) together with low body mass indices (BMIs) are judged attractive by men because these features reliably indicate superior health and fertility. However, studies show that mortality rates are higher in women with low BMIs than in women with average BMIs and are inversely related to BMI in subsistence populations. Measures of current health in women of reproductive age have not been similarly studied. We analyze large U.S. samples of reproductive-age women and show that controlling for other factors known to affect health, those with low BMIs (<20), WHRs, or waist/stature ratios did not have better health than those with values in the middle range, and there was no relationship between subsequent health outcomes and BMI in early adulthood. Lower self-reported BMIs were linked to poorer health and an increased risk of infection. However, based on recent U.S. natality data, primiparas with lower BMIs had a lower risk of an operative delivery and of gestational hypertension. Beyond these two parity-restricted effects, relevant studies and new tests fail to support the view that women with the very low BMIs and WHRs consistently judged attractive are generally healthier than women with average values; significant correlations were consistently in the opposite direction.
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Affiliation(s)
- William D. Lassek
- Department of Anthropology, University of California at Santa Barbara, Santa Barbara, CA, USA
| | - Steven J. C. Gaulin
- Department of Anthropology, University of California at Santa Barbara, Santa Barbara, CA, USA
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80
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Greiner KS, Speranza RJ, Rincón M, Beeraka SS, Burwick RM. Association between insurance type and pregnancy outcomes in women diagnosed with hypertensive disorders of pregnancy. J Matern Fetal Neonatal Med 2018; 33:1427-1433. [PMID: 30182768 DOI: 10.1080/14767058.2018.1519544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Hypertension in pregnancy is associated with adverse maternal and neonatal outcomes. Previous studies have demonstrated disparities in the risk of preeclampsia based on race, educational attainment, census tract income level and household income. Yet, data on the association of insurance type, classification of hypertension in pregnancy and outcomes have not been well described. We sought to compare outcomes in women with hypertensive disorders of pregnancy, by private versus public insurance.Study design: This was a retrospective cohort study of subjects with a hypertensive disorder of pregnancy that delivered ≥23-week gestation at Oregon Health & Science University (October 2013-December 2017). The cohort began with the 2013 American College of Obstetricians and Gynecologists Executive Summary on Hypertension in Pregnancy, which advised surveillance for severe features of disease in women with hypertension. Utilizing ICD-9 and ICD-10 discharge codes, followed by individual chart review, subjects were stratified into two groups by insurance status: Medicaid (public insurance), or individual or group health insurance (private insurance). As primary outcomes, we assessed severe features of preeclampsia, adverse maternal or neonatal outcomes (composite), and final hypertensive diagnosis: (i) chronic hypertension; (ii) gestational hypertension; (iii) preeclampsia without severe features and, (iv) preeclampsia with severe features. Differences in demographic and outcome data were analyzed by chi-square, t-test, and logistic regression.Results: Among 10 132 deliveries, 1335 (13.2%) were delivered with a hypertensive disorder of pregnancy. Medicaid covered 54.1% (722) of these deliveries; 44.1% (589) were covered by private insurance, and 1.8% (24) had unknown insurance. There was a similar percentage of subjects with Medicaid or private insurance in each hypertensive group (p = .08). However, compared to subjects with private insurance, those with Medicaid had more severe blood pressure (BP) elevations (systolic BP ≥160 mmHg, p = .001) and more cases of eclampsia (p = .04), while neonates of subjects with Medicaid had more intensive care unit admissions (p = .02), and preterm births (p < .001). The association between Medicaid insurance and severe BP elevation, or adverse neonatal outcomes, persisted after multivariable adjustment.Conclusion: Medicaid was not associated with a particular hypertensive disorder in pregnancy, yet those with Medicaid experienced more severe BP elevations and higher rates of adverse neonatal outcomes. More research is needed to understand potential risk factors and ways to improve outcomes for those with publicly funded insurance.
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Affiliation(s)
- Karen S Greiner
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Rosa J Speranza
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Monica Rincón
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Sridivya S Beeraka
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Richard M Burwick
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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81
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Abstract
Pregnancy in women with obesity is an important public health problem with short- and long-term implications for maternal and child health. Obesity complicates almost all aspects of pregnancy. Given the growing prevalence of obesity in women, obstetric providers need to understand the risks associated with obesity in pregnancy and the unique aspects of management for women with obesity. Empathic and patient-centered care, along with knowledge, can optimize outcomes for women and children.
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Affiliation(s)
- Cara D Dolin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Health, 550 1st Avenue, New York, NY 10016, USA.
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, 250 East Superior Street Suite 05-2175, Chicago, IL 60611, USA
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82
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Wojcik-Baszko D, Charkiewicz K, Laudanski P. Role of dyslipidemia in preeclampsia-A review of lipidomic analysis of blood, placenta, syncytiotrophoblast microvesicles and umbilical cord artery from women with preeclampsia. Prostaglandins Other Lipid Mediat 2018; 139:19-23. [PMID: 30248406 DOI: 10.1016/j.prostaglandins.2018.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 09/09/2018] [Accepted: 09/20/2018] [Indexed: 01/12/2023]
Abstract
Preeclampsia is a complex disorder and the pathogenesis of it is still not fully understood. The most commonly accepted theory of pathogenesis assumes that there occurs impaired trophoblastic invasion and failure in spiral artery remodeling. Nowadays, obesity becomes one of the most important, modifiable risk factors for the development of preeclampsia. Despite research into the condition, predicting which women with risk factors will develop preeclampsia remains problematic. Emerging evidence suggests that dysregulation of maternal and placental lipid metabolism are involved in the pathogenesis of the condition. Hence, researchers are focused on finding a lipid fingerprint, which contains information about the lipid composition and abundance of individual lipids by using new methods in the field of lipidomics. In this review we aimed to discuss the role of dyslipidemia in the pathogenesis of preeclampsia. In addition, on the basis of current research, we attempted to find a specific lipid profile of different tissues in women with preeclampsia.
