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Cardiac, renal and uterine hemodynamics changes throughout pregnancy in rats with a prolonged high fat diet from an early age. PLoS One 2020; 15:e0234861. [PMID: 32603330 PMCID: PMC7326224 DOI: 10.1371/journal.pone.0234861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/03/2020] [Indexed: 12/23/2022] Open
Abstract
Objective To examine whether the cardiac, renal and uterine physiological hemodynamic changes during gestation are altered in rats with an early and prolonged exposure to a high fat diet (HFD). Methods Arterial pressure and cardiac, renal, uterine and radial arteries hemodynamic changes during gestation were examined in adult SD rats exposed to normal (13%) (n = 8) or high (60%) (n = 8) fat diets from weaning. Plethysmography, high-resolution high-frequency ultrasonography and clearance of an inulin analog were used to evaluate the arterial pressure and hemodynamic changes before and at days 7, 14 and 19 of gestation. Results Arterial pressure was higher (P<0.05) in rats with high than in those with normal (NFD) fat diet before pregnancy (123 ±3 and 110 ±3 mmHg, respectively) and only decreased at day 14 of gestation in rats with NFD (98±4 mmHg, P<0.05). A significant increment in stroke volume (42 ±10%) and cardiac output (51 ±12%) was found at day 19 of pregnancy in rats with NFD. The changes in stroke volume and cardiac output were similar in rats with NFD and HFD. When compared to the values obtained before pregnancy, a transitory elevation in renal blood flow was found at day 14 of pregnancy in both groups. However, glomerular filtration rate only increased (P<0.05) in rats with NFD at days 14 (20 ±7%) and 19 (27 ±8%) of gestation. The significant elevations of mean velocity, and velocity time integral throughout gestation in radial (127 ±26% and 111 ±23%, respectively) and uterine (91 ±16% and 111 ±25%, respectively) arteries of rats with NFD were not found in rats with an early and prolonged HFD. Summary This study reports novel findings showing that the early and prolonged exposure to a HFD leads to a significant impairment in the renal, uterine and radial arteries hemodynamic changes associated to gestation.
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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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Cohen M, Guo E, Pucchio A, de Vrijer B, Shepherd TG, Eastabrook G. Maternal obesity reduces placental autophagy marker expression in uncomplicated pregnancies. J Obstet Gynaecol Res 2020; 46:1282-1291. [PMID: 32464696 DOI: 10.1111/jog.14315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 04/21/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022]
Abstract
AIM Obesity has been associated with changes in autophagy and its increasing prevalence among pregnant women is implicated in higher rates of placental-mediated complications of pregnancy such as pre-eclampsia and intrauterine growth restriction. Autophagy is involved in normal placentation, thus changes in autophagy may lead to impaired placental function and development. The aim of this study was to investigate the connection between obesity and autophagy in the placenta in otherwise uncomplicated pregnancies. METHODS Immunohistochemistry and western blot analysis were done on placental and omental samples from obese (body mass index [BMI] ≥30 kg/m2 ) and normal weight (BMI <25 kg/m2 ) pregnant women with singleton pregnancies undergoing planned Caesarean delivery without labor at term. Samples were analyzed for autophagic markers LC3B and p62 in the peripheral, middle and central regions of the placenta and in omental adipocytes, milky spots and vasculature. RESULTS As pre-pregnancy BMI increased, there was an increase in both placental and fetal weight as well as decreased levels of LC3B in the central region of the placenta (P = 0.0046). Within the obese patient group, LC3B levels were significantly decreased in the placentas of male fetuses compared to females (P < 0.0001). Adipocytes, compared to milky spots and vasculature, had lower levels of p62 (P = 0.0127) and LC3B (P = 0.003) in obese omenta and lower levels of LC3B in control omenta (P = 0.0071). CONCLUSION Obesity leads to reduced placental autophagy in uncomplicated pregnancies; thus, changes in autophagy may be involved in the underlying mechanisms of obesity-related placental diseases of pregnancy.
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Affiliation(s)
- Matthew Cohen
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Emily Guo
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Aidan Pucchio
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.,The Mary & John Knight Translational Ovarian Cancer Research Unit, Lawson Health Research Institute, London, Ontario, Canada
| | - Barbra de Vrijer
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada
| | - Trevor G Shepherd
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.,The Mary & John Knight Translational Ovarian Cancer Research Unit, Lawson Health Research Institute, London, Ontario, Canada.,Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Genevieve Eastabrook
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada
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Bohiltea RE, Zugravu CA, Nemescu D, Turcan N, Paulet FP, Gherghiceanu F, Ducu I, Cirstoiu MM. Impact of obesity on the prognosis of hypertensive disorders in pregnancy. Exp Ther Med 2020; 20:2423-2428. [PMID: 32765727 PMCID: PMC7401951 DOI: 10.3892/etm.2020.8783] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022] Open
Abstract
The prevalence of pathologies due to placental dysfunction superimposed on pregnancy is constantly increasing. The prognosis of the cases complicated by gestational hypertension is usually good, significantly better compared with that of the cases associating preeclampsia. About half of the cases with gestational hypertension will progress to preeclampsia, the risk of decompensation being inversely proportional to the gestational age of the onset of gestational hypertension. The present study, analyzed the cases of pregnancy and postpartum complicated by pathologies related to placental dysfunction, during a period of 5 years. The risk factors analyzed were the presence of infections during pregnancy, diabetes, thrombophilia, pregnancy obtained by in vitro fertilization, abnormal adherence of the placenta, obesity, multiple pregnancy, the presence of an earlier hepatic, endocrine, renal, cardiac or autoimmune pathology, and the existence of an uterine malformation. Obesity appears with a significantly increased incidence in patients with gestational hypertension and middle preeclampsia. Intrauterine growth restriction appears with a significantly increased incidence in patients with mild preeclampsia. Complications such as prematurity, acute fetal distress and abruption of placentae had a significantly increased incidence in patients with severe preeclampsia. Thus, obese patients have a higher risk of moderate preeclampsia, following gestational hypertension and finally severe preeclampsia.
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Affiliation(s)
- Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Corina-Aurelia Zugravu
- Department of Food Hygiene and Nutrition, 'Carol Davila' University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Natalia Turcan
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy Doctoral School, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Florina-Paula Paulet
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy Doctoral School, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Florentina Gherghiceanu
- Department of Marketing and Medical Technology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ionita Ducu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Monica Mihaela Cirstoiu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
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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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Spradley FT, Palei AC, Anderson CD, Granger JP. Melanocortin-4 Receptor Deficiency Attenuates Placental Ischemia-Induced Hypertension in Pregnant Rats. Hypertension 2019; 73:162-170. [PMID: 30571561 DOI: 10.1161/hypertensionaha.118.12028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Preeclampsia is a pregnancy-specific disorder of new-onset hypertension linked to placental ischemia. While obesity is a major risk factor for preeclampsia, not all obese pregnant women develop pregnancy-induced hypertension or preeclampsia. Previously, we reported that placental ischemia-induced hypertension is dependent upon intact signaling of the sympathetic nervous system. Moreover, in various models of obesity, blockade of MC4R (melanocortin-4 receptor) signaling protects against the development of hypertension via suppression of the sympathetic nervous system. Less is known about this pathway during obese pregnancy. Although blockade of MC4R may lead to increased body weight during pregnancy, we tested the hypothesis that placental ischemia-induced hypertension is attenuated in obese MC4R-deficient pregnant rats. On gestational day 14, MC4R wild-type or heterozygous-deficient (MC4R-def) rats were subjected to chronic placental ischemia via the reduced uterine perfusion pressure procedure or Sham surgery then examined on gestational day 19. In Sham MC4R-def versus Sham wild-type pregnant rats, there was increased body weight, fat mass, and circulating leptin levels but they had similar fetus weights. Reduced uterine perfusion pressure reduced fetus weights in both strains. Reduced uterine perfusion pressure increased blood pressure in wild-type rats but this response was significantly attenuated in MC4R-def rats, although blood pressure was elevated in Sham MC4R-def over Sham wild-type. These data indicate that while obese MC4R-def pregnant rats have higher blood pressure during pregnancy, placental ischemia-induced hypertension is attenuated in obese MC4R-def pregnant rats. Thus, obese women with abnormal MC4R signaling may be less susceptible to the development of placental ischemia-induced hypertension.
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Affiliation(s)
- Frank T Spradley
- From the Department of Surgery (F.T.S., A.C.P., C.D.A.), The University of Mississippi Medical Center, Jackson.,Department of Physiology and Biophysics (F.T.S., J.P.G.), The University of Mississippi Medical Center, Jackson
| | - Ana C Palei
- From the Department of Surgery (F.T.S., A.C.P., C.D.A.), The University of Mississippi Medical Center, Jackson
| | - Christopher D Anderson
- From the Department of Surgery (F.T.S., A.C.P., C.D.A.), The University of Mississippi Medical Center, Jackson
| | - Joey P Granger
- Department of Physiology and Biophysics (F.T.S., J.P.G.), The University of Mississippi Medical Center, Jackson
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Liu Y, Gao B, Zeng X, Yang J, Zhang L, Xu G, Jia R, Xu Z. Association between thyroid-stimulating hormone and maternal hemodynamics in hypertensive disorders of pregnancy: an observational study. BMC Pregnancy Childbirth 2019; 19:396. [PMID: 31675921 PMCID: PMC6824088 DOI: 10.1186/s12884-019-2556-4] [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] [Received: 06/17/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) are characterized by hemodynamic disturbances. Altered thyroid function is a risk factor for poor outcomes of pregnancy. However, the associations between thyroid function biomarkers and maternal hemodynamics during pregnancy in HDP remain unclear. Methods From January 2016 to January 2018, pregnant women diagnosed with HDP admitted to the Nanjing Maternity and Child Health Care Hospital were prospectively enrolled in the third trimester. Normally distributed variables were expressed as mean ± standard deviation and skewed variables were expressed as median (25th percentile, 75th percentile). Correlations between thyroid-stimulating hormone (TSH) or free thyroxine (FT4) and maternal hemodynamic parameters were assessed by Pearson’s correlation coefficient and 95% confidence interval (95%CI). Bonferroni’s correction for multiple correlations was performed. Logistic regression models with odd ratio (OR) and 95%CI were applied to confirm the associations. Results A total of 163 third-trimester pregnant women with HDP with a mean gestational age of 35.62 ± 2.83 weeks were recruited. The infant birth weight of patients with elevated TSH levels was lower than that of patients with normal TSH levels (2635 ± 867 g vs. 3037 ± 673 g, p = 0.002). Reduced cardiac output (CO) was defined as CO < 3.5 L/min. The infant birth weight of patients with reduced CO was lower than that of patients with normal CO (2250 ± 510 g vs. 2890 ± 774 g, p = 0.002). TSH levels were significantly and negatively correlated with CO (r = − 0.260, 95%CI: − 0.392- -0.103, p < 0.001). FT4 levels were not significantly correlated with any of the maternal hemodynamic parameters (all p > 0.05). TSH level (OR = 1.371, 95%CI: 1.086–1.733, p = 0.008) was confirmed associated with reduced CO in the logistic regression analysis. Conclusions Elevated TSH levels are associated with reduced CO in HDP during the third trimester.
