151
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Involvement of Receptor for Advanced Glycation Endproducts in Hypertensive Disorders of Pregnancy. Int J Mol Sci 2019; 20:ijms20215462. [PMID: 31683992 PMCID: PMC6862609 DOI: 10.3390/ijms20215462] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 12/12/2022] Open
Abstract
Preeclampsia/hypertensive disorders of pregnancy (PE/HDP) is a serious and potentially life-threatening disease. Recently, PE/HDP has been considered to cause adipose tissue inflammation, but the detailed mechanism remains unknown. We exposed human primary cultured adipocytes with serum from PE/HDP and healthy controls for 24 h, and analyzed mRNA expression of several adipokines, cytokines, and ligands of the receptor for advanced glycation endproducts (RAGE). We found that the mRNA levels of interleukin-6 (IL-6), C-C motif chemokine ligand 2 (CCL2), high mobility group box 1 (HMGB1), and RAGE were significantly increased by the addition of PE/HDP serum. Among RAGE ligands, advanced glycation endproducts (AGE) and HMGB1 increased mRNA levels of IL-6 and CCL2 in SW872 human adipocytes and mouse 3T3-L1 cells. The introduction of small interfering RNA for RAGE (siRAGE) into SW872 cells abolished the AGE- and HMGB1-induced up-regulation of IL-6 and CCL2. In addition, lipopolysaccharide (LPS), a ligand of RAGE, increased the expression of IL-6 and CCL2 and siRAGE attenuated the LPS-induced expression of IL-6 and CCL2. These results strongly suggest that the elevated AGE, HMGB1, and LPS in pregnant women up-regulate the expression of IL-6 and CCL2 via the RAGE system, leading to systemic inflammation such as PE/HDP.
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152
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Increased BMI has a linear association with late-onset preeclampsia: A population-based study. PLoS One 2019; 14:e0223888. [PMID: 31622409 PMCID: PMC6797165 DOI: 10.1371/journal.pone.0223888] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022] Open
Abstract
Background To investigate the ongoing controversy on the effect of BMI (body mass index) on EOP (early onset preeclampsia) vs LOP (late onset), especially focusing on diabetes and maternal booking/pre-pregnancy BMI as possible independent variables. Methods 18 year-observational cohort study (2001–2018). The study population consisted of all consecutive births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity (ap. 4,300 birth per year, only level 3 maternity in the south of Reunion Island, sole allowed to follow and deliver all preeclampsia cases of the area). History of pregnancies, deliveries and neonatal outcomes have been collected in standardized fashion into an epidemiological perinatal data base. Results Chronic hypertension and, history of preeclampsia in multigravidas, were the strongest risk factors for EOP. Primiparity, age over 35 years and BMI ≥ 35 kg/m² were rather associated with LOP. In a multivariate analysis with EOP or LOP as outcome variables compared with controls (normotensive), maternal age and pre-pregnancy BMI were independent risk factors for both EOP and LOP (p < 0.001). However, analyzing by increment of 5 (years of age, kg/m² for BMI) rising maternal ages and incidence of preeclampsia were strictly parallel for EOP and LOP, while increment of BMI was only associated with LOP. Controlling for maternal ages and booking/pre-pregnancy BMI, diabetes was not an independent risk factor neither for EOP or LOP. Conclusions Metabolic factors, other than diabetes, associated with pre-pregnancy maternal corpulence are specifically associated with LOP. This may be a direction for future researches on the maternal preeclamptic syndrome. This may explain the discrepancy we are facing nowadays where high-income countries report 90% of their preeclampsia being LOP, while it is only 60–70% in medium-low income countries.
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153
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Farrar D, Santorelli G, Lawlor DA, Tuffnell D, Sheldon TA, West J, Macdonald-Wallis C. Blood pressure change across pregnancy in white British and Pakistani women: analysis of data from the Born in Bradford cohort. Sci Rep 2019; 9:13199. [PMID: 31520065 PMCID: PMC6744423 DOI: 10.1038/s41598-019-49722-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/01/2019] [Indexed: 11/17/2022] Open
Abstract
The incidence of gestational hypertension (GH) and pre-eclampsia (PE) is increasing. Use of blood pressure (BP) change patterns may improve early detection of BP abnormalities. We used Linear spline random-effects models to estimate BP patterns across pregnancy for white British and Pakistani women. Pakistani women compared to white British women had lower BP during the first two trimesters of pregnancy, irrespective of the development of GH or PE or presence of a risk factor. Pakistani compared to white British women with GH and PE showed steeper BP increases towards the end of pregnancy. Pakistani women were half as likely to develop GH, but as likely to develop PE than white British women. To conclude; BP trajectories differ by ethnicity. Because GH developed evenly from 20 weeks gestation, and PE occurred more commonly after 36 weeks in both ethnic groups, the lower BP up to the third trimester in Pakistani women resulted in a lower GH rate, whereas PE rates, influenced by the steep third trimester BP increase were similar. Criteria for diagnosing GH and PE may benefit from considering ethnic differences in BP change across pregnancy.