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Affiliation(s)
- Daniela Wojcik-Baszko
- Department of Perinatology and Obstetrics, Medical University of Bialystok, Marii Sklodowskiej-Curie 24a, 15-276, Bialystok, Poland.
| | - Karol Charkiewicz
- Department of Perinatology and Obstetrics, Medical University of Bialystok, Marii Sklodowskiej-Curie 24a, 15-276, Bialystok, Poland
| | - Piotr Laudanski
- Department of Perinatology and Obstetrics, Medical University of Bialystok, Marii Sklodowskiej-Curie 24a, 15-276, Bialystok, Poland; 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza 1/3, 02-015, Warsaw, Poland.
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83
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Košir Pogačnik R, Trojner Bregar A, Lučovnik M, Krajec M, Verdenik I, Blickstein I, Tul N. The effect of interaction between parity, gestational diabetes, and pregravid obesity on the incidence of preeclampsia. J Matern Fetal Neonatal Med 2018; 33:931-934. [PMID: 30081684 DOI: 10.1080/14767058.2018.1509311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To examine the effect of parity, prepregnancy obesity and gestational diabetes on the incidence of preeclampsia in singleton pregnancies using a population-based dataset.Methods: We used the national perinatal information system (NPIS) to identify singleton pregnancies complicated by preeclampsia and analyzed dichotomous-independent variables: being obese or normal weight before pregnancy, being primiparous or multiparous, and being without gestational diabetes mellitus (GDM), with GDMA1, or GDMA2.Results: We found a significantly higher incidence of pregravid obesity among primiparas with preeclampsia (OR 1.6, 95% CI 1.55, 1.66). The data indicate that multiparas had always a significantly lower incidence of preeclampsia, regardless if the women had GDMA1, GDMA2 or had no GDM, and regardless of being of normal weight or obese before pregnancy. The data indicate that the incidence of preeclampsia was not influenced by GDM status, irrespective of parity pregravid BMI category.Conclusions: Our data indicate that GDM is not significantly associated with the development of preeclampsia.
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Affiliation(s)
- Renata Košir Pogačnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Andreja Trojner Bregar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Miha Lučovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Maja Krajec
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Isaac Blickstein
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel)
| | - Nataša Tul
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
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84
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Nathan HL, Seed PT, Hezelgrave NL, De Greeff A, Lawley E, Conti-Ramsden F, Anthony J, Steyn W, Hall DR, Chappell LC, Shennan AH. Maternal and perinatal adverse outcomes in women with pre-eclampsia cared for at facility-level in South Africa: a prospective cohort study. J Glob Health 2018. [PMID: 30140431 PMCID: PMC6076583 DOI: 10.7189/jogh.08-020401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Hypertensive disorders of pregnancy contribute to 14% of all maternal deaths, the majority of which occur in low- and middle-income countries. The aim of the study was to describe the maternal and perinatal clinical outcomes of women with pre-eclampsia living in middle- and low-income countries. Methods The study was a prospective observational study of women with pre-eclampsia (n = 1547, 42 twin pregnancies) at three South African tertiary facilities. Using stepwise logistic regression model area under the receiver operating characteristic curve (AUROC) values, the association between maternal baseline and admission characteristics and risk of adverse outcomes was evaluated. Main outcome measures were eclampsia, kidney injury and perinatal death. Results In 1547 women with pre-eclampsia, 16 (1%) died, 147 (9.5%) had eclampsia, four (0.3%) had a stroke and 272 (17.6%) had kidney injury. Of the 1589 births, there were 332 (21.0%) perinatal deaths; of these, 281 (84.5%) were stillbirths. Of 1308 live births, 913 (70.0%) delivered <37 completed weeks and 544 (41.7%) delivered <34 weeks’ gestation. Young maternal age (AUROC = 0.76, 95% confidence interval (CI) = 0.71-0.80) and low Body Mass Index BMI (AUROC 0.65, 95% CI = 0.59-0.69) were significant predictors of eclampsia. Highest systolic blood pressure had the strongest association with kidney injury, (AUROC = 0.64, 95% CI = 0.60-0.68). Early gestation at admission was most strongly associated with perinatal death (AUROC = 0.81, 95% CI = 0.77-0.84). Conclusions The incidence of pre-eclampsia complications, perinatal death and preterm delivery in women referred to tertiary care in South Africa was much higher than reported in other low- and middle-income studies and despite access to tertiary care interventions. Teenage mothers and those with low BMI were at highest risk of eclampsia. This information could be used to inform guidelines, the research agenda and policy.