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Affiliation(s)
- Yu Liu
- Department of Obstetrics and Gynecology, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, 210004, China
| | - Bo Gao
- Department of Clinical Nutrition, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Xin Zeng
- Department of Obstetrics and Gynecology, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, 210004, China.,Nanjing Maternal and Child Health Institute, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, China
| | - Jing Yang
- Department of Science and Education, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, China
| | - Lei Zhang
- Department of Obstetrics and Gynecology, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, 210004, China
| | - Ganwei Xu
- Department of Medical Records, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, China
| | - Ruizhe Jia
- Department of Obstetrics and Gynecology, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, 210004, China.
| | - Zhengfeng Xu
- Department of Obstetrics and Gynecology, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, 210004, China. .,Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, China.
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Beckers KF, Sones JL. Maternal microbiome and the hypertensive disorder of pregnancy, preeclampsia. Am J Physiol Heart Circ Physiol 2019; 318:H1-H10. [PMID: 31626558 DOI: 10.1152/ajpheart.00469.2019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Preeclampsia (PE) is a pregnancy-specific disorder that can be life threatening for both mother and baby. It is characterized by a new onset hypertension during the second half of pregnancy and affects ~300,000 women in the United States every year. There is no cure for PE, and the only effective treatment is delivery of the placenta and the fetus, which is often preterm. PE is believed to be a severe manifestation of placental dysfunction due to early angiogenic imbalances and inflammatory disturbances; however, the cause of this is unknown. The once thought "sterile" placenta now has been proposed to have a unique microbiome of its own. Under ideal conditions, the microbiome represents a balanced bacterial community that is important to the maintenance of a healthy environment. Dysbiosis of these communities may lead to inflammation that potentially contributes to adverse pregnancy outcomes, such as preterm birth and PE. Thus far, the female reproductive tract microbiome has been found to be influenced by periodontal disease, cardiometabolic complications, and maternal obesity, all of which have been identified as contributors to PE. This review will look at the maternal reproductive tract microbiome, evidence for and against, and its role in pregnancy and PE-related events as well as data from relevant mouse models that could be useful for further investigating the influence of the reproductive tract microbiome on the pathogenesis of PE.
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Affiliation(s)
- Kalie F Beckers
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Jenny L Sones
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
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Erfanian S, Yazdanpour L, Javeshghani D, Roustazadeh A. Association of arginine vasopressin (AVP) promoter polymorphisms with preeclampsia. Pregnancy Hypertens 2019; 18:122-125. [PMID: 31593833 DOI: 10.1016/j.preghy.2019.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Preeclampsia (PE) is a disease of pregnancy characterized by early onset of maternal hypertension and proteinuria. New findings indicate that arginine vasopressin (AVP) may be a contributing factor to ignite PE. The aim of this study was to identify if there is any correlation between arginine vasopressin promoter polymorphisms and PE. STUDY DESIGN Venous blood samples of 100 PE and 100 normal pregnant women were obtained for DNA extraction to identify the polymorphisms of AVP promoter by RFLP and nested-PCR techniques. MAIN OUTCOME rs3729965 polymorphism of PE women was detected to have significant correlation with body mass index (BMI) (P = 0.028). RESULTS Statistical analysis of three polymorphisms namely rs3729965, rs61138008 and rs3761249 of preeclamptic women (PEW) and none preeclamptic pregnant women (NPEW) revealed that rs3729965 genotypic distribution was significantly different between both groups (P = 0.04). Further analysis revealed that rs3729965 CT genotype of PEW had significant correlation to their BMI (P = 0.028). CONCLUSION Polymorphic variants located on the promoter region of AVP are associated with PE. Thus we hypothesize that allelic variation may have a role in increasing the risk of developing PE.
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Affiliation(s)
- Saiedeh Erfanian
- Research Center for Non-Communicable Diseases, Department of Advanced Medical Sciences and Technologies, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Danesh Javeshghani
- Department of Physiology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Abazar Roustazadeh
- Department of Biochemistry, Department of Advanced Medical Sciences and Technologies, Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
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NAMPT levels are inversely related to nitric oxide formation and positively related to soluble fms-like tyrosine kinase-1 levels in preeclampsia. Pregnancy Hypertens 2019; 18:137-140. [DOI: 10.1016/j.preghy.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/26/2019] [Accepted: 09/28/2019] [Indexed: 12/16/2022]
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Transactivation of Met signalling by semaphorin4D in human placenta: implications for the pathogenesis of preeclampsia. J Hypertens 2019; 36:2215-2225. [PMID: 29939944 DOI: 10.1097/hjh.0000000000001808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The signalling of the receptor tyrosine kinase Met is critical in promoting trophoblast cell invasion, and the deficiency in HGF/Met signalling is associated with preeclampsia. The semaphorin family member semaphorin4D (sema4D) and its receptor Plexin-B1 have been reported to control tumour cell invasion by coupling with Met. We hypothesized that sema4D/Plexin-B1 may promote trophoblast invasion by activating Met, and downregulation of sema4D/Plexin-B1 may account for the deficiency in Met signalling in preeclamptic placenta. METHODS In this study, Met and Erk activation and the expression of sema4D/Plexin-B1 in normal and preeclamptic placentas were comparably measured. The role of sema4D in trophoblast cell invasion and tubulogenesis was examined in vitro using the Transwell invasion assay and tube formation assay in trophoblast-endothelial cell co-culture model. RESULTS Met, sema4D and Plexin-B1 co-localized in various subtypes of human trophoblast cells, including villous trophoblasts and extravillous trophoblasts (EVTs). In early-onset preeclampsia (E-PE) placentas, the phosphorylated Met and Erk as well as sema4D and Plexin-B1 were much lower than those in gestational week-matched preterm-labour (PTL) placentas. In human trophoblast HTR8/SVneo cell line, sema4D could promote Met and Erk phosphorylation as well as enhance trophoblast cell invasion and tubulogenesis with endothelial cells. Moreover, the effect of sema4D on HTR8/SVneo could be blocked by knocking down Met with specific siRNA. CONCLUSION The crosstalk between sema4D and Met could transactivate Met to promote trophoblast cell invasion and differentiation, and decreased expression of sema4D and Plexin-B1 may be responsible for the deficiency in Met signalling and the development of preeclampsia.
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Shenouda C, Wijesooriya A, Toufeili A, Miller MR, Penava D, de Vrijer B. Labour Progression in Obese Women: Are Women With Increased Body Mass Index Having Unnecessary Cesarean Sections? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:293-300. [PMID: 31324481 DOI: 10.1016/j.jogc.2019.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study sought to determine whether obese pregnant women undergo cesarean sections without an adequate trial of labour. This may affect future birth and pregnancy outcomes. METHODS A retrospective analysis was done on 526 parturients at Victoria Hospital in London, Ontario. Women were categorized according to parity and pre-pregnancy body mass index (BMI; normal weight, BMI 18.5-24.9 kg/m2; obese class II, BMI 35.0-39.9 kg/m2; obese class III, BMI ≥40 kg/m2). Patient charts and partograms were reviewed for labour progression (time at cervical dilation), demographics, and infant outcomes (Canadian Task Force Classification II-2). RESULTS Obese class II and III primiparous women required an additional 1.62 and 2.67 hours (P = 0.012), respectively, to reach a dilation of 10 cm compared with their normal weight counterparts; obese class II and III multiparous women required an additional 1.25 and 2.05 hours (P = 0.003), respectively. A higher BMI was associated with increased oxytocin use and infant birth weight in primiparous women. Obese women had less gestational weight gain and required more cervical examinations. Cesarean section rates were low for obese parturients (primiparous, 19%; multiparous, 0.8%) and not significantly different among BMI categories. CONCLUSION This study confirmed published results that labour progresses more slowly as maternal BMI increases. The study was performed in a centre with a specialized BMI pregnancy clinic; thus weight gain adherence, awareness of labour differences, and patient counselling may have contributed to low cesarean section rates. Obstetric care providers should consider differences in maternal BMI in labour progression before undertaking a potentially premature cesarean birth, especially in primiparous women.
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Affiliation(s)
- Caroline Shenouda
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | | | | | - Michael R Miller
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON; Children's Health Research Institute, London, ON
| | - Debbie Penava
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON; Children's Health Research Institute, London, ON
| | - Barbra de Vrijer
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON; Children's Health Research Institute, London, ON.
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Shi Z, Hansen KM, Bullock KM, Morofuji Y, Banks WA, Brooks VL. Resistance to the sympathoexcitatory effects of insulin and leptin in late pregnant rats. J Physiol 2019; 597:4087-4100. [PMID: 31209877 DOI: 10.1113/jp278282] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/10/2019] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS Pregnancy increases sympathetic nerve activity (SNA), although the mechanisms responsible for this remain unknown. We tested whether insulin or leptin, two sympathoexcitatory hormones increased during pregnancy, contribute to this. Transport of insulin across the blood-brain barrier in some brain regions, and into the cerebrospinal fluid (CSF), was increased, although brain insulin degradation was also increased. As a result, brain and CSF insulin levels were not different between pregnant and non-pregnant rats. The sympathoexcitatory responses to insulin and leptin were abolished in pregnant rats. Blockade of arcuate nucleus insulin receptors did not lower SNA in pregnant or non-pregnant rats. Collectively, these data suggest that pregnancy renders the brain resistant to the sympathoexcitatory effects of insulin and leptin, and that these hormones do not mediate pregnancy-induced sympathoexcitation. Increased muscle SNA stimulates glucose uptake. Therefore, during pregnancy, peripheral insulin resistance coupled with blunted insulin- and leptin-induced sympathoexcitation ensures adequate delivery of glucose to the fetus. ABSTRACT Pregnancy increases basal sympathetic nerve activity (SNA), although the mechanism responsible for this remains unknown. Insulin and leptin are two sympathoexcitatory hormones that increase during pregnancy, yet, pregnancy impairs central insulin- and leptin-induced signalling. Therefore, to test whether insulin or leptin contribute to basal sympathoexcitation or, instead, whether pregnancy induces resistance to the sympathoexcitatory effects of insulin and leptin, we investigated α-chloralose anaesthetized late pregnant rats, which exhibited increases in lumbar SNA (LSNA), splanchnic SNA and heart rate (HR) compared to non-pregnant animals. In pregnant rats, transport of insulin into cerebrospinal fluid and across the blood-brain barrier in some brain regions increased, although brain insulin degradation was also increased; brain and cerebrospinal fluid insulin levels were not different between pregnant and non-pregnant rats. Although i.c.v. insulin increased LSNA and HR and baroreflex control of LSNA and HR in non-pregnant rats, these effects were abolished in pregnant rats. In parallel, pregnancy completely prevented the actions of leptin with respect to increasing lumbar, splanchnic and renal SNA, as well as baroreflex control of SNA. Blockade of insulin receptors (with S961) in the arcuate nucleus, the site of action of insulin, did not decrease LSNA in pregnant rats, despite blocking the effects of exogenous insulin. Thus, pregnancy is associated with central resistance to insulin and leptin, and these hormones are not responsible for the increased basal SNA of pregnancy. Because increases in LSNA to skeletal muscle stimulates glucose uptake, blunted insulin- and leptin-induced sympathoexcitation reinforces systemic insulin resistance, thereby increasing the delivery of glucose to the fetus.