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Affiliation(s)
- Diane Farrar
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol National Institute for Health Research Biomedical Resource Centre, Bristol, UK
| | | | | | - Jane West
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
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154
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Schütze ST, Groten T, Schleussner E, Battefeld W. Evaluation of Treatment Strategies to Manage Diabetes Mellitus in Pregnancy: Use of Fetal Sonography Compared to Monitoring of Maternal Blood Glucose Alone. Geburtshilfe Frauenheilkd 2019; 79:1199-1207. [PMID: 31736509 PMCID: PMC6846735 DOI: 10.1055/a-0865-4684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/13/2019] [Accepted: 02/28/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction When planning the treatment of women with gestational diabetes, the current standard approach also takes fetal growth development into account. The treatment of pregnant women with type 1 diabetes mellitus (DM) used to be based exclusively on maternal blood glucose values. This study investigated the impact of including fetal growth parameters in the monitoring of pregnant women with type 1 diabetes mellitus. Patients/Method 199 pregnant women with type 1 DM were included in a cohort study. The patient population was divided into two study cohorts. In the mBG cohort (n = 94; investigation period: 1994 - 2005) treatment was monitored using only maternal blood glucose (mBG) values; the aim was to achieve standard target glucose values (mean BG < 5.5 mmol/l, postprandial: at 1 h < 7.7 mmol/l, at 2 h < 6.6 mmol/l). In the fUS collective (n = 101, investigation period: 2006 - 2014) fetal growth parameters were additionally included when monitoring treatment from the 22nd week of gestation, and maternal target glucose values were then individually adjusted to take account of fetal growth. This study aimed to investigate the impact of these two different ways of monitoring treatment on perinatal and peripartum outcomes. Results 91.4% of all patients were normoglycemic at the time of delivery (HbA 1c < 6.7%); 58.9% of patients achieved strict normoglycemia (HbA 1c < 5.7%). No differences were found between the two study cohorts (fUS vs. mBG: HbA 1c < 6.7%: 93.9 vs. 88.4%, n. s.; mean blood glucose (BG): 5.4 ± 0.6 to 6.6 ± 1.1 vs. 5.9 ± 0.7 to 7.4 ± 1.9 mmol/l, n. s.). Patients from the fUS cohort required significantly lower weight-adjusted maximum insulin doses (0.9 ± 0.3 vs. 1.0 ± 0.4 IE/kg bodyweight, p < 0.05). Pregnancy complications occurred significantly less often in the fUS cohort (preeclampsia: 7.1 vs. 20.9%, p = 0.01; premature labor: 4.0 vs. 23.3%, p < 0.001; cervical insufficiency: 0.0 vs. 11.6%, p = 0.001), and there were significantly fewer cases with neonatal hyperbilirubinemia (19.2 vs. 40.7%, p = 0.001). There was no difference in the rates of LGA infants between the two cohorts (21.2 vs. 24.4%, n. s.). Conclusion Using maternal blood glucose values combined with fetal growth parameters to monitor DM treatment allows therapeutic interventions to be individualized and reduces the risk of maternal and infant morbidity. The metabolism of patients in the fUS cohort was significantly more stable and there were fewer variations in glucose values. It is possible that the detected benefits are due to this metabolic stabilization.
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Affiliation(s)
- Sarah Theresa Schütze
- Klinik für Frauenheilkunde und Geburtshilfe, Krankenhaus der Augustinerinnen Köln, Köln, Germany
| | - Tanja Groten
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Jena, Jena, Germany
| | - Ekkehard Schleussner
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Jena, Jena, Germany
| | - Wilgard Battefeld
- Medizinisches Versorgungszentrum Kempten-Allgäu, Kempten, Kempten, Germany
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155
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Krishnaswami J, del C. Colon-Gonzalez M. Reforming Women's Health Care: A Call to Action for Lifestyle Medicine Practitioners to Save Lives of Mothers and Infants. Am J Lifestyle Med 2019; 13:495-504. [PMID: 31523215 PMCID: PMC6732876 DOI: 10.1177/1559827619838461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 12/16/2022] Open
Abstract
Maternal and infant mortality are fundamental indicators of a society's health and wellness. These measures depict a health crisis in the United States. Compared with other rich countries, women in the United States more frequently die from pregnancy or childbirth, and infants are less likely to survive to their first birthday. Most of these deaths are preventable; disproportionately affect diverse, low-income groups; and are perpetuated by social and health care inequities and subpar preventive care. Lifestyle medicine (LM) is uniquely positioned to ameliorate this growing crisis. The article presents key prescriptions for LM practitioners to build health and health equity for women. These prescriptions, summarized by the acronym PURER, include action in the areas of (1) practice, (2) understanding/empathy, (3) reform, (4) empowerment, and (5) relationship health. The PURER approach focuses on partnering with diverse female patients to promote resilience, promoting social connection and engagement, facilitating optimal family planning and advocating for culturally responsive, equitable health care systems. Through PURER, LM practitioners can help women and partners resiliently overcome the harmful challenges of discrimination and stress characterizing present-day American life. Over time, the equitable and collective practice of LM can help ameliorate the health care barriers undermining the health of women, families, and society.
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Affiliation(s)
- Janani Krishnaswami
- Internal Medicine / Preventive Medicine, University
of Texas Rio Grande Valley. Texas (MDCCG)
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156
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Preeclampsia: The Relationship between Uterine Artery Blood Flow and Trophoblast Function. Int J Mol Sci 2019; 20:ijms20133263. [PMID: 31269775 PMCID: PMC6651116 DOI: 10.3390/ijms20133263] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/29/2022] Open
Abstract
Maternal uterine artery blood flow is critical to maintaining the intrauterine environment, permitting normal placental function, and supporting fetal growth. It has long been believed that inadequate transformation of the maternal uterine vasculature is a consequence of primary defective trophoblast invasion and leads to the development of preeclampsia. That early pregnancy maternal uterine artery perfusion is strongly associated with placental cellular function and behaviour has always been interpreted in this context. Consistently observed changes in pre-conceptual maternal and uterine artery blood flow, abdominal pregnancy implantation, and late pregnancy have been challenging this concept, and suggest that abnormal placental perfusion may result in trophoblast impairment, rather than the other way round. This review focuses on evidence that maternal cardiovascular function plays a significant role in the pathophysiology of preeclampsia.