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Affiliation(s)
- Hannah L Nathan
- Department of Women and Children's Health, King's College London, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, London, UK
| | | | - Annemarie De Greeff
- Department of Women and Children's Health, King's College London, London, UK
| | - Elodie Lawley
- Department of Women and Children's Health, King's College London, London, UK
| | | | - John Anthony
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Wilhelm Steyn
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - David R Hall
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, London, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, King's College London, London, UK
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85
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Canto-Cetina T, Coral-Vázquez RM, Rojano-Mejía D, Pérez Godoy S, Coronel A, Canto P. Higher prepregnancy body mass index is a risk factor for developing preeclampsia in Maya-Mestizo women: a cohort study. ETHNICITY & HEALTH 2018; 23:682-690. [PMID: 28385076 DOI: 10.1080/13557858.2017.1315367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM Preeclampsia and obesity are two closely related syndromes. The high maternal prepregnancy body mass index (BMI) is a risk factor for present preeclampsia, independently of the ethnic background of the studied population. The aim of this study was to analyse in a prospective cohort study the relation between prepregnancy BMI and development of preeclampsia in Maya-Mestizo women. DESIGN This is a prospective cohort study of 642 pregnant women that were included in the first trimester of the pregnancy (gestational age ≤12 weeks at the first antenatal visit) and all of them were of Maya-Mestizo ethnic origin from the state of Yucatán, México. We assessed the potential risk factors for preeclampsia and documented the prepregnancy BMI (kg/m2) that was based on measured height and maternal self-report of prepregnancy weight at the initial visit. Besides, in the antenatal visit we documented if the pregnant women developed preeclampsia. RESULTS Of the 642 pregnant Maya-Mestizo women, 49 developed preeclampsia, with an incidence of 7.6% (44.9% had severe and 55% mild). The prepregnancy BMI was higher in women with developed preeclampsia than in those with normal pregnancies. Women with overweight or obesity in comparison with normal weight presented a RR = 2.82 (95% CI: 1.32-6.03; P = 0.008) and RR= 4.22 (95% CI: 2.07-8.61; P = 0.001), respectively. CONCLUSIONS Our findings expand the previous studies to show that the higher prepregnancy BMI is a strong, independent risk factor for preeclampsia.
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Affiliation(s)
- Thelma Canto-Cetina
- a Laboratorio de Biología de la Reproducción , Centro de Investigaciones Regionales "Dr. Hideyo NoguchiUniversidad Autónoma de Yucatán" , Mérida , México
| | - Ramón Mauricio Coral-Vázquez
- b Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina , Instituto Politécnico Nacional , México , D.F. , México
- c Subdirección de Enseñanza e Investigación , Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado , México , D.F. , México
| | - David Rojano-Mejía
- d Unidad de Medicina Física y Rehabilitación, Región Centro, UMAE Lomas Verdes , Instituto Mexicano del Seguro Social , México , D.F. , México
| | - Sergio Pérez Godoy
- e Servicio Prenatal, del Hospital Materno Infantil, S.S. , Mérida , México
| | - Agustín Coronel
- f División de Investigación Biomédica, Subdirección de Enseñanza e Investigación , Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado , México , D.F. , México
| | - Patricia Canto
- g Unidad de Investigación en Obesidad, Facultad de Medicina , Universidad Nacional Autónoma de México & Clínica de Obesidad, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , México , D.F. , México
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86
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Rivera-Romero O, Olmo A, Muñoz R, Stiefel P, Miranda ML, Beltrán LM. Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review. JMIR Mhealth Uhealth 2018; 6:e130. [PMID: 29848473 PMCID: PMC6000483 DOI: 10.2196/mhealth.9671] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 02/07/2023] Open
Abstract
Background Hypertensive disorders are the most common complications during pregnancy, occurring in 5% to 11% of pregnancies; gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality, especially in low- and middle-income countries (LMIC) where maternal and perinatal mortality ratios are still high. Pregnant women with hypertensive disorders could greatly benefit from mobile health (mHealth) solutions as a novel way to identify and control early symptoms, as shown in an increasing number of publications in the field. Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource-poor environments. Objective The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy, with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice. Methods A methodological review following a scoping methodology was conducted. Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included, categorizing articles in different groups: Diagnosis and Monitoring, mHealth Decision Support System, Education, and Health Promotion, and seven research questions were posed to study the manuscripts. Results The search in electronic research databases yielded 327 articles. After removing duplicates, 230 articles were selected for screening. Finally, 11 articles met the inclusion criteria, and data were extracted from them. Very positive results in the improvement of maternal health and acceptability of solutions were found, although most of the studies involved a small number of participants, and none were complete clinical studies. Accordingly, none of the reported prototypes were integrated in the different health care systems. Only 4 studies used sensors for physiological measurements, and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension. The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget, of special relevance in LMIC, although again, no extensive clinical validation has been carried out in these environments. Conclusions mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice. Although very positive results have been reported in terms of usability and the improvement of maternal health, rigorous complete clinical trials are still necessary to support integration in health care systems. There is a clear need for simple mHealth solutions specifically developed for resource-poor environments that meet the United Nations Sustainable Development Goal (SDG); of enormous interest in LMIC.
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Affiliation(s)
| | - Alberto Olmo
- Department of Electronic Technology, Universidad de Sevilla, Sevilla, Spain
| | - Rocío Muñoz
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain
| | - Pablo Stiefel
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - María Luisa Miranda
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luis M Beltrán
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
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87
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Cristiano C, Lama A, Lembo F, Mollica MP, Calignano A, Mattace Raso G. Interplay Between Peripheral and Central Inflammation in Autism Spectrum Disorders: Possible Nutritional and Therapeutic Strategies. Front Physiol 2018; 9:184. [PMID: 29563885 PMCID: PMC5845898 DOI: 10.3389/fphys.2018.00184] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/20/2018] [Indexed: 12/16/2022] Open
Abstract
Pre- and post-natal factors can affect brain development and function, impacting health outcomes with particular relevance to neurodevelopmental diseases, such as autism spectrum disorders (ASDs). Maternal obesity and its associated complications have been related to the increased risk of ASDs in offspring. Indeed, animals exposed to maternal obesity or high fat diets are prone to social communication impairment and repetitive behavior, the hallmarks of autism. During development, fatty acids and sugars, as well as satiety hormones, like insulin and leptin, and inflammatory factors related to obesity-induced low grade inflammation, could play a role in the impairment of neuroendocrine system and brain neuronal circuits regulating behavior in offspring. On the other side, post-natal factors, such as mode of delivery, stress, diet, or antibiotic treatment are associated to a modification of gut microbiota composition, perturbing microbiota-gut-brain axis. Indeed, the interplay between the gastrointestinal tract and the central nervous system not only occurs through neural, hormonal, and immune pathways, but also through microbe-derived metabolic products. The modification of unhealthy perinatal and postnatal environment, manipulation of gut microbiota, nutritional, and dietary interventions could represent possible strategies in preventing or limiting ASDs, through targeting inflammatory process and gut microbiota.