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Affiliation(s)
- Zhigang Shi
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR, USA
| | - Kim M Hansen
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Kristin M Bullock
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Yoichi Morofuji
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - William A Banks
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Virginia L Brooks
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR, USA
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Rottenstreich A, Levin G, Rottenstreich M, Ezra Y, Elazary R, Elchalal U. Twin pregnancy outcomes after metabolic and bariatric surgery. Surg Obes Relat Dis 2019; 15:759-765. [PMID: 30745150 DOI: 10.1016/j.soard.2019.01.014] [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: 11/18/2018] [Revised: 12/26/2018] [Accepted: 01/22/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The effect of bariatric surgery (BS) on twin pregnancy outcomes is unclear. OBJECTIVES We examined associations of BS with maternal and perinatal outcomes among women with twin gestation. SETTING A university hospital. METHODS A retrospective case-control study of twin deliveries during 2006 through 2017. The study group comprised all women with twin pregnancy who had undergone BS and delivered during the study period. A control group was established by matching preoperative body mass index, age, parity, and delivery year. RESULTS Data from 66 women with twin gestation were analyzed, 22 postBS and 44 matched control parturients. Compared with the control group, the study group had lower rates of gestational diabetes (9.1% versus 36.4%, P = .02) and gestational hypertensive disorders (0% versus 25.0%, P = .01); hemoglobin levels were lower at both early pregnancy (median 12.3 versus 13.4 g/dL, P < .001) and after delivery (9.3 versus 10.5 g/dL, P < .001). Median neonatal birthweights and the proportion of small-for-gestational-age infants were comparable between the groups. The degree of birth weight discordance between the twins was higher (17.2% versus 8.8%, P < .001) in the control group. CONCLUSIONS In this study involving twin gestations, pregnancy outcomes were more positive among women who had undergone BS; as noted by reduced prevalences of gestational diabetes and gestational hypertensive disorders as well as a lesser degree of birth weight discordance. Nevertheless, BS was associated with lower hemoglobin levels during pregnancy and the postpartum period. Future studies are warranted to confirm our findings and evaluate the long-term outcomes of newborns of postBS mothers.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Elazary
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Christians JK, Grynspan D. Placental villous hypermaturation is associated with improved neonatal outcomes. Placenta 2019; 76:1-5. [PMID: 30803708 DOI: 10.1016/j.placenta.2019.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Accelerated placental maturation is considered a sign of maternal vascular malperfusion, and is often interpreted as an adaptive, compensatory response by the placenta. We tested this interpretation by comparing outcomes in pregnancies with and without accelerated maturation. METHODS Using data from the National Collaborative Perinatal Project, we categorized preterm placentas (24-34 weeks, inclusive; 2525 births) by whether they showed placental villous hypermaturation (PVH), i.e., had the appearance of a placenta of 37 weeks or over upon microscopic examination. We assessed whether PVH was associated with maternal race, maternal BMI, fetal sex, type of preterm birth, preeclampsia, signs of infection or inflammation or placental abruption. We also assessed whether placentas showing PVH were associated with improved outcomes in terms of survival, Apgar score, or oxygen use. RESULTS PVH was more common in preeclamptic pregnancies and less common in pregnancies complicated by placental abruption or showing signs of placental infection or inflammation. Adjusting for potentially confounding factors, PVH was associated with reduced odds of fetal death, death between birth and 120 days of age, low Apgar scores and oxygen use. PVH was also associated with higher birthweights for gestational age. When correcting for the effect of birthweight, the association between PVH and reduced fetal and neonatal death remained significant. DISCUSSION Accelerated placental maturation, as manifested by PVH, is associated with improved outcomes. Our work therefore supports the hypothesis that accelerated maturation is a compensatory response by the placenta to improve its transport capacity in specific pregnancy complications.
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Affiliation(s)
- Julian K Christians
- Department of Biological Sciences, Simon Fraser University, Burnaby, Canada.
| | - David Grynspan
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada.
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Falcone V, Stopp T, Feichtinger M, Kiss H, Eppel W, Husslein PW, Prager G, Göbl CS. Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome. BMC Pregnancy Childbirth 2018; 18:507. [PMID: 30587161 PMCID: PMC6307154 DOI: 10.1186/s12884-018-2124-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
Bariatric surgery (BS) is regarded to be the most effective treatment of obesity with long lasting beneficial effects including weight loss and improvement of metabolic disorders. A considerable number of women undergoing BS are at childbearing age.Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes as well, for example micronutrient deficiencies, iron or B12 deficiency anemia, dumping syndrome, surgical complications such as internal hernias, and small for gestational age (SGA) offspring, possibly due to maternal undernutrition. Also, there is no international consensus concerning the ideal time to conception after BS. Hence, the present narrative review intents to summarize the available literature concerning the most common challenges which arise before and during pregnancy after BS, such as fertility related considerations, vitamin and nutritional deficiencies and their adequate compensation through supplementation, altered glucose metabolism and its implications for gestational diabetes screening, the symptoms and treatment of dumping syndrome, surgical complications and the impact of BS on pregnancy outcome. The impact of different bariatric procedures on pregnancy and fetal outcome will also be discussed, as well as general considerations concerning the monitoring and management of pregnancies after BS.Whereas BS leads to the mitigation of many obesity-related pregnancy complications, such as gestational diabetes mellitus (GDM), pregnancy induced hypertension and fetal macrosomia; those procedures pose new risks which might lead to adverse outcomes for mothers and offspring, for example nutritional deficiencies, anemia, altered maternal glucose metabolism and small for gestational age children.
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Affiliation(s)
- Veronica Falcone
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tina Stopp
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Wunschbaby Institut Feichtinger, Lainzerstrasse 6, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Eppel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Wolf Husslein
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Department of General Surgery, Division of Bariatric Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian S Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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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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Stopp T, Falcone V, Feichtinger M, Göbl C. Fertility, Pregnancy and Lactation After Bariatric Surgery - a Consensus Statement from the OEGGG. Geburtshilfe Frauenheilkd 2018; 78:1207-1211. [PMID: 30655646 PMCID: PMC6294640 DOI: 10.1055/a-0706-7578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022] Open
Abstract
Bariatric surgery is recommended when other weight loss interventions, such as lifestyle modification or medications, have failed. A considerable number of women undergoing bariatric surgery are of childbearing age; hence, it is necessary to be aware of the effects of bariatric surgery on pregnancy for managing these patients. Although bariatric surgery is associated with positive effects on cardiovascular and metabolic parameters, side effects such as anaemia, the risk of developing internal hernia, altered glucose metabolism and the risk of small for gestational age offspring have to be considered. Pregnant women with a history of gastric bypass should not undergo the oral glucose tolerance test (OGTT) due to the high risk of hypoglycaemia. There are no contraindications for vaginal delivery and breastfeeding. This paper has been published as a consensus statement by the Austrian Society of Gynaecology and Obstetrics (OEGGG).
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Affiliation(s)
- Tina Stopp
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
| | - Veronica Falcone
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
| | | | - Christian Göbl
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
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69
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Leptin and Adiponectin as markers for preeclampsia in obese pregnant women, a cohort study. Pregnancy Hypertens 2018; 15:78-83. [PMID: 30825932 DOI: 10.1016/j.preghy.2018.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/20/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Preeclampsia (PE) is a serious complication of pregnancy, the pathogenesis of which is largely unknown. We hypothesize that adipocytokines may play a role in the pathogenesis of PE, particularly in obese women, and evaluate leptin and adiponectin as potential first trimester markers for predicting PE. STUDY DESIGN A cohort of 2503 pregnancies, containing 93 PE pregnancies, was divided into women with normal weight, moderate, or severe obesity. All pregnancies had serum adiponectin and leptin measured in first trimester. Logistic regression was used to model PE with maternal characteristics and concentrations of the biomarkers. RESULTS In obese women a lower concentration of adiponectin was found in PE pregnancies; the concentration was lowest in the severely obese (p = 0.005). No association was found in normal weight women (p = 0.72). Leptin concentration had no association with PE in normal weight and moderately obese (p = 0.175-0.072), however in women with severe obesity a lower level of leptin was found (p = 0.049). The AUC was 0.73 for the ROC curve of combined maternal characteristics and adiponectin. Using adiponectin in women with moderate to severe obesity the sensitivity was 72.9% and the specificity was 49%. CONCLUSIONS In severely obese women, PE is associated with low serum adiponectin and leptin concentrations in first trimester. This indicates that the inability of adipokine regulation to adapt to severe obesity may play a role in the pathogenesis of PE. Adipocytokines may contribute in identification of risk pregnancies among severe obese.
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70
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Grieger JA, Bianco-Miotto T, Grzeskowiak LE, Leemaqz SY, Poston L, McCowan LM, Kenny LC, Myers JE, Walker JJ, Dekker GA, Roberts CT. Metabolic syndrome in pregnancy and risk for adverse pregnancy outcomes: A prospective cohort of nulliparous women. PLoS Med 2018; 15:e1002710. [PMID: 30513077 PMCID: PMC6279018 DOI: 10.1371/journal.pmed.1002710] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 11/02/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obesity increases the risk for developing gestational diabetes mellitus (GDM) and preeclampsia (PE), which both associate with increased risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) in women in later life. In the general population, metabolic syndrome (MetS) associates with T2DM and CVD. The impact of maternal MetS on pregnancy outcomes, in nulliparous pregnant women, has not been investigated. METHODS AND FINDINGS Low-risk, nulliparous women were recruited to the multi-centre, international prospective Screening for Pregnancy Endpoints (SCOPE) cohort between 11 November 2004 and 28 February 2011. Women were assessed for a range of demographic, lifestyle, and metabolic health variables at 15 ± 1 weeks' gestation. MetS was defined according to International Diabetes Federation (IDF) criteria for adults: waist circumference ≥80 cm, along with any 2 of the following: raised trigycerides (≥1.70 mmol/l [≥150 mg/dl]), reduced high-density lipoprotein cholesterol (<1.29 mmol/l [<50 mg/dl]), raised blood pressure (BP) (i.e., systolic BP ≥130 mm Hg or diastolic BP ≥85 mm Hg), or raised plasma glucose (≥5.6 mmol/l). Log-binomial regression analyses were used to examine the risk for each pregnancy outcome (GDM, PE, large for gestational age [LGA], small for gestational age [SGA], and spontaneous preterm birth [sPTB]) with each of the 5 individual components for MetS and as a composite measure (i.e., MetS, as defined by the IDF). The relative risks, adjusted for maternal BMI, age, study centre, ethnicity, socioeconomic index, physical activity, smoking status, depression status, and fetal sex, are reported. A total of 5,530 women were included, and 12.3% (n = 684) had MetS. Women with MetS were at an increased risk for PE by a factor of 1.63 (95% CI 1.23 to 2.15) and for GDM by 3.71 (95% CI 2.42 to 5.67). In absolute terms, for PE, women with MetS had an adjusted excess risk of 2.52% (95% CI 1.51% to 4.11%) and, for GDM, had an adjusted excess risk of 8.66% (95% CI 5.38% to 13.94%). Diagnosis of MetS was not associated with increased risk for LGA, SGA, or sPTB. Increasing BMI in combination with MetS increased the estimated probability for GDM and decreased the probability of an uncomplicated pregnancy. Limitations of this study are that there are several different definitions for MetS in the adult population, and as there are none for pregnancy, we cannot be sure that the IDF criteria are the most appropriate definition for pregnancy. Furthermore, MetS was assessed in the first trimester and may not reflect pre-pregnancy metabolic health status. CONCLUSIONS We did not compare the impact of individual metabolic components with that of MetS as a composite, and therefore cannot conclude that MetS is better at identifying women at risk. However, more than half of the women who had MetS in early pregnancy developed a pregnancy complication compared with just over a third of women who did not have MetS. Furthermore, while increasing BMI increases the probability of GDM, the addition of MetS exacerbates this probability. Further studies are required to determine if individual MetS components act synergistically or independently.