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157
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Georgiadou D, Afink GB, van Dijk M. The apelinergic-axis in human preeclamptic pregnancies: A systematic review. Pregnancy Hypertens 2019; 17:148-157. [DOI: 10.1016/j.preghy.2019.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 11/16/2022]
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158
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Bahri Khomami M, Joham AE, Boyle JA, Piltonen T, Silagy M, Arora C, Misso ML, Teede HJ, Moran LJ. Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity-A systematic review, meta-analysis, and meta-regression. Obes Rev 2019; 20:659-674. [PMID: 30674081 DOI: 10.1111/obr.12829] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 01/21/2023]
Abstract
Polycystic ovary syndrome (PCOS) is associated with an increased risk of maternal pregnancy and delivery complications. However, the impact of clinical features of PCOS and other potential risk factors in PCOS is still unknown. We aimed to investigate the association of PCOS with maternal pregnancy and delivery complications with consideration of risk factors and potential confounders. The meta-analysis included 63 studies. PCOS was associated with higher miscarriage, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, induction of labour, and caesarean section. The association of PCOS with these outcomes varied by geographic continent, PCOS phenotypes, and study quality. Pre-eclampsia and induction of labour were not associated with PCOS on body mass index-matched studies. No outcome was associated with PCOS on assisted pregnancies. Age was significantly associated with higher miscarriage on meta-regression. There were no studies assessing perinatal depression. We confirm that PCOS is associated with an increased risk of maternal pregnancy and delivery complications. The association of PCOS with the outcomes is worsened in hyperandrogenic PCOS phenotypes, in specific geographic continents, and in the highest quality studies but disappears in assisted pregnancies. Future studies in PCOS are warranted to investigate proper timing for screening and prevention of maternal pregnancy and delivery complications with consideration of clinical features of PCOS.
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Affiliation(s)
- Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Australia
| | - Terhi Piltonen
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Michael Silagy
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Australia
| | - Chavy Arora
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Australia
| | - Marie L Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia.,Monash Partners Academic Health Sciences Centre, Melbourne, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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159
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Hocaoglu M, Demirer S, Senturk H, Turgut A, Komurcu-Bayrak E. Differential expression of candidate circulating microRNAs in maternal blood leukocytes of the patients with preeclampsia and gestational diabetes mellitus. Pregnancy Hypertens 2019; 17:5-11. [PMID: 31487656 DOI: 10.1016/j.preghy.2019.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/20/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Preeclampsia (PE) is diagnosed in women presenting with new onset hypertension accompanied by proteinuria. Gestational diabetes mellitus (GDM) is the carbohydrate intolerance that can occur in pregnancy. Neutrophil activation is related to PE and GDM. Circulating microRNAs (miRs) are small, noncoding RNA molecules. The aim of this study was to verify the expression levels of three candidate miRs in blood leukocytes of the patients with PE, GDM, and PE-GDM compared to healthy controls. STUDY DESIGN We selected miR-21-3p, miR-155-5p, and miR-16-5p which have been associated with GDM and PE. Using real-time quantitative PCR, the expression levels of miR-21-3p, miR-155-5p, miR-16-5p were analyzed in PE (n = 23), GDM (n = 19), PE, and GDM (n = 9) compared to healthy controls (n = 28). MAIN OUTCOME MEASURES The relative expression of the target miR in patient samples was compared to the calibrator and the results were expressed as relative quantification values. RESULTS There was a significant decrease in the expression levels of miR-21-3p in GDM and PE and miR-155-5p in PE group. No significant differences were observed in the expression levels of miRs in PE-GDM group. On receiving operator characteristic (ROC) analysis, areas under the curve (AUC) of the expression ratio of miR-21-3p in GDM was 0.73, and miR-21-3p, miR-155-5p in PE were 0.69 and 0.81, respectively. CONCLUSIONS Our findings indicated that decreased miR-21-3p and miR-155-5p expression levels are associated with PE and miR-21-3p levels are associated with GDM. Our study for the first time revealed that miR-21-3p, miR-16-5p and miR155-5p are not related to PE-GDM group.
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Affiliation(s)
- Meryem Hocaoglu
- Department of Obstetrics and Gynecology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Selin Demirer
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Hilal Senturk
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Abdulkadir Turgut
- Department of Obstetrics and Gynecology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey; Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Evrim Komurcu-Bayrak
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
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160
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Zhang X, Xiao Y. The Association Between Trimester-Specific Weight Gain and Severe Preeclampsia/Adverse Perinatal Outcome in Gestational Diabetes Mellitus Complicated by Preeclampsia: A Retrospective Case Study. Diabetes Ther 2019; 10:725-734. [PMID: 30838548 PMCID: PMC6437224 DOI: 10.1007/s13300-019-0589-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) and preeclampsia share many risk factors, e.g., gestational weight gain (GWG). Previous studies on the co-occurrence of these two diseases cannot powerfully clear up the effects of GWG on perinatal outcome. METHODS A total of 329 pregnant women with GDM complicated by preeclampsia were enrolled. Clinical data of mothers and newborns were retrospectively analyzed, including baseline characteristics of pregnant women and pregnancy outcomes. We focused on the association between trimester-specific weight gain and severe preeclampsia (s-PE)/adverse perinatal outcomes in GDM complicated by preeclampsia, including cesarean section (C-sect), preterm birth, and large for gestational age birth (LGA). Regression analysis was used to adjust the impact of confounding factors, including height, age, parity, scarred uterus, and so on. RESULT By unconditional regression analysis, middle trimester excessive GWG is a risk factor for LGA [OR 6.586, 95% CI (2.254-19.242), AOR 6.481, 95% CI (2.213-18.981)]; late excessive GWG is a risk factor for s-PE and C-sect [OR 1.683, 95% CI (1.084-2.614), AOR 1.888, 95% CI (1.193-2.990); and OR 1.754, 95% CI (1.121-2.744), AOR 1.841, 95% CI (1.153-2.937)], excessive total GWG is a risk factor for LGA, and is a protective factor for the preterm [OR 5.920, 95% CI (2.479-14.139), AOR 5.602, 95% CI (2.337-13.431); and OR 0.448, 95% CI (0.248-0.841), AOR 0.429, 95% CI (0.235-0.783)]. CONCLUSIONS The trimester-specific weight gain has a significant impact on the perinatal outcomes among pregnant women with both GDM and preeclampsia. This study is helpful for carry out risk monitoring in time, identifying early warning signs, and improving maternal and infant health.