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Affiliation(s)
- Claudia Cristiano
- Department of Pharmacy, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Adriano Lama
- Department of Pharmacy, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesca Lembo
- Department of Pharmacy, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maria P Mollica
- Department of Biology, University of Naples Federico II, Naples, Italy
| | - Antonio Calignano
- Department of Pharmacy, School of Medicine, University of Naples Federico II, Naples, Italy
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88
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Wilson RL, Bianco-Miotto T, Leemaqz SY, Grzeskowiak LE, Dekker GA, Roberts CT. Early pregnancy maternal trace mineral status and the association with adverse pregnancy outcome in a cohort of Australian women. J Trace Elem Med Biol 2018; 46:103-109. [PMID: 29413099 DOI: 10.1016/j.jtemb.2017.11.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 01/26/2023]
Abstract
Maternal micronutrient deficiencies in pregnancy can have profound effects on fetal development and pregnancy outcome. Plasma trace minerals including copper, zinc, selenium and iron have been shown to be extremely important in supporting reproduction. We sought to determine whether there is an association between maternal trace mineral status in early pregnancy and pregnancy complications using a prospective cohort study of 1065 pregnant Australian women who were recruited as part of the Screening for Pregnancy Endpoints (SCOPE) study in Adelaide. Copper, zinc, selenium and iron present in the plasma were measured using mass spectrometry in samples collected at 15±1 weeks' gestation. After adjusting for covariates, women with lower plasma copper (<27.9μmol/L and 27.9-32.5μmol/L) had decreased risk for any pregnancy complication when compared with women with high plasma copper (>32.5μmol/L) (aRR=0.87; 95% CI=0.76, 0.99 and aRR=0.88; 95% CI=0.78, 1.00, respectively). This was also observed when adjusting for plasma zinc and selenium status (<27.9μmol/L: aRR=0.81; 95% CI=0.69, 0.96 and 27.9-32.5μmol/L: aRR=0.84; 95% CI=0.72, 0.98). Combined low copper and zinc status was also associated with a reduced risk of any pregnancy complication as compared with high copper and zinc status (aRR=0.80; 95% CI=0.70, 0.93). These results provide justification for further work into elucidating the mechanistic role of trace elements in early pregnancy, as well as their interactions in supporting successful pregnancy outcomes.
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Affiliation(s)
- Rebecca L Wilson
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Tina Bianco-Miotto
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Waite Research Institute & School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia
| | - Shalem Y Leemaqz
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Luke E Grzeskowiak
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Gustaaf A Dekker
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Women's and Children's Division, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Claire T Roberts
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia.
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89
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Guan HB, Wei Y, Wang LL, Qiao C, Liu CX. Prenatal Selective Serotonin Reuptake Inhibitor Use and Associated Risk for Gestational Hypertension and Preeclampsia: A Meta-Analysis of Cohort Studies. J Womens Health (Larchmt) 2018; 27:791-800. [PMID: 29489446 DOI: 10.1089/jwh.2017.6642] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To analyze existing cohort studies and provide evidence for the use of prenatal selective serotonin reuptake inhibitor (SSRI) monotherapy and the associated risk of gestational hypertension and preeclampsia. METHODS A comprehensive search of English language articles published before 30th April 2017 was conducted on PubMed, EMBASE, and the Web of Science databases. Using data acquired, we summarized the relative risks (RRs) and 95% confidence intervals (CIs) of gestational hypertension and preeclampsia using the random-effects model. Heterogeneity between studies was also assessed with the I2 statistic. RESULTS Seven cohort studies with 1,108,261 individuals were included for analysis. Compared with nonusers, those undertaking prenatal SSRI monotherapy were more likely to develop gestational hypertension or preeclampsia (summarized RR = 1.21, 95% CI: 1.05-1.40, I2 = 71.3%), gestational hypertension (summarized RR = 1.14, 95% CI: 1.00-1.30, I2 = 5.7%), and preeclampsia (summarized RR = 1.32, 95% CI: 0.99-1.78, I2 = 83.3%). In addition, although subgroup analyses, which were stratified by study design, number of cases, geographic location, duration of SSRI monotherapy, registry databases, and adjustment for potential confounders and risk factors, were consistent with the main findings, not all of these showed statistical significance. No evidence of publication bias was detected. CONCLUSIONS Women who receive SSRI monotherapy during pregnancy are at increased risk of gestational hypertension and preeclampsia.