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Affiliation(s)
- Jessica A. Grieger
- 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
| | - Luke E. Grzeskowiak
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Shalem Y. Leemaqz
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Lucilla Poston
- Department of Women and Children’s Health, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Lesley M. McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Louise C. Kenny
- Faculty of Health & Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Jenny E. Myers
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, United Kingdom
| | - James J. Walker
- Obstetrics and Gynaecology Section, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Gus A. Dekker
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Women and Children’s Division, Lyell McEwin Hospital, Adelaide, Australia
| | - Claire T. Roberts
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- * E-mail:
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Maher GM, McCarthy FP, McCarthy CM, Kenny LC, Kearney PM, Khashan AS, O'Keeffe GW. A perspective on pre-eclampsia and neurodevelopmental outcomes in the offspring: Does maternal inflammation play a role? Int J Dev Neurosci 2018; 77:69-76. [PMID: 30391740 DOI: 10.1016/j.ijdevneu.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 10/28/2022] Open
Abstract
Pre-eclampsia is a leading cause of maternal death and maternal and perinatal morbidity. Whilst the clinical manifestations of pre-eclampsia often occur in late pregnancy, the molecular events leading into the onset of this disease are thought to originate in early pregnancy and result in insufficient placentation. Although the causative molecular basis of pre-eclampsia remains poorly understood, maternal inflammation is recognised as a core clinical feature. While the adverse effects of pre-eclampsia on maternal and fetal health in pregnancy is well-recognised, the long-term impact of pre-eclampsia exposure on the risk of autism spectrum disorder (ASD) in exposed offspring is a topic of on-going debate. In particular, a recent systematic review has reported an association between exposure to pre-eclampsia and increased risk of ASD, however the molecular basis of this association is unknown. Here we review recent evidence for; 1) maternal inflammation in pre-eclampsia; 2) epidemiological evidence for alterations in neurodevelopmental outcomes in offspring exposed to pre-eclampsia; 3) long-term changes in the brains of offspring exposed to pre-eclampsia; and 4) how maternal inflammation may lead to altered neurodevelopmental outcomes in pre-eclampsia exposed offspring. Finally, we discuss the implications of this for the development of future studies in this field.
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Affiliation(s)
- Gillian M Maher
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Ireland
| | - Cathal M McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland.,Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland
| | - Louise C Kenny
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Patricia M Kearney
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland
| | - Gerard W O'Keeffe
- Department of Anatomy and Neuroscience and Cork Neuroscience Centre, Western Gateway Building, University College Cork, Cork, Ireland
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Yu W, Gao W, Rong D, Wu Z, Khalil RA. Molecular determinants of microvascular dysfunction in hypertensive pregnancy and preeclampsia. Microcirculation 2018; 26:e12508. [PMID: 30338879 PMCID: PMC6474836 DOI: 10.1111/micc.12508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 12/16/2022]
Abstract
Preeclampsia is a pregnancy-related disorder characterized by hypertension and often fetal intrauterine growth restriction, but the underlying mechanisms are unclear. Defective placentation and apoptosis of invasive cytotrophoblasts cause inadequate remodeling of spiral arteries, placental ischemia, and reduced uterine perfusion pressure (RUPP). RUPP causes imbalance between the anti-angiogenic factors soluble fms-like tyrosine kinase-1 and soluble endoglin and the pro-angiogenic vascular endothelial growth factor and placental growth factor, and stimulates the release of proinflammatory cytokines, hypoxia-inducible factor, reactive oxygen species, and angiotensin AT1 receptor agonistic autoantibodies. These circulating factors target the vascular endothelium, smooth muscle and various components of the extracellular matrix. Generalized endotheliosis in systemic, renal, cerebral, and hepatic vessels causes decreases in endothelium-derived vasodilators such as nitric oxide, prostacyclin and hyperpolarization factor, and increases in vasoconstrictors such as endothelin-1 and thromboxane A2. Enhanced mechanisms of vascular smooth muscle contraction, such as intracellular Ca2+ , protein kinase C, and Rho-kinase cause further increases in vasoconstriction. Changes in matrix metalloproteinases and extracellular matrix cause inadequate vascular remodeling and increased arterial stiffening, leading to further increases in vascular resistance and hypertension. Therapeutic options are currently limited, but understanding the molecular determinants of microvascular dysfunction could help in the design of new approaches for the prediction and management of preeclampsia.
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Affiliation(s)
- Wentao Yu
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wei Gao
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dan Rong
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zhixian Wu
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raouf A Khalil
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Gestational diabetes modifies the association between PlGF in early pregnancy and preeclampsia in women with obesity. Pregnancy Hypertens 2018; 13:267-272. [PMID: 30177064 PMCID: PMC6130745 DOI: 10.1016/j.preghy.2018.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 11/29/2022]
Abstract
Objective To identify clinical and biomarker risk factors for preeclampsia in women with obesity and to explore interactions with gestational diabetes, a condition associated with preeclampsia. Study design In women with obesity (body mass index ≥ 30 kg/m2) from the UK Pregnancies Better Eating and Activity Trial (UPBEAT), we examined 8 clinical factors (socio-demographic characteristics, BMI, waist circumference and clinical variables) and 7 biomarkers (HDL cholesterol, hemoglobin A1c, adiponectin, interleukin-6, high sensitivity C-reactive protein, and placental growth factor (PlGF)) in the early second trimester for association with later development of preeclampsia using logistic regression. Factors were selected based on prior association with preeclampsia. Interaction with gestational diabetes was assessed. Main outcome measure Preeclampsia. Results Prevalence of preeclampsia was 7.3% (59/824). Factors independently associated with preeclampsia were higher mean arterial blood pressure (Odds Ratio (OR) 2.22; 95% Confidence Interval (CI) 1.58–3.12, per 10 mmHg) and lower PlGF (OR 1.39; 95% CI 1.03–1.87, per each lower 1 log2). The association of PlGF with preeclampsia was present amongst obese women without gestational diabetes (OR 1.91; 95% CI 1.32–2.78), but not in those with GDM (OR 1.05; 95% CI 0.67–1.63), p = 0.04 for interaction. Conclusion The relationship between PlGF and preeclampsia differed in women with obesity according to gestational diabetes status, which may suggest different mechanistic pathways to preeclampsia. Whilst replication is required in other populations, this study suggests that performance of prediction models for preeclampsia should be confirmed in pre-specified subgroups.
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Hutcheon JA, Stephansson O, Cnattingius S, Bodnar LM, Wikström AK, Johansson K. Pregnancy Weight Gain Before Diagnosis and Risk of Preeclampsia: A Population-Based Cohort Study in Nulliparous Women. Hypertension 2018; 72:433-441. [PMID: 29915016 DOI: 10.1161/hypertensionaha.118.10999] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/04/2018] [Accepted: 05/07/2018] [Indexed: 12/15/2022]
Abstract
Weight gain in early pregnancy may influence a woman's risk of developing preeclampsia. However, the consequences of weight gain throughout pregnancy up to the diagnosis of preeclampsia are unknown. The aim of this study was to determine whether pregnancy weight gain before the diagnosis of preeclampsia is associated with increased risks of preeclampsia (overall and by preeclampsia subtype). The study population included nulliparous pregnant women in the Swedish counties of Gotland and Stockholm, 2008 to 2013, stratified by early pregnancy body mass index category. Electronic medical records were linked with population inpatient and outpatient records to establish date of preeclampsia diagnosis (classified as any, early preterm <34 weeks, late preterm 34-36 weeks, or term ≥37 weeks). Antenatal weight gain measurements were standardized into gestational age-specific z scores. Among 62 705 nulliparous women, 2770 (4.4%) developed preeclampsia. Odds of preeclampsia increased by ≈60% with every 1 z score increase in pregnancy weight gain among normal weight and overweight women and by 20% among obese women. High pregnancy weight gain was more strongly associated with term preeclampsia than early preterm preeclampsia (eg, 64% versus 43% increased odds per 1 z score difference in weight gain in normal weight women, and 30% versus 0% in obese women, respectively). By 25 weeks, the weight gain of women who subsequently developed preeclampsia was significantly higher than women who did not (eg, 0.43 kg in normal weight women). In conclusion, high pregnancy weight gain before diagnosis increases the risk of preeclampsia in nulliparous women and is more strongly associated with later-onset preeclampsia than early-onset preeclampsia.
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Affiliation(s)
- Jennifer A Hutcheon
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (J.A.H.)
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine, Solna (O.S., S.C., K.W., K.J.).,Division of Obstetrics and Gynaecology, Department of Women's and Children's Health (O.S.)
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine, Solna (O.S., S.C., K.W., K.J.)
| | - Lisa M Bodnar
- Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (L.M.B.)
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Sweden (A.-K.W.)
| | - Kari Johansson
- Clinical Epidemiology Unit, Department of Medicine, Solna (O.S., S.C., K.W., K.J.)
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75
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Cormick G, Betrán AP, Harbron J, Dannemann Purnat T, Parker C, Hall D, Seuc AH, Roberts JM, Belizán JM, Hofmeyr GJ. Are women with history of pre-eclampsia starting a new pregnancy in good nutritional status in South Africa and Zimbabwe? BMC Pregnancy Childbirth 2018; 18:236. [PMID: 29907146 PMCID: PMC6003186 DOI: 10.1186/s12884-018-1885-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 06/05/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Maternal nutritional status before and during pregnancy is an important contributor to pregnancy outcomes and early child health. The aim of this study was to describe the preconceptional nutritional status and dietary intake during pregnancy in high-risk women from South Africa and Zimbabwe. METHODS This is a prospective observational study, nested to the CAP trial. Anthropometric measurements before and during pregnancy and dietary intake using 24-h recall during pregnancy were assessed. The Intake Distribution Estimation software (PC-SIDE) was used to evaluate nutrient intake adequacy taking the Estimated Average Requirement (EAR) as a cut-off point. RESULTS Three hundred twelve women who had pre-eclampsia in their last pregnancy and delivered in hospitals from South Africa and Zimbabwe were assessed. 73.7 and 60.2% women in South Africa and Zimbabwe, respectively started their pregnancy with BMI above normal (BMI ≥ 25) whereas the prevalence of underweight was virtually non-existent. The majority of women had inadequate intakes of micronutrients. Considering food and beverage intake only, none of the micronutrients measured achieved the estimated average requirement. Around 60% of pregnant women reported taking folic acid or iron supplements in South Africa, but almost none did so in Zimbabwe. CONCLUSION We found a high prevalence of overweight and obesity and high micronutrient intake inadequacy in pregnant women who had the previous pregnancy complicated with pre-eclampsia. The obesity figures and micronutrient inadequacy are issues of concern that need to be addressed. Pregnant women have regular contacts with the health system; these opportunities could be used to improve diet and nutrition. TRIAL REGISTRATION PACTR201105000267371 . Registered 06 December 2010.