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Affiliation(s)
- Xueqin Zhang
- Department of Obstetrics, Xiamen Maternal and Child Healthcare Hospital, Xiamen, 361003, Fujian, People's Republic of China
| | - Yunshan Xiao
- Department of Obstetrics, Xiamen Maternal and Child Healthcare Hospital, Xiamen, 361003, Fujian, People's Republic of China.
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161
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Narvaez-Sanchez R, Calderón JC, Vega G, Trillos MC, Ospina S. Skeletal muscle as a protagonist in the pregnancy metabolic syndrome. Med Hypotheses 2019; 126:26-37. [PMID: 31010495 DOI: 10.1016/j.mehy.2019.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
The pregnant woman normally shows clinical manifestations similar to a metabolic syndrome (MS), due to her metabolic and hemodynamic adaptations in order to share nutrients with the child. If those adjustments are surpassed, a kind of pregnancy MS (PregMS) could appear, characterized by excessive insulin resistance and vascular maladaptation. Skeletal muscle (SKM) must be a protagonist in the PregMS: SKM strength and mass have been associated inversely with MS incidence in non-pregnant patients, and in pregnant women muscular activity modulates metabolic and vascular adaptations that favor better outcomes. Of note, a sedentary lifestyle affects exactly in the other way. Those effects may be explained not only by the old paradigm of SKM being a great energy consumer and store, but because it is an endocrine organ whose chronic activity or deconditioning correspondingly releases myokines modulating insulin sensitivity and cardiovascular adaptation, by direct or indirect mechanisms not well understood. In this document, we present evidence to support the concept of a PregMS and hypothesize on the role of the SKM mass, fiber types composition and myokines in its pathophysiology. Also, we discuss some exercise interventions in pregnancy as a way to test our hypotheses.
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Affiliation(s)
- Raul Narvaez-Sanchez
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Red iberoamericana de trastornos vasculares y del embarazo, RIVATREM, Colombia.
| | - Juan C Calderón
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Gloria Vega
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Maria Camila Trillos
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Sara Ospina
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
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162
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Stojanovska V, Dijkstra DJ, Vogtmann R, Gellhaus A, Scherjon SA, Plösch T. A double-hit pre-eclampsia model results in sex-specific growth restriction patterns. Dis Model Mech 2019; 12:dmm.035980. [PMID: 30683649 PMCID: PMC6398487 DOI: 10.1242/dmm.035980] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/09/2019] [Indexed: 12/29/2022] Open
Abstract
Pre-eclampsia is a multifactorial pregnancy-associated disorder characterized by angiogenic dysbalance and systemic inflammation; however, animal models that combine these two pathophysiological conditions are missing. Here, we introduce a novel double-hit pre-eclampsia mouse model that mimics the complex multifactorial conditions present during pre-eclampsia and allows for the investigation of early consequences for the fetus. Adenoviral overexpression of soluble fms-like tyrosine kinase (sFlt-1) and lipopolysaccharide (LPS) administration at mid-gestation in pregnant mice resulted in hypertension and albuminuria comparable to that of the manifestation in humans. A metabolomics analysis revealed that pre-eclamptic dams have increased plasma concentrations of phosphadytilcholines. The fetuses of both sexes were growth restricted; however, in males a brain-sparing effect was seen as compensation for this growth restriction. According to the plasma metabolomics, male fetuses showed changes in amino acid metabolism, while female fetuses showed pronounced alterations in lipid metabolism. Our results show that combined exposure to sFlt-1 and LPS mimics the clinical symptoms of pre-eclampsia and affects fetal growth in a sex-specific manner, with accompanying metabolome changes.
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Affiliation(s)
- Violeta Stojanovska
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Dorieke J Dijkstra
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Rebekka Vogtmann
- Department of Gynecology and Obstetrics, University Hospital Duisburg-Essen, 45147 Essen, Germany
| | - Alexandra Gellhaus
- Department of Gynecology and Obstetrics, University Hospital Duisburg-Essen, 45147 Essen, Germany
| | - Sicco A Scherjon
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
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163
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Sim YE, Sia AL, Tan CW, Sng BL. Implications of diabetes in obstetric anaesthesia. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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164
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Choe SA, Kauderer S, Eliot MN, Glazer KB, Kingsley SL, Carlson L, Awad YA, Schwartz JD, Savitz DA, Wellenius GA. Air pollution, land use, and complications of pregnancy. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 645:1057-1064. [PMID: 30248831 DOI: 10.1016/j.scitotenv.2018.07.237] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/14/2018] [Accepted: 07/17/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Mounting evidence suggests that the natural and built environment can affect human health, but relatively few studies have considered links between features of the residential natural and built environment other than air pollution and complications of pregnancy. OBJECTIVES To quantify the impact of features of the maternal residential natural and built environments on risk of gestational diabetes mellitus (GDM), gestational hypertension and preeclampsia among 61,640 women who delivered at a single hospital in Rhode Island between 2002 and 2012. METHODS We estimated residential levels of ambient fine particulate matter (PM2.5) and black carbon (BC) using spatiotemporal models, neighborhood green space using remote sensing and proximity to recreational facilities, and neighborhood blue space using distance to coastal and fresh water. We used logistic regression to separately estimate the association between each feature and GDM, gestational hypertension, and preeclampsia, adjusting for individual and neighborhood markers of socioeconomic status. RESULTS GDM, gestational hypertension, and preeclampsia were diagnosed in 8.0%, 5.0%, and 3.6% of women, respectively. We found 2nd trimester PM2.5 (OR = 1.08, 95% CI: 1.00, 1.15 per interquartile range increase in PM2.5) and living close to a major roadway (1.09, 95% CI: 1.00, 1.19) were associated with higher odds of GDM, while living <1 km from the coast was associated with lower odds of GDM (0.87, 95% CI: 0.78, 0.96). Living <500 m from a recreational facility was associated with lower odds of gestational hypertension (0.89, 95% CI: 0.80, 0.99). None of these features were associated with odds of preeclampsia. Results were qualitatively similar in mutually-adjusted models and sensitivity analyses. CONCLUSIONS In this small coastal US state, risk of GDM was positively associated with PM2.5 and proximity to busy roadways, and negatively associated with proximity to blue space, highlighting the importance of the natural and built environment to maternal health.