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Affiliation(s)
- Hong-Bo Guan
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University , Shenyang, P.R. China
| | - Yang Wei
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University , Shenyang, P.R. China
| | - Lei-Lei Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University , Shenyang, P.R. China
| | - Chong Qiao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University , Shenyang, P.R. China
| | - Cai-Xia Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University , Shenyang, P.R. China
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90
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Mrema D, Lie RT, Østbye T, Mahande MJ, Daltveit AK. The association between pre pregnancy body mass index and risk of preeclampsia: a registry based study from Tanzania. BMC Pregnancy Childbirth 2018; 18:56. [PMID: 29466949 PMCID: PMC5822591 DOI: 10.1186/s12884-018-1687-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/12/2018] [Indexed: 01/15/2023] Open
Abstract
Background Preeclampsia is among the leading causes of maternal mortality and morbidity worldwide, occurs in 2-8% of all pregnancies, and is estimated to account for at least 9 % of maternal deaths in Africa. Studies from developed countries show that high pre pregnancy body mass index (BMI) increases the risk of preeclampsia. We examined the association between pre pregnancy BMI and the risk of preeclampsia in Tanzania, a low income country. Methods Data from the Kilimanjaro Christian Medical Center (KCMC) Medical Birth Registry recorded between July 2000 and May 2013 were used. We restricted the study population to singleton deliveries among women with no or one previous pregnancy. Pre pregnancy BMI (kg/m2) was categorized according to the WHO categories of underweight (less than 18.5), normal (18.5 – 24.9), overweight (25.0 – 29.9) and obese (30 or more). Potential confounders were adjusted for in multivariable analyses. Results Among the 17,738 singleton births, 6.6% of the mothers were underweight, 62.1% were of normal BMI, 24.0% were overweight, and 7.3% were obese. Five hundred and eighty-two pregnancies (3.3%) were affected by preeclampsia. Compared to those with normal BMI, overweight and obese women had a higher risk of preeclampsia (aOR (95% CI) 1.4 (1.2 – 1.8) and 1.8 (1.3 – 2.4)), respectively, while underweight women had a lower risk (0.7 (0.4-1.1)). Conclusions Pre pregnancy maternal overweight and obesity were associated with an increased risk of preeclampsia in Tanzania. Risks were similar to those reported in high income countries.
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Affiliation(s)
- Dorah Mrema
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Postboks 7804, N-5020, Bergen, Norway.,Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Rolv Terje Lie
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Postboks 7804, N-5020, Bergen, Norway.,Norwegian Institute of Public Health, Bergen, Norway
| | - Truls Østbye
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Postboks 7804, N-5020, Bergen, Norway
| | - Michael Johnson Mahande
- Institute of Public Health, Department of Epidemiology & Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Postboks 7804, N-5020, Bergen, Norway. .,Norwegian Institute of Public Health, Bergen, Norway.
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91
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Bello JK, Stulberg DB, Zhou Y, Wang C. Physical Activity and Consumption Patterns of Reproductive-Aged Women by BMI Category. Matern Child Health J 2018; 22:713-724. [PMID: 29344750 DOI: 10.1007/s10995-018-2440-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives Obesity before and during pregnancy is associated with adverse effects for mother and child, but little is known about physical activity and consumption patterns among reproductive-aged women. The goal of this study is to identify behaviors of nonpregnant reproductive-aged women associated with normal weight, overweight, and obesity. Methods Data from the nationally representative National Eating Trends survey (2003-2011) were analyzed, comparing number of days of exercise in a 1-week period and consumption of fruits/vegetables, sugar sweetened beverages (SSB), and concentrated sweets by BMI. Behaviors were compared using analysis of variance and Chi square test across groups. Ordinal logistic regression was used to compare behaviors across groups controlling for demographic factors. Multivariable Poisson regression was used to identify demographic factors associated with behaviors among obese women. Results Among 5941 18-45-year-old women, exercise and fruit/vegetable consumption were associated with healthy weight controlling for demographic factors. Reporting any exercise or fruit/vegetable consumption was associated with decreased odds of overweight or obesity (aOR 0.73, 95% CI 0.64-0.83 and aOR 0.74, 95% CI 0.58-0.95, respectively). Consuming SSBs was associated with increasing BMI category while consuming concentrated sweets was unexpectedly associated with normal weight. Among obese women, being on any diet was associated with increased exercise frequency and fruit/vegetable consumption and decreased SSB consumption. Conclusions for Practice Physical activity and consumption behaviors are associated with weight among reproductive-aged women in ways similar to those in the general population. Promoting exercise and fruit/vegetable consumption has the potential to reduce obesity.
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Affiliation(s)
- Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University, 1402 South Grand Blvd., Saint Louis, MO, 63104, USA. .,Ambulatory Primary Care Innovations Group (APCIG), NorthShore University HealthSystem, Evanston, IL, USA.
| | - Debra B Stulberg
- Department of Family Medicine, University of Chicago, 5841 S. Maryland Ave., MC 7110, Chicago, IL, 60637, USA.,Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA.,MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
| | - Ying Zhou
- Center for Biomedical Research Informatics (CBRI), NorthShore University HealthSystem, 1001 University Place, Suite 150, Evanston, IL, 60201, USA
| | - Chi Wang
- Department of Biostatistics and Research Informatics, NorthShore University HealthSystem, 1001 University Place, Evanston, IL, 60201, USA
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92
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Suarez EA, Landi SN, Conover MM, Jonsson Funk M. Bias from restricting to live births when estimating effects of prescription drug use on pregnancy complications: A simulation. Pharmacoepidemiol Drug Saf 2018; 27:307-314. [DOI: 10.1002/pds.4387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/17/2017] [Accepted: 12/16/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Elizabeth A. Suarez
- Department of Epidemiology, Gillings School of Global Public Health; University of North Carolina; Chapel Hill NC USA
| | - Suzanne N. Landi
- Department of Epidemiology, Gillings School of Global Public Health; University of North Carolina; Chapel Hill NC USA
| | - Mitchell M. Conover
- Department of Epidemiology, Gillings School of Global Public Health; University of North Carolina; Chapel Hill NC USA
| | - Michele Jonsson Funk
- Department of Epidemiology, Gillings School of Global Public Health; University of North Carolina; Chapel Hill NC USA
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93
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Shao Y, Qiu J, Huang H, Mao B, Dai W, He X, Cui H, Lin X, Lv L, Wang D, Tang Z, Xu S, Zhao N, Zhou M, Xu X, Qiu W, Liu Q, Zhang Y. Pre-pregnancy BMI, gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou, China. BMC Pregnancy Childbirth 2017; 17:400. [PMID: 29191156 PMCID: PMC5709979 DOI: 10.1186/s12884-017-1567-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/06/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND To evaluate the independent and joint effects of maternal pre-pregnancy BMI and gestational weight gain (GWG) on the risk of preeclampsia and its subtypes. METHODS A birth cohort study was conducted from 2010 to 2012 in Lanzhou, China. Three hundred fourty seven pregnant women with preeclampsia and 9516 normotensive women at Gansu Provincial Maternity and Child Care Hospital were included in the present study. Unconditional logistic regression models were used to evaluate the associations between pre-pregnancy BMI, GWG, and risk of preeclampsia and its subtypes. RESULTS Compared to women with normal pre-pregnancy BMI, those who were overweight/obese had an increased risk of preeclampsia (OR = 1.81; 95%CI: 1.37-2.39). Women with excessive GWG had an increased risk of preeclampsia (OR = 2.28; 95%CI: 1.70-3.05) compared to women with adequate GWG. The observed increased risk was similar for mild-, severe- and late-onset preeclampsia. No association was found for early-onset preeclampsia. Overweight/obese women with excessive GWG had the highest risk of developing preeclampsia compared to normal weight women with no excessive weight gain (OR = 3.78; 95%CI: 2.65-5.41). CONCLUSIONS Our results suggested that pre-pregnancy BMI and GWG are independent risk factors for preeclampsia and that the risk might vary by preeclampsia subtypes. Our study also proposed a potential synergistic effect of pre-pregnancy BMI and GWG that warrants further investigation.