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Affiliation(s)
- Gabriela Cormick
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Emilio Ravignani, 2024 Buenos Aires, Argentina
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ana Pilar Betrán
- HRP – UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Janetta Harbron
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Catherine Parker
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Effective Care Research Unit, Eastern Cape Department of Health Walter Sisulu University, Mthatha, South Africa
- Effective Care Research Unit, University of Fort Hare, East London, South Africa
| | - David Hall
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Armando H. Seuc
- Epidemiología y Microbiología La Habana, Instituto Nacional de Higiene, Havana, Cuba
| | - James M. Roberts
- Magee-Womens Research Institute, Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, USA
| | - José M. Belizán
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Emilio Ravignani, 2024 Buenos Aires, Argentina
| | - G. Justus Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Effective Care Research Unit, Eastern Cape Department of Health Walter Sisulu University, Mthatha, South Africa
- Effective Care Research Unit, University of Fort Hare, East London, South Africa
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76
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Stuart TJ, O’Neill K, Condon D, Sasson I, Sen P, Xia Y, Simmons RA. Diet-induced obesity alters the maternal metabolome and early placenta transcriptome and decreases placenta vascularity in the mouse. Biol Reprod 2018; 98:795-809. [PMID: 29360948 PMCID: PMC6454478 DOI: 10.1093/biolre/ioy010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/19/2017] [Accepted: 01/17/2018] [Indexed: 12/19/2022] Open
Abstract
Maternal obesity is associated with an increased risk of obesity and metabolic disease in offspring. Increasing evidence suggests that the placenta plays an active role in fetal programming. In this study, we used a mouse model of diet-induced obesity to demonstrate that the abnormal metabolic milieu of maternal obesity sets the stage very early in pregnancy by altering the transcriptome of placenta progenitor cells in the preimplantation (trophectoderm [TE]) and early postimplantation (ectoplacental cone [EPC]) placenta precursors, which is associated with later changes in placenta development and function. Sphingolipid metabolism was markedly altered in the plasma of obese dams very early in pregnancy as was expression of genes related to sphingolipid processing in the early placenta. Upregulation of these pathways inhibits angiogenesis and causes endothelial dysfunction. The expression of many other genes related to angiogenesis and vascular development were disrupted in the TE and EPC. Other key changes in the maternal metabolome in obese dams that are likely to influence placenta and fetal development include a marked decrease in myo and chiro-inositol. These early metabolic and gene expression changes may contribute to phenotypic changes in the placenta, as we found that exposure to a high-fat diet decreased placenta microvessel density at both mid and late gestation. This is the first study to demonstrate that maternal obesity alters the transcriptome at the earliest stages of murine placenta development.
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Affiliation(s)
- Tami J Stuart
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathleen O’Neill
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Condon
- Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Issac Sasson
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Payel Sen
- Epigenetics Center, Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yunwei Xia
- College of Arts and Sciences, Cornell University, Ithaca, New York, USA
| | - Rebecca A Simmons
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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77
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Mahany EB, Han X, Borges BC, da Silveira Cruz-Machado S, Allen SJ, Garcia-Galiano D, Hoenerhoff MJ, Bellefontaine NH, Elias CF. Obesity and High-Fat Diet Induce Distinct Changes in Placental Gene Expression and Pregnancy Outcome. Endocrinology 2018; 159:1718-1733. [PMID: 29438518 PMCID: PMC6456933 DOI: 10.1210/en.2017-03053] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/29/2018] [Indexed: 12/25/2022]
Abstract
Obese women are at high risk of pregnancy complications, including preeclampsia, miscarriage, preterm birth, stillbirth, and neonatal death. In the current study, we aimed to determine the effects of obesity on pregnancy outcome and placental gene expression in preclinical mouse models of genetic and nutritional obesity. The leptin receptor (LepR) null-reactivatable (LepRloxTB), LepR-deficient (Leprdb/+), and high-fat diet (HFD)-fed mice were assessed for fertility, pregnancy outcome, placental morphology, and placental transcriptome using standard quantitative polymerase chain reaction (qPCR) and qPCR arrays. The restoration of fertility of LepRloxTB was performed by stereotaxic delivery of adeno-associated virus-Cre into the hypothalamic ventral premammillary nucleus. Fertile LepRloxTB females were morbidly obese, whereas the wild-type mice-fed HFD showed only a mild increase in body weight. Approximately 80% of the LepRloxTB females had embryo resorptions (∼40% of the embryos). In HFD mice, the number of resorptions was not different from controls fed a regular diet. Placentas of resorbed embryos from obese mice displayed necrosis and inflammatory infiltrate in the labyrinth and changes in the expression of genes associated with angiogenesis and inflammation (e.g., Vegfa, Hif1a, Nfkbia, Tlr3, Tlr4). In contrast, placentas from embryos of females on HFD showed changes in a different set of genes, mostly associated with cellular growth and response to stress (e.g., Plg, Ang, Igf1, Igfbp1, Fgf2, Tgfb2, Serpinf1). Sexual dimorphism in gene expression was only apparent in placentas from obese LepRloxTB mice. Our findings indicate that an obese environment and HFD have distinct effects on pregnancy outcome and the placental transcriptome.
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Affiliation(s)
- Erica B Mahany
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- Correspondence: Erica B. Mahany, MD, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109. E-mail:
| | - Xingfa Han
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
- Isotope Research Laboratory, Sichuan Agricultural University, Ya'an, China
| | - Beatriz C Borges
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sanseray da Silveira Cruz-Machado
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
- Department of Physiology, Institute of Biosciences, Cidade Universitária, University of São Paulo, São Paulo, Brazil
| | - Susan J Allen
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - David Garcia-Galiano
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Mark J Hoenerhoff
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nicole H Bellefontaine
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Carol F Elias
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
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78
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Gandhi K, Li C, German N, Skobowiat C, Carrillo M, Kallem RR, Larumbe E, Martinez S, Chuecos M, Ventolini G, Nathanielsz P, Schlabritz-Loutsevitch N. Effect of maternal high-fat diet on key components of the placental and hepatic endocannabinoid system. Am J Physiol Endocrinol Metab 2018; 314:E322-E333. [PMID: 29138223 PMCID: PMC5966752 DOI: 10.1152/ajpendo.00119.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 02/06/2023]
Abstract
Maternal obesity in pregnancy has been linked to a spectrum of adverse developmental changes. Involvement of eCBs in obesity is well characterized. However, information regarding eCB physiology in obesity associated with pregnancy is sparse. This study evaluated fetomaternal hepatic, systemic, and placental eCB molecular changes in response to maternal consumption of a HFD. From ≥9 mo before conception, nonpregnant baboons ( Papio spp.) were fed a diet of either 45 (HFD; n = 11) or 12% fat or a control diet (CTR; n = 11), and dietary intervention continued through pregnancy. Maternal and fetal venous plasma samples were evaluated using liquid chromatography-mass spectrometry to quantify AEA and 2-AG. Placental, maternal and fetal hepatic tissues were analyzed using RT-PCR, Western blot, and immunohistochemistry. mRNA and protein expression of endocannabinoid receptors (CB1R and CB2R), FAAH, DAGL, MAGL, and COX-2 were determined. Statistical analyses were performed with the nonparametric Scheirer-Ray-Hare extension of the Kruskal-Wallis test to analyze the effects of diet (HFD vs. CTR), fetal sex (male vs. female), and the diet × sex interaction. Fetal weight was influenced by fetal sex but not by maternal diet. The increase in maternal weight in animals fed the HFD vs. the CTR diet approached significance ( P = 0.055). Maternal circulating 2-AG concentrations increased, and fetal circulating concentrations decreased in the HFD group, independently of fetal sex. CB1R receptor expression was detected in syncytiotrophoblasts (HFD) and the fetal endothelium (CTR and HFD). Placental CB2R protein expression was higher in males and lower in female fetuses in the HFD group. Fetal hepatic CB2R, FAAH, COX-2 (for both fetal sexes), and DAGLα (in male fetuses) protein expression decreased in the HFD group compared with the CTR group. We conclude that consumption of a HFD during pregnancy results in fetal systemic 2-AG and hepatic eCB deficiency.
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Affiliation(s)
- Kushal Gandhi
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
| | - Cun Li
- Department of Animal Science, University of Wyoming , Laramie, Wyoming
- Texas Biomedical Research Institute and Southwest National Primate Research Center , San Antonio, Texas
| | - Nadezhda German
- School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | | | - Maira Carrillo
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
| | - Raja Reddy Kallem
- School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | - Eneko Larumbe
- Clinical Research Institute, Texas Tech University Health Sciences , Lubbock, Texas
| | - Stacy Martinez
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
| | - Marcel Chuecos
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
| | - Gary Ventolini
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
| | - Peter Nathanielsz
- Department of Animal Science, University of Wyoming , Laramie, Wyoming
- Texas Biomedical Research Institute and Southwest National Primate Research Center , San Antonio, Texas
| | - Natalia Schlabritz-Loutsevitch
- School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin , Odessa, Texas
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79
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Abstract
Preeclampsia is characterized by blood pressure greater than 140/90 mmHg in the second half of pregnancy. This disease is a major contributor to preterm and low birth weight babies. The early delivery of the baby, which becomes necessary for maintaining maternal well-being, makes preeclampsia the leading cause for preterm labor and infant mortality and morbidity. Currently, there is no cure for this pregnancy disorder. The current clinical management of PE is hydralazine with labetalol and magnesium sulfate to slow disease progression and prevent maternal seizure, and hopefully prolong the pregnancy. This review will highlight factors implicated in the pathophysiology of preeclampsia and current treatments for the management of this disease.
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80
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Pérez‐Pérez A, Toro A, Vilariño‐García T, Maymó J, Guadix P, Dueñas JL, Fernández‐Sánchez M, Varone C, Sánchez‐Margalet V. Leptin action in normal and pathological pregnancies. J Cell Mol Med 2018; 22:716-727. [PMID: 29160594 PMCID: PMC5783877 DOI: 10.1111/jcmm.13369] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/10/2017] [Indexed: 12/11/2022] Open
Abstract
Leptin is now considered an important signalling molecule of the reproductive system, as it regulates the production of gonadotrophins, the blastocyst formation and implantation, the normal placentation, as well as the foeto-placental communication. Leptin is a peptide hormone secreted mainly by adipose tissue, and the placenta is the second leptin-producing tissue in humans. Placental leptin is an important cytokine which regulates placental functions in an autocrine or paracrine manner. Leptin seems to play a crucial role during the first stages of pregnancy as it modulates critical processes such as proliferation, protein synthesis, invasion and apoptosis in placental cells. Furthermore, deregulation of leptin levels has been correlated with the pathogenesis of various disorders associated with reproduction and gestation, including polycystic ovary syndrome, recurrent miscarriage, gestational diabetes mellitus, pre-eclampsia and intrauterine growth restriction. Due to the relevant incidence of the mentioned diseases and the importance of leptin, we decided to review the latest information available about leptin action in normal and pathological pregnancies to support the idea of leptin as an important factor and/or predictor of diverse disorders associated with reproduction and pregnancy.