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Affiliation(s)
- Seung-Ah Choe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America; Department of Obstetrics and Gynecology, CHA University School of Medicine, Gyunggi, South Korea
| | - Sophie Kauderer
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Melissa N Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Kimberly B Glazer
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Samantha L Kingsley
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Lynn Carlson
- Institute at Brown for Environment and Society, Brown University, Providence, RI, United States of America
| | - Yara A Awad
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Joel D Schwartz
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America; Institute at Brown for Environment and Society, Brown University, Providence, RI, United States of America.
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165
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Lokki AI, Heikkinen-Eloranta JK, Laivuori H. The Immunogenetic Conundrum of Preeclampsia. Front Immunol 2018; 9:2630. [PMID: 30483272 PMCID: PMC6243043 DOI: 10.3389/fimmu.2018.02630] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/25/2018] [Indexed: 12/12/2022] Open
Abstract
Pregnancy is an immunological challenge to the mother. The fetal tissues including the placenta must be protected from activation of the maternal immune system. On the other hand, the placental tissue sheds into the maternal circulation and must be adequately identified and phagocytized by the maternal immune system. During a healthy pregnancy, numerous immunosuppressive processes take place that allow the allograft fetus to thrive under exposure to humoral and cellular components of the maternal immune system. Breakdown of immune tolerance may result in sterile inflammation and cause adverse pregnancy outcomes such as preeclampsia, a vascular disease of the pregnancy with unpredictable course and symptoms from several organs. Immunological incompatibility between mother and fetus is strongly indicated in preeclampsia. Recently, genetic factors linking immunological pathways to predisposition to preeclampsia have been identified. In this mini-review genetic variation in immunological factors are discussed in the context of preeclampsia. Specifically, we explore immunogenetic and immunomodulary mechanisms contributing to loss of tolerance, inflammation, and autoimmunity in preeclampsia.
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Affiliation(s)
- A Inkeri Lokki
- Research Programs Unit, Immunobiology Research Program, University of Helsinki, Helsinki, Finland.,Bacteriology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Hannele Laivuori
- Medical and Clinical genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
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166
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Abstract
OBJECTIVE To evaluate the pregnancy outcomes in mothers with controlled Type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS Thirty seven pregnant patients with controlled T1DM were included in the study. RESULTS Twenty (54%) out of 37 patients had preterm delivery (<37 weeks of gestation). The type of delivery was induced vaginal delivery in 9 (24.3%) patients and cesarean section in 27 (72.9%) patients. Preeclampsia developed in 6 (16.2%) patients. Macrosomia was found in 9 (24%) patients. Two antenatal death occured. CONCLUSION Even in the most favorable conditions, the pregnant patients with T1DM would have a great risk for preterm delivery and cesarean section, moderate risk for macrosomia, preeclampsia, and an undefined risk for antenatal death.
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167
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Heath LJ, Hyde H, Miller C, Norris JM. Investigation of elevation as a risk factor for hypertensive disorders of pregnancy among Colorado women between 2007 and 2015. Hypertens Pregnancy 2018; 38:1-12. [PMID: 30384782 DOI: 10.1080/10641955.2018.1538378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study is to determine the association between high elevation and hypertensive disorders of pregnancy (HDP). METHODS Retrospective cohort study using Colorado birth certificate data to compare HDP at high (≥8,000 ft), moderate (4,501-7,999 ft), or low (≤4,500 ft) elevation using logistic regression. RESULTS Among the cohort (n = 314,431), 3.4% of women developed a HDP. High or moderate elevation was not significantly associated with HDP relative to low elevation (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 0.93-1.43; aOR 1.14, 95% CI 0.98-1.31, respectively). CONCLUSION Women living at high or moderate elevation do not have higher odds of HDP.
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Affiliation(s)
- Lauren J Heath
- a Department of Pharmacotherapy , University of Utah College of Pharmacy , Salt Lake City , Utah , USA
| | - Hailey Hyde
- b Department of Epidemiology , Colorado School of Public Health , Aurora , Colorado , USA
| | - Christin Miller
- b Department of Epidemiology , Colorado School of Public Health , Aurora , Colorado , USA
| | - Jill M Norris
- b Department of Epidemiology , Colorado School of Public Health , Aurora , Colorado , USA
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168
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Akhaphong B, Lockridge A, Jo S, Mohan R, Wilcox JA, Wing CR, Regal JF, Alejandro EU. Reduced uterine perfusion pressure causes loss of pancreatic β-cell area but normal function in fetal rat offspring. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1220-R1231. [PMID: 30303709 DOI: 10.1152/ajpregu.00458.2017] [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] [Indexed: 12/16/2022]
Abstract
Maternal hypertension during pregnancy is a major risk factor for intrauterine growth restriction (IUGR), which increases susceptibility to cardiovascular and metabolic disease in adulthood through unclear mechanisms. The aim of this study was to characterize the pancreatic β-cell area and function in the fetal rat offspring of a reduced uterine perfusion pressure (RUPP) model of gestational hypertension. At embryonic day 19.5, RUPP dams exhibited lower body weight, elevated mean blood pressure, reduced litter size, and higher blood glucose compared with sham-operated controls. In RUPP placental lysates, a nonsignificant change in mammalian target of rapamycin (mTOR) activity markers, phosphorylated S6 at serine 240, and phosphorylated AKT (at S473) was observed. RUPP offspring showed significantly reduced β-cell-to-pancreas area and increased β-cell death but normal insulin levels in serum. Isolated islets had normal insulin content and secretory function in response to glucose and palmitate. Fetal pancreatic lysates showed a tendency for reduced insulin levels, with a significant reduction in total mTOR protein with RUPP surgery. In addition, its downstream complex 2 targets phosphorylation of AKT at S473, and pAKT at Thr308 tended to be reduced in the fetal RUPP pancreas. Altogether, these data show that RUPP offspring demonstrated increased β-cell death, reduced β-cell area, and altered nutrient-sensor mTOR protein level in the pancreas. This could represent a mechanistic foundation in IUGR offspring's risk for enhanced susceptibility to type 2 diabetes and other metabolic vulnerabilities seen in adulthood.