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Affiliation(s)
- Yawen Shao
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Jie Qiu
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Huang Huang
- Yale University School of Public Health, 60 College Street, New Haven, CT 06520 USA
| | - Baohong Mao
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Wei Dai
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Xiaochun He
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Hongmei Cui
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Xiaojuan Lin
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Ling Lv
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Dennis Wang
- Yale University School of Public Health, 60 College Street, New Haven, CT 06520 USA
| | - Zhongfeng Tang
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Sijuan Xu
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Nan Zhao
- Yale University School of Public Health, 60 College Street, New Haven, CT 06520 USA
| | - Min Zhou
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Xiaoying Xu
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Weitao Qiu
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Qing Liu
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Yawei Zhang
- Yale University School of Public Health, 60 College Street, New Haven, CT 06520 USA
- Yale School of Medicine, New Haven, CT USA
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94
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Daly AL, Sriram N, Woodall C, Selvakumar K, Briggs K, Garg P, Russell L, Yu M, Beetson K, Hennessy A. Risk factors associated with hypertensive disorders of pregnancy within an urban indigenous population in south western Sydney. Intern Med J 2017; 48:269-275. [PMID: 29083111 DOI: 10.1111/imj.13669] [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: 05/12/2017] [Revised: 09/24/2017] [Accepted: 10/20/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of hypertensive disorders of pregnancy (HDP) in Australia's urban indigenous women is unknown. AIM To explore the risk factors associated with HDP for a cohort of urban indigenous women in South-Western Sydney, Australia. METHODS This study was conducted in partnership with the Tharawal Aboriginal Medical Service. Women (18-45 years) were recruited at the clinic and community events. The quantitative questionnaire included obstetric history, personal and family history of hypertension. Anthropometric measurements and blood pressure were conducted. Rates were compared with Australian Bureau of Statistics (ABS) national rates. RESULTS Eighty-three participants completed the questionnaire. The rate of ever having HDP in a pregnancy was 36.1%. The overall ABS rate was 9.8% and for indigenous women, 14%. The mean maternal age at first pregnancy was 20.8 years (SD 3.7 years). The mean body mass index (BMI) of the sample population (n = 81) was 32.2 kg/m2 (SD 9.5 kg/m2 ) and BMI was not related to HDP (P = 0.197). Of those questioned, 25.3% had an individual history and 63.9% had a family history of hypertension. The effect of family history of hypertension (P = 0.020) (odds ratio (OR) 4.29; 95% confidence interval (CI); 1.42-12.93) and individual history of hypertension (P < 0.001) (OR 15.69; 95% CI; 4.50-54.76) were associated with HDP. CONCLUSION There was a higher rate of HDP in urban indigenous women compared to the national indigenous prevalence. The family history, or individual history of hypertension was the most significant risk factors and BMI was not identified as a risk factor for HDP in this population.
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Affiliation(s)
- Amy L Daly
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Nina Sriram
- Westmead Hospital, Sydney, New South Wales, Australia
| | | | | | - Kelly Briggs
- Tharawal AMS, Sydney, New South Wales, Australia
| | - Parul Garg
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Lisa Russell
- Tharawal AMS, Sydney, New South Wales, Australia
| | - Michelle Yu
- Nepean Hospital, Sydney, New South Wales, Australia
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- Tharawal Cooperation, Sydney, New South Wales, Australia
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95
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Nakagawa K, Lim E, Harvey S, Miyamura J, Juarez DT. Racial/Ethnic Disparities in the Association Between Preeclampsia Risk Factors and Preeclampsia Among Women Residing in Hawaii. Matern Child Health J 2017; 20:1814-24. [PMID: 27000850 DOI: 10.1007/s10995-016-1984-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective To assess differences in the rates of preeclampsia among a multiethnic population in Hawaii. Methods We performed a retrospective study on statewide inpatient data for delivery hospitalizations in Hawaii between January 1995 and December 2013. Multivariable logistic regression was used to assess the impact of maternal race/ethnicity on the rates of preeclampsia after adjusting for age, multiple gestation, multiparity, chronic hypertension, pregestational diabetes, obesity and smoking. Results A total of 271,569 hospital discharges for delivery were studied. The rates of preeclampsia ranged from 2.0 % for Chinese to 4.6 % for Filipinos. Preeclampsia rates were higher among Native Hawaiians who are age <35 and non-obese (OR 1.54; 95 % CI 1.43-1.66), age ≥35 and non-obese (OR 2.31; 95 % CI 2.00-2.68), age ≥35 and obese (OR 1.80; 95 % CI 1.24-2.60); other Pacific Islanders who are age <35 and non-obese (OR 1.40; 95 % CI 1.27-1.54), age ≥35 and non-obese (OR 2.18; 95 % CI 1.79-2.64), age ≥35 and obese (OR 1.68; 95 % CI 1.14-2.49); and Filipinos who are age <35 and non-obese (OR 1.55; 95 % CI 1.43-1.67), age ≥35 and non-obese (OR 2.26; 95 % CI 1.97-2.60), age ≥35 and obese (OR 1.64; 95 % CI 1.04-2.59) compared to whites. Pregestational diabetes (OR 3.41; 95 % CI 3.02-3.85), chronic hypertension (OR 5.98; 95 % CI 4.98-7.18), and smoking (OR 1.19; 95 % CI 1.07-1.33) were also independently associated with preeclampsia. Conclusions for Practice In Hawaii, Native Hawaiians, other Pacific Islanders and Filipinos have a higher risk of preeclampsia compared to whites. For these high-risk ethnic groups, more frequent monitoring for preeclampsia may be needed.