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Affiliation(s)
- Antonio Pérez‐Pérez
- Department of Medical Biochemistry and Molecular BiologyVirgen Macarena University HospitalUniversity of SevilleSevilleSpain
| | - Ayelén Toro
- Laboratory of Placental Molecular PhysiologyDepartment of Biological ChemistrySchool of SciencesUniversity of Buenos AiresIQUIBICEN‐CONICETBuenos AiresArgentina
| | - Teresa Vilariño‐García
- Department of Medical Biochemistry and Molecular BiologyVirgen Macarena University HospitalUniversity of SevilleSevilleSpain
| | - Julieta Maymó
- Laboratory of Placental Molecular PhysiologyDepartment of Biological ChemistrySchool of SciencesUniversity of Buenos AiresIQUIBICEN‐CONICETBuenos AiresArgentina
| | - Pilar Guadix
- Department of Obstetrics and GynecologyVirgen Macarena University HospitalUniversity of SevilleSevilleSpain
| | - José L. Dueñas
- Department of Obstetrics and GynecologyVirgen Macarena University HospitalUniversity of SevilleSevilleSpain
| | | | - Cecilia Varone
- Laboratory of Placental Molecular PhysiologyDepartment of Biological ChemistrySchool of SciencesUniversity of Buenos AiresIQUIBICEN‐CONICETBuenos AiresArgentina
| | - Víctor Sánchez‐Margalet
- Department of Medical Biochemistry and Molecular BiologyVirgen Macarena University HospitalUniversity of SevilleSevilleSpain
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81
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Zambon M, Mandò C, Lissoni A, Anelli GM, Novielli C, Cardellicchio M, Leone R, Monari MN, Massari M, Cetin I, Abati S. Inflammatory and Oxidative Responses in Pregnancies With Obesity and Periodontal Disease. Reprod Sci 2018; 25:1474-1484. [PMID: 29343164 DOI: 10.1177/1933719117749758] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Maternal obesity is related to immunologic and inflammatory systemic modifications that may worsen the pregnancy inflammatory status. Hormonal changes during pregnancy can adversely affect oral biofilms and oral health initiating or worsening periodontal diseases, with enhanced local and systemic oxidative stress and inflammation. OBJECTIVE The aim of this study was to examine the relationship between local salivary and systemic parameters of oxidative stress and inflammation in relation to obesity and periodontal diseases. STUDY DESIGN Sixty-two women with singleton pregnancies were enrolled. Twenty-seven women were normal weight (NW; 18.5< body mass index [BMI] <25 kg/m2) and 35 obese (BMI ≥30 kg/m2). Seventeen of the obese had gestational diabetes mellitus (GDM). During third trimester, periodontal status was evaluated, saliva (s) was collected to assess total antioxidant capacity (s-TAC) and C-reactive protein (s-CRP) levels, and venous plasma (p) was used to measure CRP levels (p-CRP). Maternal, fetal, and placental data were registered at delivery. RESULTS Levels of s-TAC, s-CRP, and p-CRP were significantly higher in obese, particularly in the presence of GDM, compared to NW and related to each other ( P = .000; r > 0.59), to maternal BMI ( P = .000; r > 0.52), and fasting glycemia ( P < .002; r > 0.47). Periodontal disease was more frequent in obese groups (80%) versus NW (52%; P = .04), particularly when GDM was diagnosed ( P = .009). A significant interaction effect between maternal BMI and oral condition was found for s-TAC levels. Obese with periodontitis showed significant increase in local and systemic parameters versus NW. CONCLUSION Obesity and periodontal disease could synergistically amplify the inflammatory and oxidative status, resulting in increased local and systemic biomarkers particularly when GDM is diagnosed.
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Affiliation(s)
- Marta Zambon
- 1 Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Chiara Mandò
- 1 Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Lissoni
- 2 Unit of Oral Pathology, Department of Dentistry, University Vita-Salute San Raffaele and IRCCS San Raffaele University Hospital, Milan, Italy
| | - Gaia Maria Anelli
- 1 Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Chiara Novielli
- 1 Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Manuela Cardellicchio
- 1 Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Roberto Leone
- 3 Humanitas Clinical and Research Center, Rozzano, Italy
| | - Marta Noemi Monari
- 4 Laboratory of Analysis, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Maddalena Massari
- 1 Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Irene Cetin
- 1 Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Silvio Abati
- 2 Unit of Oral Pathology, Department of Dentistry, University Vita-Salute San Raffaele and IRCCS San Raffaele University Hospital, Milan, Italy
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82
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Sones JL, Merriam AA, Seffens A, Brown-Grant DA, Butler SD, Zhao AM, Xu X, Shawber CJ, Grenier JK, Douglas NC. Angiogenic factor imbalance precedes complement deposition in placentae of the BPH/5 model of preeclampsia. FASEB J 2018; 32:2574-2586. [PMID: 29279353 DOI: 10.1096/fj.201701008r] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Preeclampsia (PE), a hypertensive disorder of pregnancy, is a leading cause of maternal and fetal morbidity and mortality. Although the etiology is unknown, PE is thought to be caused by defective implantation and decidualization in pregnancy. Pregnant blood pressure high (BPH)/5 mice spontaneously develop placentopathies and maternal features of human PE. We hypothesized that BPH/5 implantation sites have transcriptomic alterations. Next-generation RNA sequencing of implantation sites at peak decidualization, embryonic day (E)7.5, revealed complement gene up-regulation in BPH/5 vs. controls. In BPH/5, expression of complement factor 3 was increased around the decidual vasculature of E7.5 implantation sites and in the trophoblast giant cell layer of E10.5 placentae. Altered expression of VEGF pathway genes in E5.5 BPH/5 implantation sites preceded complement dysregulation, which correlated with abnormal vasculature and increased placental growth factor mRNA and VEGF164 expression at E7.5. By E10.5, proangiogenic genes were down-regulated, whereas antiangiogenic sFlt-1 was up-regulated in BPH/5 placentae. We found that early local misexpression of VEGF genes and abnormal decidual vasculature preceded sFlt-1 overexpression and increased complement deposition in BPH/5 placentae. Our findings suggest that abnormal decidual angiogenesis precedes complement activation, which in turn contributes to the aberrant trophoblast invasion and poor placentation that underlie PE.-Sones, J. L., Merriam, A. A., Seffens, A., Brown-Grant, D.-A., Butler, S. D., Zhao, A. M., Xu, X., Shawber, C. J., Grenier, J. K., Douglas, N. C. Angiogenic factor imbalance precedes complement deposition in placentae of the BPH/5 model of preeclampsia.
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Affiliation(s)
- Jennifer L Sones
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Audrey A Merriam
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Angelina Seffens
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Dex-Ann Brown-Grant
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Scott D Butler
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA; and
| | - Anna M Zhao
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Xinjing Xu
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Carrie J Shawber
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jennifer K Grenier
- RNA Sequencing Core, Center for Reproductive Genomics, Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Nataki C Douglas
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Tolcher MC, Chu DM, Hollier LM, Mastrobattista JM, Racusin DA, Ramin SM, Sangi-Haghpeykar H, Aagaard KM. Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia. Am J Obstet Gynecol 2017; 217:365.e1-365.e8. [PMID: 28455079 DOI: 10.1016/j.ajog.2017.04.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/17/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND The US Preventive Services Task Force recommends low-dose aspirin for the prevention of preeclampsia among women at high risk for primary occurrence or recurrence of disease. Recommendations for the use of aspirin for preeclampsia prevention were issued by the US Preventive Services Task Force in September 2014. OBJECTIVES The objective of the study was to evaluate the incidence of recurrent preeclampsia in our cohort before and after the US Preventive Services Task Force recommendation for aspirin for preeclampsia prevention. STUDY DESIGN This was a retrospective cohort study designed to evaluate the rates of recurrent preeclampsia among women with a history of preeclampsia. We utilized a 2-hospital, single academic institution database from August 2011 through June 2016. We excluded multiple gestations and included only the first delivery for women with multiple deliveries during the study period. The cohort of women with a history of preeclampsia were divided into 2 groups, before and after the release of the US Preventive Services Task Force 2014 recommendations. Potential confounders were accounted for in multivariate analyses, and relative risk and adjusted relative risk were calculated. RESULTS A total of 17,256 deliveries occurred during the study period. A total of 417 women had a documented history of prior preeclampsia: 284 women before and 133 women after the US Preventive Services Task Force recommendation. Comparing the before and after groups, the proportion of Hispanic women in the after group was lower and the method of payment differed between the groups (P <.0001). The prevalence of type 1 diabetes was increased in the after period, but overall rates of pregestational diabetes were similar (6.3% before vs 5.3% after [P > .05]). Risk factors for recurrent preeclampsia included maternal age >35 years (relative risk, 1.83; 95% confidence interval, 1.34-2.48), Medicaid insurance (relative risk, 2.08; 95% confidence interval, 1.15-3.78), type 2 diabetes (relative risk, 2.13; 95% confidence interval, 1.37-3.33), and chronic hypertension (relative risk, 1.96; 95% confidence interval, 1.44-2.66). The risk of recurrent preeclampsia was decreased by 30% in the after group (adjusted relative risk, 0.70; 95% confidence interval, 0.52-0.95). CONCLUSION Rates of recurrent preeclampsia among women with a history of preeclampsia decreased by 30% after release of the US Preventive Services Task Force recommendation for aspirin for preeclampsia prevention. Future prospective studies should include direct measures of aspirin compliance, gestational age at initiation, and explore the influence of race and ethnicity on the efficacy of this primary prevention.
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Does a body mass index greater than 25 kg/m 2 increase maternal and neonatal morbidity? A French historical cohort study. J Gynecol Obstet Hum Reprod 2017; 46:601-608. [DOI: 10.1016/j.jogoh.2017.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 06/19/2017] [Accepted: 06/30/2017] [Indexed: 11/18/2022]
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Wallace JM, Bhattacharya S, Horgan GW. Weight change across the start of three consecutive pregnancies and the risk of maternal morbidity and SGA birth at the second and third pregnancy. PLoS One 2017. [PMID: 28628636 PMCID: PMC5476268 DOI: 10.1371/journal.pone.0179589] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Weight-change across parities and/or current BMI may influence maternal and fetal morbidity and requires to be differentiated to better inform weight-management guidance. METHODS Direction, pattern and magnitude of weight-change across three consecutive parities and thereby two inter-pregnancy periods was described in 5079 women. The association between inter-pregnancy weight-change versus current BMI and adverse maternal events, SGA-birth and preterm delivery at second and third pregnancy were investigated by logistic regression. RESULTS More women gained weight across the defined childbearing period than lost it, with ~35% of normal and overweight women gaining sufficient weight to move up a BMI-category. Nine patterns of weight-change were defined across two inter-pregnancy periods and 50% of women remained weight-stable throughout (within 2BMI units/period). Women who were overweight/obese at first pregnancy had higher risk of substantial weight-gain and loss (>10kg) during each of two inter-pregnancy periods. Inter-pregnancy weight-gain (> 2BMI units) between first and second pregnancy increased the risk of maternal morbidity (1or more event of hypertensive disease, caesarean-section, thromboembolism) at second pregnancy, while weight-loss (>2BMI units) increased the risk of SGA-birth. Similarly, increased risk of maternal morbidity at the third pregnancy was influenced by weight-gain during both inter-pregnancy periods but not by current BMI-category. Both weight-gain between first and second pregnancy, and being overweight/obese by third pregnancy protected the fetus against SGA-birth whereas weight-loss between second and third pregnancy doubled the SGA risk. CONCLUSION Half the women studied exhibited significant weight-fluctuations. This influenced their risk of maternal morbidity and SGA-birth at second and third pregnancy.