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Affiliation(s)
- Brian Akhaphong
- Department of Integrative Biology & Physiology, University of Minnesota: Twin Cities, Minnesota
| | - Amber Lockridge
- Department of Integrative Biology & Physiology, University of Minnesota: Twin Cities, Minnesota
| | - Seokwon Jo
- Department of Integrative Biology & Physiology, University of Minnesota: Twin Cities, Minnesota
| | - Ramkumar Mohan
- Department of Integrative Biology & Physiology, University of Minnesota: Twin Cities, Minnesota
| | - Jacob A Wilcox
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, Minnesota
| | - Cameron R Wing
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, Minnesota
| | - Jean F Regal
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, Minnesota
| | - Emilyn U Alejandro
- Department of Integrative Biology & Physiology, University of Minnesota: Twin Cities, Minnesota
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169
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Fulay AP, Rifas-Shiman SL, Oken E, Perng W. Associations of the dietary approaches to stop hypertension (DASH) diet with pregnancy complications in Project Viva. Eur J Clin Nutr 2018; 72:1385-1395. [PMID: 29339829 PMCID: PMC6050156 DOI: 10.1038/s41430-017-0068-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/14/2017] [Accepted: 11/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to improve cardiometabolic outcomes in non-pregnant populations. Little is known regarding the impact of this diet on health during pregnancy. The objective of this research is to examine associations of adherence to the DASH diet with hypertensive disorders of pregnancy (HDP) and other pregnancy outcomes. SUBJECTS/METHODS We conducted analyses with data that came from 1760 women in Project Viva, a Boston-area longitudinal cohort recruited in early pregnancy 1999-2002. We derived a DASH score using data from a food frequency questionnaire (FFQ) administered at median 11.1 weeks gestation. Next, we used multivariable linear regression models that accounted for the woman's age at enrollment, pre-pregnancy body mass index (BMI), education, smoking habits, race/ethnicity, gestational weight gain (GWG) up until the time of the FFQ, and total energy intake to examine associations of the DASH score with HDP, gestational diabetes, preterm delivery (<37 weeks), birth size, and GWG from FFQ to delivery. Models for HDP and GDM were additionally mutually adjusted for each other. Because pre-pregnancy weight status may modify these relationships, we tested for interactions between pre-pregnancy BMI and the DASH score. RESULTS Mean ± SD age of the women was 32.2 ± 4.9 years; 71.9% were white. Overall, the DASH diet score (mean: 24.0, SD: 5.0) was not associated with any of the pregnancy outcomes or complications. However, we found a positive association between the DASH diet and subsequent GWG among women who were obese before pregnancy (0.19 [95% CI: 0.05, 0.34], P ≤ 0.05 kg higher GWG per 1 unit DASH score). CONCLUSIONS Adherence to DASH diet during early pregnancy does not appear to be protective against HDP or other adverse pregnancy outcomes.
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Affiliation(s)
- Aarohee P Fulay
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 41809, USA
| | - Sheryl L Rifas-Shiman
- The Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, 401 Park Drive, Boston, MA, 02215, USA
| | - Emily Oken
- The Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, 401 Park Drive, Boston, MA, 02215, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Wei Perng
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 41809, USA.
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 41809, USA.
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170
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Clemmensen TS, Christensen M, Kronborg CJS, Knudsen UB, Løgstrup BB. Long-term follow-up of women with early onset pre-eclampsia shows subclinical impairment of the left ventricular function by two-dimensional speckle tracking echocardiography. Pregnancy Hypertens 2018; 14:9-14. [DOI: 10.1016/j.preghy.2018.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/21/2018] [Accepted: 07/05/2018] [Indexed: 01/15/2023]
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171
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Abo-Elmatty DM, Mehanna ET. MIR146A rs2910164 (G/C) Polymorphism is Associated with Incidence of Preeclampsia in Gestational Diabetes Patients. Biochem Genet 2018; 57:222-233. [PMID: 30121885 DOI: 10.1007/s10528-018-9886-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/12/2018] [Indexed: 12/21/2022]
Abstract
Preeclampsia and gestational diabetes are common pregnancy disorders that may be interrelated. MIR146A rs2910164 (G/C) is a functional polymorphism that was associated with several diseases. This study aimed to investigate the frequency of rs2910164 polymorphism and its possible correlation with the incidence of preeclampsia in gestational diabetes patients. The study involved 250 pregnant women divided into 80 healthy control subjects, 85 gestational diabetes patients only, and 85 patients of gestational diabetes combined with preeclampsia. Systolic and diastolic blood pressures, urinary proteins, kidney and liver functions, glucose homeostasis parameters, and lipid profile were determined. Genotyping of the polymorphism was conducted by PCR-RFLP. The frequency of the minor C allele of rs2910164 polymorphism was significantly higher among patients of gestational diabetes combined with preeclampsia compared to the control group (p = 0.012) and the gestational diabetes group (p = 0.014). Patients of gestational diabetes and preeclampsia carrying CC genotype showed higher systolic and diastolic blood pressure, and increased urea, creatinine, urine protein, and dyslipidemia compared to the carriers of GG and GC genotypes. In conclusion, the results of the current study suggest that the rare CC genotype of MIR146A rs2910164 (G/C) polymorphism may be related to increased incidence of preeclampsia in gestational diabetes patients.