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Affiliation(s)
- Kazuma Nakagawa
- The Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI, 96813, USA. .,Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
| | - Eunjung Lim
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Scott Harvey
- The Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI, 96813, USA.,Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Jill Miyamura
- Hawaii Health Information Corporation, Honolulu, HI, USA
| | - Deborah T Juarez
- Daniel K. Inouye College of Pharmacy, University of Hawaii, Hilo, HI, USA
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96
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Sominsky L, Hodgson DM, McLaughlin EA, Smith R, Wall HM, Spencer SJ. Linking Stress and Infertility: A Novel Role for Ghrelin. Endocr Rev 2017; 38:432-467. [PMID: 28938425 DOI: 10.1210/er.2016-1133] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/24/2017] [Indexed: 12/23/2022]
Abstract
Infertility affects a remarkable one in four couples in developing countries. Psychological stress is a ubiquitous facet of life, and although stress affects us all at some point, prolonged or unmanageable stress may become harmful for some individuals, negatively impacting on their health, including fertility. For instance, women who struggle to conceive are twice as likely to suffer from emotional distress than fertile women. Assisted reproductive technology treatments place an additional physical, emotional, and financial burden of stress, particularly on women, who are often exposed to invasive techniques associated with treatment. Stress-reduction interventions can reduce negative affect and in some cases to improve in vitro fertilization outcomes. Although it has been well-established that stress negatively affects fertility in animal models, human research remains inconsistent due to individual differences and methodological flaws. Attempts to isolate single causal links between stress and infertility have not yet been successful due to their multifaceted etiologies. In this review, we will discuss the current literature in the field of stress-induced reproductive dysfunction based on animal and human models, and introduce a recently unexplored link between stress and infertility, the gut-derived hormone, ghrelin. We also present evidence from recent seminal studies demonstrating that ghrelin has a principal role in the stress response and reward processing, as well as in regulating reproductive function, and that these roles are tightly interlinked. Collectively, these data support the hypothesis that stress may negatively impact upon fertility at least in part by stimulating a dysregulation in ghrelin signaling.
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Affiliation(s)
- Luba Sominsky
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - Deborah M Hodgson
- School of Psychology, Faculty of Science and IT, The University of Newcastle, New South Wales 2308, Australia
| | - Eileen A McLaughlin
- School of Biological Sciences, Faculty of Science, The University of Auckland, Auckland 1010, New Zealand.,School of Environmental & Life Sciences, Faculty of Science and IT, The University of Newcastle, New South Wales 2308, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Lookout Road, New Lambton Heights, New South Wales 2305, Australia.,Priority Research Centre in Reproductive Science, The University of Newcastle, New South Wales 2308, Australia
| | - Hannah M Wall
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - Sarah J Spencer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
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97
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Myeloperoxidase is not a good biomarker for preeclampsia prediction. Sci Rep 2017; 7:10257. [PMID: 28860607 PMCID: PMC5579011 DOI: 10.1038/s41598-017-09272-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/05/2017] [Indexed: 01/23/2023] Open
Abstract
Myeloperoxidase is a proinflammatory enzyme found to be increased in patients with established preeclampsia but never investigated before the disease onset. Here we examined myeloperoxidase concentration and activity in plasma and urine samples from pregnant women who remained normotensive throughout pregnancy and those who developed preeclampsia in order to assess its potential to predict this disorder. Our sample consisted of 30 cases who developed preeclampsia (14 severe and 16 mild) and 57 controls who remained healthy throughout pregnancy, derived from the Brazilian Ribeirão Preto and São Luís prenatal cohort (BRISA). Myeloperoxidase concentration were assessed using a commercial ELISA kit and enzymatic activity through tetramethylbenzidine oxidation. No statistical differences were found in myeloperoxidase levels nor activity between plasma or urine samples from controls, severe and mild cases. Myeloperoxidase did not seem to have a potential application for preeclampsia prediction.