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Affiliation(s)
- Jacqueline M. Wallace
- Rowett Institute, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- * E-mail:
| | - Sohinee Bhattacharya
- Dugald Baird Centre for Research on Women’s Health, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom
| | - Graham W. Horgan
- Biomathematics & Statistics Scotland, Rowett Institute, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Chen J, Khalil RA. Matrix Metalloproteinases in Normal Pregnancy and Preeclampsia. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2017; 148:87-165. [PMID: 28662830 PMCID: PMC5548443 DOI: 10.1016/bs.pmbts.2017.04.001] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Normal pregnancy is associated with marked hemodynamic and uterine changes that allow adequate uteroplacental blood flow and uterine expansion for the growing fetus. These pregnancy-associated changes involve significant uteroplacental and vascular remodeling. Matrix metalloproteinases (MMPs) are important regulators of vascular and uterine remodeling. Increases in MMP-2 and MMP-9 have been implicated in vasodilation, placentation, and uterine expansion during normal pregnancy. The increases in MMPs could be induced by the increased production of estrogen and progesterone during pregnancy. MMP expression/activity may be altered during complications of pregnancy. Decreased vascular MMP-2 and MMP-9 may lead to decreased vasodilation, increased vasoconstriction, hypertensive pregnancy, and preeclampsia. Abnormal expression of uteroplacental integrins, cytokines, and MMPs may lead to decreased maternal tolerance, apoptosis of invasive trophoblast cells, inadequate remodeling of spiral arteries, and reduced uterine perfusion pressure (RUPP). RUPP may cause imbalance between the antiangiogenic factors soluble fms-like tyrosine kinase-1 and soluble endoglin and the proangiogenic vascular endothelial growth factor and placental growth factor, or stimulate the release of inflammatory cytokines, hypoxia-inducible factor, reactive oxygen species, and angiotensin AT1 receptor agonistic autoantibodies. These circulating factors could target MMPs in the extracellular matrix as well as endothelial and vascular smooth muscle cells, causing generalized vascular dysfunction, increased vasoconstriction and hypertension in pregnancy. MMP activity can also be altered by endogenous tissue inhibitors of metalloproteinases (TIMPs) and changes in the MMP/TIMP ratio. In addition to their vascular effects, decreases in expression/activity of MMP-2 and MMP-9 in the uterus could impede uterine growth and expansion and lead to premature labor. Understanding the role of MMPs in uteroplacental and vascular remodeling and function could help design new approaches for prediction and management of preeclampsia and premature labor.
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Affiliation(s)
- Juanjuan Chen
- Vascular Surgery Research Laboratories, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Raouf A Khalil
- Vascular Surgery Research Laboratories, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.
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Piccoli GB, Cabiddu G, Castellino S, Gernone G, Santoro D, Moroni G, Spotti D, Giacchino F, Attini R, Limardo M, Maxia S, Fois A, Gammaro L, Todros T. A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy. J Nephrol 2017; 30:307-317. [PMID: 28434090 DOI: 10.1007/s40620-017-0390-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/09/2017] [Indexed: 02/07/2023]
Abstract
Preeclampsia (PE) is a protean syndrome causing a transitory kidney disease, characterised by hypertension and proteinuria, ultimately reversible after delivery. Its prevalence is variously estimated, from 3 to 5% to 10% if all the related disorders, including also pregnancy-induced hypertension (PIH) and HELLP syndrome (haemolysis, increase in liver enzyme, low platelets) are included. Both nephrologists and obstetricians are involved in the management of the disease, according to different protocols, and the clinical management, as well as the role for each specialty, differs worldwide. The increased awareness of the role of chronic kidney disease in pregnancy, complicating up to 3% of pregnancies, and the knowledge that PE is associated with an increased risk for development of CKD later in life have recently increased the interest and redesigned the role of the nephrologists in this context. However, while the heterogeneous definitions of PE, its recent reclassification, an emerging role for biochemical biomarkers, the growing body of epidemiological data and the new potential therapeutic interventions lead to counsel long-term follow-up, the lack of resources for chronic patients and the increasing costs of care limit the potential for preventive actions, and suggest tailoring specific interventional strategies. The aim of the present position statement of the Kidney and Pregnancy Study Group of the Italian Society of Nephrology is to review the literature and to try to identify theoretical and pragmatic bases for an agreed management of PE in the nephrological setting, with particular attention to the prevention of the syndrome (recurrent PE, presence of baseline CKD) and to the organization of the postpartum follow-up.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy. .,Nephrologie, Centre Hospitalier Le Mans, Avenue Roubillard, 72000, Le Mans, France.
| | | | | | | | | | - Gabriella Moroni
- Nephrology, Fondazione Ca' Granda Ospedale Maggiore, Milan, Italy
| | - Donatella Spotti
- Nephrology and Dialysis, IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - Rossella Attini
- Obstetrics, Department of Surgery, University of Torino, Turin, Italy
| | - Monica Limardo
- Nephrology, Azienda Ospedaliera della Provincia di Lecco, Lecco, Italy
| | | | - Antioco Fois
- Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Linda Gammaro
- Nephrology Ospedale Fracastoro San Bonifacio, San Bonifacio, Italy
| | - Tullia Todros
- Obstetrics, Department of Surgery, University of Torino, Turin, Italy
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Vieira MC, Poston L, Fyfe E, Gillett A, Kenny LC, Roberts CT, Baker PN, Myers JE, Walker JJ, McCowan LM, North RA, Pasupathy D. Clinical and biochemical factors associated with preeclampsia in women with obesity. Obesity (Silver Spring) 2017; 25:460-467. [PMID: 28008746 DOI: 10.1002/oby.21715] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/23/2016] [Accepted: 11/02/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare early pregnancy clinical and biomarker risk factors for later development of preeclampsia between women with obesity (body mass index, BMI ≥30 kg/m2 ) and those with a normal BMI (20-25 kg/m2 ). METHODS In 3,940 eligible nulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study, a total of 53 biomarkers of glucose and lipid metabolism, placental function, and known markers of preeclampsia were measured at 14 to 16 weeks' gestation. Logistic regression was performed to identify clinical and biomarker risk factors for preeclampsia in women with and without obesity. RESULTS Among 834 women with obesity and 3,106 with a normal BMI, 77 (9.2%) and 105 (3.4%) developed preeclampsia, respectively. In women with obesity, risk factors included a family history of thrombotic disease, low plasma placental growth factor, and higher uterine artery resistance index at 20 weeks. In women with a normal BMI, a family history of preeclampsia or gestational hypertension, mean arterial blood pressure, plasma endoglin and cystatin C, and uterine artery resistance index were associated with preeclampsia, while high fruit intake was protective. CONCLUSIONS Women with obesity and a normal BMI have different early pregnancy clinical and biomarker risk factors for preeclampsia.
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Affiliation(s)
- Matias C Vieira
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Lucilla Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Elaine Fyfe
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alexandra Gillett
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Claire T Roberts
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, Adelaide, South Australia
| | - Philip N Baker
- College of Medicine, Biological Sciences & Psychology, University of Leicester, UK
| | - Jenny E Myers
- Division of Developmental Biology, School of Medical Sciences, The Faculty of Biology Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, UK
| | - James J Walker
- Department of Obstetrics and Gynaecology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, UK
| | - Lesley M McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robyn A North
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Dharmintra Pasupathy
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
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Coll CDVN, Domingues MR, Hallal PC, da Silva ICM, Bassani DG, Matijasevich A, Barros A, Santos IS, Bertoldi AD. Changes in leisure-time physical activity among Brazilian pregnant women: comparison between two birth cohort studies (2004 - 2015). BMC Public Health 2017; 17:119. [PMID: 28122524 PMCID: PMC5267459 DOI: 10.1186/s12889-017-4036-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/13/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Low levels of leisure-time physical activity (LTPA) during pregnancy have been shown in studies conducted worldwide. Surveillance is extremely important to monitor the progress of physical activity patterns over time and set goals for effective interventions to decrease inactivity among pregnant women. The aim of this study was to evaluate time changes in LTPA among Brazilian pregnant women in an 11-year period (2004-2015) by comparing data from two birth cohort studies. METHODS Two population-based birth cohort studies were carried out in the city of Pelotas, southern Brazil, in 2004 and 2015. A total of 4244 and 4271 mothers were interviewed after delivery. Weekly frequency and duration of each session of LTPA in a typical week were reported for the pre-pregnancy period and for each trimester of pregnancy. Trends in both recommended LTPA (≥150 min/week) and any LTPA (regardless of weekly amount) were analysed overtime. Changes were also calculated separately for subgroups of maternal age, schooling, family income, parity, pre-pregnancy body mass index and pre-pregnancy LTPA. RESULTS The proportion of women engaged in recommended levels of LTPA pre-pregnancy increased from 11.2% (95%CI 10.0-12.2) in 2004 to 15.8% (95%CI 14.6-16.9) in 2015. During pregnancy, no changes were observed over the period for the first (10.6 to 10.9%) and second (8.7 to 7.9%) trimesters, whereas there was a decrease from 3.4% (95%CI 2.9-4.0) to 2.4% (95%CI 1.9-2.8) in the last trimester. Major decreases in LTPA in the last trimester were observed among women who were younger, with intermediate to high income, high schooling, primiparous, pre-pregnancy obese and, engaged in LTPA before pregnancy. Changes in any LTPA practice followed the same patterns described for recommended LTPA. CONCLUSIONS Despite the increase in the proportion of women engaged in LTPA before pregnancy between 2004 and 2005, LTPA levels remained stable during the first and second trimesters of pregnancy and declined during the third gestational trimester over the period. Interventions to encourage the maintenance of LTPA practice throughout pregnancy are urgently needed.
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Affiliation(s)
| | | | - Pedro Curi Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Inácio Crochemore Mohnsam da Silva
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Diego Garcia Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alicia Matijasevich
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Aluísio Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Iná S. Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Calderón-Garcidueñas L, de la Monte SM. Apolipoprotein E4, Gender, Body Mass Index, Inflammation, Insulin Resistance, and Air Pollution Interactions: Recipe for Alzheimer's Disease Development in Mexico City Young Females. J Alzheimers Dis 2017; 58:613-630. [PMID: 28527212 PMCID: PMC9996388 DOI: 10.3233/jad-161299] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Given the epidemiological trends of increasing Alzheimer's disease (AD) and growing evidence that exposure and lifestyle factors contribute to AD risk and pathogenesis, attention should be paid to variables such as air pollution, in order to reduce rates of cognitive decline and dementia. Exposure to fine particulate matter (PM2.5) and ozone (O3) above the US EPA standards is associated with AD risk. Mexico City children experienced pre- and postnatal high exposures to PM2.5, O3, combustion-derived iron-rich nanoparticles, metals, polycyclic aromatic hydrocarbons, and endotoxins. Exposures are associated with early brain gene imbalance in oxidative stress, inflammation, innate and adaptive immune responses, along with epigenetic changes, accumulation of misfolded proteins, cognitive deficits, and brain structural and metabolic changes. The Apolipoprotein E (APOE) 4 allele, the most prevalent genetic risk for AD, plays a key role in the response to air pollution in young girls. APOE 4 heterozygous females with >75% to <94% BMI percentiles are at the highest risk of severe cognitive deficits (1.5-2 SD from average IQ). This review focused on the relationships between gender, BMI, systemic and neural inflammation, insulin resistance, hyperleptinemia, dyslipidemia, vascular risk factors, and central nervous system involvement in APOE4 urbanites exposed to PM2.5 and magnetite combustion-derived iron-rich nanoparticles that can reach the brain. APOE4 young female heterozygous carriers constitute a high-risk group for a fatal disease: AD. Multidisciplinary intervention strategies could be critical for prevention or amelioration of cognitive deficits and long-term AD progression in young individuals at high risk.