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Affiliation(s)
- Dina M Abo-Elmatty
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522, Egypt
| | - Eman T Mehanna
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522, Egypt.
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172
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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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173
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Nørgaard SK, Vestgaard MJ, Jørgensen IL, Ásbjörnsdóttir B, Ringholm L, McIntyre HD, Damm P, Mathiesen ER. Diastolic blood pressure is a potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes. Diabetes Res Clin Pract 2018; 138:229-237. [PMID: 29475019 DOI: 10.1016/j.diabres.2018.02.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/09/2018] [Accepted: 02/06/2018] [Indexed: 11/30/2022]
Abstract
AIMS To identify early clinical, modifiable risk factors for preeclampsia present at first antenatal visit and assess the prevalence of pregnancy-related hypertensive disorders in women with pre-existing diabetes treated with tight glycemic and blood pressure (BP) control. METHODS A population-based cohort study of 494 women with pre-existing diabetes (307 and 187 women with type 1 and type 2 diabetes, respectively), included at their first antenatal visit from 2012 to 2016. The prevalence of chronic hypertension (without diabetic nephropathy or microalbuminuria), gestational hypertension and preeclampsia was recorded. Diabetic microangiopathy included presence of nephropathy, microalbuminuria and/or retinopathy. Treatment target was BP <135/85 mmHg. RESULTS HbA1c was 6.9 ± 2.4% (50 ± 12 mmol/mol) at first antenatal visit and 6.0 ± 0.6% (43 ± 6 mmol/mol) before delivery with no differences between women with type 1 and type 2 diabetes. At the first antenatal visit, the prevalence of microalbuminuria was 6% (6% vs. 6%), nephropathy 2% (1% vs. 2%) and chronic hypertension 6% (3% vs. 10%, p = 0.03). Gestational hypertension developed in 8% (9% vs. 6%) and preeclampsia developed in 8% (9% vs. 7%). Presence of diabetic microangiopathy (adjusted odds ratio (OR) 4.35 (confidence interval 2.12-8.93)) and diastolic BP (adjusted OR 1.72 per 10 mmHg (1.05-2.82)) at the first antenatal visit were independent risk factors for preeclampsia. CONCLUSIONS At the first antenatal visit, diastolic BP was the only independent, potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes in the context of tight glycemic and BP control. One out of four women had hypertensive disorders during pregnancy.
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Affiliation(s)
- Sidse Kjærhus Nørgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.
| | - Marianne Jenlev Vestgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Isabella Lindegaard Jørgensen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Björg Ásbjörnsdóttir
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Harold David McIntyre
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Mater Clinical School and Mater Research, The University of Queensland, Brisbane, Australia
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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174
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Weber KA, Mayo JA, Carmichael SL, Stevenson DK, Winn VD, Shaw GM. Occurrence of Selected Structural Birth Defects Among Women With Preeclampsia and Other Hypertensive Disorders. Am J Epidemiol 2018; 187:668-676. [PMID: 29020134 DOI: 10.1093/aje/kwx269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/27/2017] [Indexed: 12/13/2022] Open
Abstract
To explore a potential association between preeclampsia and selected birth defects, we examined the prevalence of certain birth defects among women with hypertensive disorders including preeclampsia. We analyzed data from 2,499,536 singleton live births in California from 2007 to 2011, including maternal and infant demographics from birth certificates as well as clinical details from delivery hospitalization records. We examined defect groups that were recognizable at birth (e.g., spina bifida and cleft lip). Hypertensive disorders included preexisting hypertension, gestational hypertension, mild preeclampsia, severe preeclampsia/eclampsia, and preeclampsia superimposed on preexisting hypertension. Relative risk values with 95% confidence intervals for each birth defect were calculated by hypertensive group, as well as independent and joint associations of hypertensive and diabetic disorders. Risks of each type of birth defect were higher among offspring of women with hypertensive disorders compared with those without. The risks of birth defects among offspring of women with only a hypertensive disorder were significantly higher than that among women with neither hypertensive nor diabetic disorders (relative risks ranged from 1.37 to 2.77). Risks of birth defects were highest among those born to women with both hypertensive and diabetic disorders compared with those with neither (relative risks ranged from 1.80 to 6.22). These findings support the existence of an association between preeclampsia and certain birth defects and suggest that diabetes may be a contributing factor.
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Affiliation(s)
- Kari A Weber
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jonathan A Mayo
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K Stevenson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Virginia D Winn
- Division of Reproductive, Stem Cell and Perinatal Biology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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175
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Dachew BA, Mamun A, Maravilla JC, Alati R. Pre-eclampsia and the risk of autism-spectrum disorder in offspring: meta-analysis. Br J Psychiatry 2018; 212:142-147. [PMID: 29436313 DOI: 10.1192/bjp.2017.27] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence about the effect of intrauterine exposure to pre-eclampsia on offspring autism-spectrum disorder (ASD) is not well established. Aims To examine the association between pre-eclampsia and ASD. METHOD PubMed, Embase and PsycINFO databases were searched. Pooled relative risks (RR) with 95% confidence intervals were calculated. Subgroup and sensitivity analyses were performed. Heterogeneity was assessed using Cochran's Q- and the I 2-test. The presence of publication bias was evaluated by Egger's test and visual inspection of the symmetry in funnel plots. RESULTS Ten studies meet the inclusion criteria. The risk of ASD was 32% higher in offspring who had intrauterine exposure to pre-eclampsia compared with those not exposed (RR = 1.32, 95% CI 1.20-1.45). Sensitivity analysis revealed consistent pooled estimates ranging from RR = 1.30 (95% CI 1.17-1.44) to RR = 1.37 (95% CI 1.26-1.48). We found no significant heterogeneity and evidence of publication bias. CONCLUSION Pre-eclampsia increased the risk of ASD in offspring. The finding suggests a need for early screening for ASD in offspring of women with pre-eclampsia. Declaration of interest None.