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98
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Ujvari D, Jakson I, Oldmark C, Attarha S, Alkasalias T, Salamon D, Gidlöf S, Hirschberg AL. Prokineticin 1 is up-regulated by insulin in decidualizing human endometrial stromal cells. J Cell Mol Med 2017; 22:163-172. [PMID: 28782224 PMCID: PMC5742737 DOI: 10.1111/jcmm.13305] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/03/2017] [Indexed: 12/21/2022] Open
Abstract
Prokineticin 1 (PROK1), a hypoxia‐regulated angiogenic factor, has emerged as a crucial regulator of embryo implantation and placentation. Dysregulation of PROK1 has been linked to recurrent pregnancy loss, pre‐eclampsia, foetal growth restriction and preterm birth. These pregnancy complications are common in women with obesity and polycystic ovary syndrome, i.e. conditions associated with insulin resistance and compensatory hyperinsulinaemia. We investigated the effect of insulin on PROK1 expression during in vitro decidualization. Endometrial stromal cells were isolated from six healthy, regularly menstruating women and decidualized in vitro. Insulin induced a significant dose‐dependent up‐regulation of PROK1 on both mRNA and protein level in decidualizing endometrial stromal cells. This up‐regulation was mediated by hypoxia‐inducible factor 1‐alpha (HIF1α) via the phosphatidylinositol 3‐kinase (PI3K) pathway. Furthermore, we demonstrated that PROK1 did not affect the viability, but significantly inhibited the migration of endometrial stromal cells and the migratory and invasive capacity of trophoblast cell lines. This in vitro study provides new insights into the regulation of PROK1 by insulin in human decidualizing endometrial stromal cells, the action of PROK1 on migration of endometrial stromal cells, as well as migration and invasion of trophoblasts. We speculate that hyperinsulinaemia may be involved in the mechanisms by which PROK1 is linked to placenta‐related pregnancy complications.
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Affiliation(s)
- Dorina Ujvari
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ivika Jakson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Oldmark
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Sanaz Attarha
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Twana Alkasalias
- Department of Microbiology, Tumour, and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Biology, College of Science, Salahaddin University, Irbil, Kurdistan-Iraq
| | - Daniel Salamon
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Gidlöf
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
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99
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Yeboah FA, Ngala RA, Bawah AT, Asare-Anane H, Alidu H, Hamid AWM, Wumbee JDK. Adiposity and hyperleptinemia during the first trimester among pregnant women with preeclampsia. Int J Womens Health 2017; 9:449-454. [PMID: 28670144 PMCID: PMC5481409 DOI: 10.2147/ijwh.s134088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Leptin levels start increasing from the early stages of pregnancy, irrespective of the maternal body mass index. Leptin levels are increased in pregnant women with preeclampsia (PE) and may precede the clinical onset of the disease, with peaks occurring around 28 weeks of gestation. This study was aimed at determining whether serum leptin concentration and body fat percentage are significantly altered during the first trimester in pregnancies that subsequently develop PE and whether such changes are useful in predicting the disease. MATERIALS AND METHODS This was a prospective longitudinal study conducted among pregnant women in Ho municipality. A cohort of 314 pregnant women was monitored from the first antenatal visit to delivery period at the Volta Regional Hospital, Ho, Ghana. Maternal serum leptin and lipid profile were analyzed and body fat percentage determined during first trimester. Body mass index was also calculated. RESULTS First trimester serum leptin level (P<0.0001) and body fat percentage (P<0.0001) were significantly higher in those who developed PE than those who did not; while triglycerides (P=0.8600), total cholesterol (P=0.5620), high-density lipoprotein (P=0.5880), low-density lipoprotein (P=0.4870) and very low-density lipoprotein (P=0.6540) did not show any significant difference between those with PE and those without PE. CONCLUSION Leptin levels are increased significantly during the first trimester of pregnancy in obese women with PE, and these increases precede the onset of PE.
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Affiliation(s)
- Francis Agyemang Yeboah
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi
| | - Robert Amadu Ngala
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi
| | - Ahmed Tijani Bawah
- Department of Medical Laboratory Science, University of Health and Allied Sciences, Ho
| | - Henry Asare-Anane
- Department of Chemical Pathology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra
| | - Huseini Alidu
- Department of Medical Laboratory Science, University of Health and Allied Sciences, Ho
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100
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Khader YS, Batieha A, Al-Njadat RA, Hijazi SS. Preeclampsia in Jordan: incidence, risk factors, and its associated maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2017; 31:770-776. [PMID: 28274172 DOI: 10.1080/14767058.2017.1297411] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To estimate the incidence of preeclampsia among Jordanian pregnant women, determine its risk factors and its associated neonatal morbidity and mortality. METHODS The study is a part of a comprehensive national study of perinatal mortality that was conducted in Jordan. This study included all women who gave birth in the selected hospitals during the study period. Maternal and medical conditions during pregnancy and neonatal outcomes were compared between women who developed preeclampsia and who did not. RESULTS This study included a total of 21,928 women. The overall incidence rate of preeclampsia was 1.3%. Obesity (OR = 2.6) and high blood pressure (OR = 11.9) were significantly associated with increasing odds of preeclampsia. The risk of preeclampsia was 2.3 times higher in first pregnancies than that in second or more pregnancies. The rates of low birth weight (LBW) delivery (32.5% vs. 8.3%), and prematurity (30.8% vs. 7%), and the neonatal mortality rate (81 vs. 12 per 1000 live births) were significantly higher among women with preeclampsia. CONCLUSIONS The overall incidence rate of preeclampsia was 1.3%. Preeclampsia was significantly associated with maternal and neonatal morbidity and mortality as well as increasing vaginal operative delivery, cesarean section, LBW, and birth asphyxia.
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Affiliation(s)
- Yousef S Khader
- a Department of Public Health/Faculty of Medicine , Jordan University of Science & Technology , Irbid , Jordan
| | - Anwar Batieha
- a Department of Public Health/Faculty of Medicine , Jordan University of Science & Technology , Irbid , Jordan
| | - Rania Ali Al-Njadat
- a Department of Public Health/Faculty of Medicine , Jordan University of Science & Technology , Irbid , Jordan
| | - Sa'ad S Hijazi
- a Department of Public Health/Faculty of Medicine , Jordan University of Science & Technology , Irbid , Jordan
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