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Spradley FT. Metabolic abnormalities and obesity's impact on the risk for developing preeclampsia. Am J Physiol Regul Integr Comp Physiol 2016; 312:R5-R12. [PMID: 27903516 DOI: 10.1152/ajpregu.00440.2016] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/11/2016] [Accepted: 11/29/2016] [Indexed: 02/07/2023]
Abstract
Preeclampsia (PE), a hypertensive disorder of pregnancy, is increasing as a major contributor to perinatal and long-term morbidity of mother and offspring. PE is thought to originate from ischemic insults in the placenta driving the release of prohypertensive anti-angiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1)] and proinflammatory [tumor necrosis factor-α (TNF-α)] factors into the maternal circulation. Whereas the increased incidence of PE is hypothesized to be largely due to the obesity pandemic, the mechanisms whereby obesity increases this risk are unknown. The maternal endothelium is targeted by placental and adipose tissue-derived factors like sFlt-1 and TNF-α that promote hypertension during pregnancy, resulting in vascular dysfunction and hypertension. Interestingly, not all obese pregnant women develop PE. Data suggest that obese pregnant women with the greatest metabolic abnormalities have the highest incidence of PE. Identifying obesity-related mechanisms driving hypertension in some obese pregnant women and pathways that protect normotensive obese pregnant women, may uncover novel protocols to treat PE. Metabolic abnormalities, such as increased circulating leptin, glucose, insulin, and lipids, are likely to increase the risk for PE in obese women. It is not only important to understand whether each of these metabolic factors contribute to the increased risk for PE in obesity, but also their cumulative effects. This is particularly relevant to obese pregnant women with gestational diabetes mellitus (GDM) where all of these factors are increased and the risk for PE is highest. It is speculated that these factors potentiate the anti-angiogenic and proinflammatory mechanisms of placental ischemia-induced vascular dysfunction thereby contributing to the increasing incidence of PE.
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Affiliation(s)
- Frank T Spradley
- Department of Surgery, Department of Physiology and Biophysics, Cardiovascular-Renal Research Center, Women's Health Research Center, The University of Mississippi Medical Center, Jackson, Mississippi
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92
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Howell KR, Powell TL. Effects of maternal obesity on placental function and fetal development. Reproduction 2016; 153:R97-R108. [PMID: 27864335 DOI: 10.1530/rep-16-0495] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/10/2016] [Accepted: 11/18/2016] [Indexed: 12/11/2022]
Abstract
Obesity has reached epidemic proportions, and pregnancies in obese mothers have increased risk for complications including gestational diabetes, hypertensive disorders, pre-term birth and caesarian section. Children born to obese mothers are at increased risk of obesity and metabolic disease and are susceptible to develop neuropsychiatric and cognitive disorders. Changes in placental function not only play a critical role in the development of pregnancy complications but may also be involved in linking maternal obesity to long-term health risks in the infant. Maternal adipokines, i.e., interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), leptin and adiponectin link maternal nutritional status and adipose tissue metabolism to placental function. Adipokines and metabolic hormones have direct impact on placental function by modulating placental nutrient transport. Nutrient delivery to the fetus is regulated by a complex interaction including insulin signaling, cytokine profile and insulin responsiveness, which is modulated by adiponectin and IL-1β. In addition, obese pregnant women are at risk for hypertension and preeclampsia with reduced placental vascularity and blood flow, which would restrict placental nutrient delivery to the developing fetus. These sometimes opposing signals regulating placental function may contribute to the diversity of short and long-term outcomes observed in pregnant obese women. This review focuses on the changes in adipokines and obesity-related metabolic hormones, how these factors influence placental function and fetal development to contribute to long-term metabolic and behavioral consequences of children born to obese mothers.
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Affiliation(s)
- Kristy R Howell
- Departments of PsychiatryObstetrics/Gynecology and Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Theresa L Powell
- Departments of PsychiatryObstetrics/Gynecology and Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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Persson M, Cnattingius S, Wikström AK, Johansson S. Maternal overweight and obesity and risk of pre-eclampsia in women with type 1 diabetes or type 2 diabetes. Diabetologia 2016; 59:2099-105. [PMID: 27369871 PMCID: PMC5016540 DOI: 10.1007/s00125-016-4035-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/09/2016] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS Women with type 1 or type 2 diabetes are at increased risk of pre-eclampsia. Overweight and obesity are associated with an increased risk of pre-eclampsia in women without diabetes. The aim of the study was to investigate the impact of maternal overweight and obesity on the risk of pre-eclampsia in women with type 1 diabetes or type 2 diabetes. METHODS In a population-based cohort study including singleton births in Sweden, we estimated the risk of pre-eclampsia among women with type 1 diabetes (n = 7062) and type 2 diabetes (n = 886), and investigated whether maternal overweight (BMI 25-29.9 kg/m(2)) and obesity (BMI ≥30.0 kg/m(2)) modified the risk. Logistic regression analyses were used to estimate crude and adjusted ORs with 95% CIs, using women without diabetes as the reference group (n = 1,509,525). RESULTS Compared with women without diabetes, the adjusted ORs for pre-eclampsia in women with type 1 and type 2 diabetes were 5.74 (95% CI 5.31, 6.20) and 2.11 (95% CI 1.65, 2.70), respectively. The corresponding risks of pre-eclampsia combined with preterm birth were even higher. Risks of pre-eclampsia increased with maternal overweight (BMI 25-29.9 kg/m(2)) and obesity (BMI ≥30.0 kg/m(2)), foremost in women without diabetes, to a lesser extent in women with type 1 diabetes but not in women with type 2 diabetes. CONCLUSIONS/INTERPRETATION Maternal overweight and obesity increased risks of pre-eclampsia in women with type 1 diabetes but not in women with type 2 diabetes. Even so, considering associations between maternal BMI and overall maternal and offspring risk, all women (with and without diabetes) should aim for a normal weight before pregnancy.
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Affiliation(s)
- Martina Persson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2, 17176, Stockholm, Sweden.
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2, 17176, Stockholm, Sweden
| | - Anna-Karin Wikström
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2, 17176, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Stefan Johansson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2, 17176, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Possomato-Vieira JS, Khalil RA. Mechanisms of Endothelial Dysfunction in Hypertensive Pregnancy and Preeclampsia. ADVANCES IN PHARMACOLOGY 2016; 77:361-431. [PMID: 27451103 DOI: 10.1016/bs.apha.2016.04.008] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Preeclampsia is a pregnancy-related disorder characterized by hypertension and could lead to maternal and fetal morbidity and mortality. Although the causative factors and pathophysiological mechanisms are unclear, endothelial dysfunction is a major hallmark of preeclampsia. Clinical tests and experimental research have suggested that generalized endotheliosis in the systemic, renal, cerebral, and hepatic circulation could decrease endothelium-derived vasodilators such as nitric oxide, prostacyclin, and hyperpolarization factor and increase vasoconstrictors such as endothelin-1 and thromboxane A2, leading to increased vasoconstriction, hypertension, and other manifestation of preeclampsia. In search for the upstream mechanisms that could cause endothelial dysfunction, certain genetic, demographic, and environmental risk factors have been suggested to cause abnormal expression of uteroplacental integrins, cytokines, and matrix metalloproteinases, leading to decreased maternal tolerance, apoptosis of invasive trophoblast cells, inadequate spiral arteries remodeling, reduced uterine perfusion pressure (RUPP), and placental ischemia/hypoxia. RUPP may cause imbalance between the antiangiogenic factors soluble fms-like tyrosine kinase-1 and soluble endoglin and the proangiogenic factors vascular endothelial growth factor and placental growth factor, or stimulate the release of other circulating bioactive factors such as inflammatory cytokines, hypoxia-inducible factor-1, reactive oxygen species, and angiotensin AT1 receptor agonistic autoantibodies. These circulating factors could then target endothelial cells and cause generalized endothelial dysfunction. Therapeutic options are currently limited, but understanding the factors involved in endothelial dysfunction could help design new approaches for prediction and management of preeclampsia.
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Affiliation(s)
- J S Possomato-Vieira
- Vascular Surgery Research Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - R A Khalil
- Vascular Surgery Research Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
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Gene–gene interactions in the NAMPT pathway, plasma visfatin/NAMPT levels, and antihypertensive therapy responsiveness in hypertensive disorders of pregnancy. THE PHARMACOGENOMICS JOURNAL 2016; 17:427-434. [DOI: 10.1038/tpj.2016.35] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/08/2016] [Accepted: 03/28/2016] [Indexed: 12/16/2022]
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96
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Malverdy Z, Kazemi A. Health beliefs and stages of changes to improve behaviors among obese and overweight women undergoing preconception care. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:595-600. [PMID: 28194199 PMCID: PMC5301066 DOI: 10.4103/1735-9066.197677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Beginning and continuing pregnancy with obesity and being overweight has some known side effects for the mother and the fetus. Preventing these complications requires medical interventions before pregnancy. Because designing health improvement interventions requires understanding of the related factors of the behavior, the aim of this study was to determine the relation between health beliefs of women regarding the risks of obesity for pregnancy and stages of behavioral changes in women under preconception care. Materials and Methods: This study was a cross-sectional study that was conducted on 120 obese and overweight women under preconception care. Health belief structures including perceived sensitivity/intensity, perceived benefits, perceived barriers, and perceived self-efficacy were measured using a questionnaire, and its relation with stages of nutrition and physical activity behavior changes was evaluated according to a transtheoretical model. Results: Results showed a significant correlation between the stage of nutrition behavioral change and perceived sensitivity/intensity, perceived benefits, and self-efficacy (P < 0.05). In addition, the stage of physical activity behavioral change showed a negative and significant correlation with perceived barriers and a positive and low-to-moderate significant correlation with other health belief structures (P < 0.05). Furthermore, the relation of perceived sensitivity/intensity with perceived benefits and self-efficacy was positive and significant, and that with perceived barriers was negative and significant (P < 0.01). Conclusions: Results showed that a health belief model could be a predictor of weight adjustment behaviors including nutrition and physical activity behaviors. Therefore, educational interventions based on a health belief model could be effective for improvement of these behaviors in obese and overweight women under preconception care.
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Affiliation(s)
- Zahra Malverdy
- Health and Treatment Networks in Isfahan Province, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Kazemi
- Department of Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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