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Affiliation(s)
- Berihun Assefa Dachew
- Institute for Social Science Research and School of Public Health,The University of Queensland,Brisbane,Australia and Department of Epidemiology and Biostatistics,Institute of Public Health,University of Gondar,Ethiopia
| | - Abdullah Mamun
- Institute for Social Science Research and School of Public Health,The University of Queensland,Brisbane,Australia
| | | | - Rosa Alati
- Institute for Social Science Research,The University of Queensland,Brisbane,Australia
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176
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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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177
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Vokalova L, van Breda SV, Ye XL, Huhn EA, Than NG, Hasler P, Lapaire O, Hoesli I, Rossi SW, Hahn S. Excessive Neutrophil Activity in Gestational Diabetes Mellitus: Could It Contribute to the Development of Preeclampsia? Front Endocrinol (Lausanne) 2018; 9:542. [PMID: 30298053 PMCID: PMC6161643 DOI: 10.3389/fendo.2018.00542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022] Open
Abstract
Gestational diabetes mellitus is a transient form of glucose intolerance occurring during pregnancy. Pregnancies affected by gestational diabetes mellitus are at risk for the development of preeclampsia, a severe life threatening condition, associated with significant feto-maternal morbidity and mortality. It is a risk factor for long-term health in women and their offspring. Pregnancy has been shown to be associated with a subliminal degree of neutrophil activation and tightly regulated generation of neutrophil extracellular traps (NETs). This response is excessive in cases with preeclampsia, leading to the presence of large numbers of NETs in affected placentae. We have recently observed that circulatory neutrophils in cases with gestational diabetes mellitus similarly exhibit an excessive pro-NETotic phenotype, and pronounced placental presence, as detected by expression of neutrophil elastase. Furthermore, exogenous neutrophil elastase liberated by degranulating neutrophils was demonstrated to alter trophoblast physiology and glucose metabolism by interfering with key signal transduction components. In this review we examine whether additional evidence exists suggesting that altered neutrophil activity in gestational diabetes mellitus may contribute to the development of preeclampsia.
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Affiliation(s)
- Lenka Vokalova
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- Institute of Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Shane V. van Breda
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- Department of Rheumatology, Kantonsspital Aarau, Aarau, Switzerland
| | - Xi Lun Ye
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Evelyn A. Huhn
- Department of Obstetrics, University Women's Hospital Basel, Basel, Switzerland
| | - Nandor G. Than
- Systems Biology of Reproduction Momentum Research Group, Research Centre for Natural Sciences, Institute of Enzymology, Hungarian Academy of Sciences, Budapest, Hungary
| | - Paul Hasler
- Department of Rheumatology, Kantonsspital Aarau, Aarau, Switzerland
| | - Olav Lapaire
- Department of Obstetrics, University Women's Hospital Basel, Basel, Switzerland
| | - Irene Hoesli
- Department of Obstetrics, University Women's Hospital Basel, Basel, Switzerland
| | - Simona W. Rossi
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- *Correspondence: Simona W. Rossi
| | - Sinuhe Hahn
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- Sinuhe Hahn
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178
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Litang Z, Hong W, Weimin Z, Xiaohui T, Qian S. Serum NF-κBp65, TLR4 as Biomarker for Diagnosis of Preeclampsia. Open Med (Wars) 2017; 12:399-402. [PMID: 29318184 PMCID: PMC5757355 DOI: 10.1515/med-2017-0057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 09/17/2017] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to evaluate the serum NF-κBp65, TLR4 (Toll-like receptor 4) expression in patients of preeclampsia and its diagnostic value as biomarkers.
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Affiliation(s)
- Zhao Litang
- Department of Obstetrics and Gynecology, Zhangqiu maternity and child care hospital, 250200shandongChina
| | - Wang Hong
- Department of Obstetrics and Gynecology, Zhangqiu maternity and child care hospital, 250200shandongChina
| | - Zhang Weimin
- Department of Obstetrics and Gynecology, Zhangqiu maternity and child care hospital, 250200shandongChina
| | - Tian Xiaohui
- Department of Obstetrics and Gynecology, Zhangqiu maternity and child care hospital, 250200shandongChina
| | - Sun Qian
- Department of Obstetrics and Gynecology, Jinan Maternity and Child Care Hospital, 250001. No.2 jianguoxiaojingsanlu Road, Jinan City, Shandong Province, 25001ChinaTel:+86-0531-89029000
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179
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Gutaj P, Zawiejska A, Mantaj U, Wender-Ożegowska E. Determinants of preeclampsia in women with type 1 diabetes. Acta Diabetol 2017; 54:1115-1121. [PMID: 28975446 PMCID: PMC5680366 DOI: 10.1007/s00592-017-1053-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 09/08/2017] [Indexed: 01/19/2023]
Abstract
AIMS Despite improvement in diabetic care over the years, the incidence of hypertensive disorders of pregnancy is still very high. Therefore, the aim of our study was to determine risk factors for PE in women with T1DM. METHODS This study was a prospective, nested case-control study on a population of 165 women with T1DM. Women were divided into 3 subgroups: normotensive (N = 141), gestational hypertension (GH) (N = 8), and PE (N = 16). Clinical data were collected in the first trimester (< 12th week), in mid-pregnancy (20-24th weeks), and just prior to delivery (34-39th weeks). IR in the first trimester was quantified using the estimated glucose disposal rate formula (eGDR, milligrams/kilogram/minute). Simple logistic regression was used to search for factors associated with PE and GH. For multivariate comparisons, we used multiple logistic regression with stepwise selection. RESULTS All preeclampsia cases were diagnosed in primiparae. The presence of vasculopathy was the strongest determinant of PE (OR 10.8, 95% CI 3.27-35.97, P = 0.0001), followed by a history of chronic hypertension (6.05, 1.75-20.8, P = 0.004) and the duration of diabetes (1.11, 1.03-1.12, P = 0.009). However, chronic hypertension and duration of diabetes were no longer associated with PE after adjustment for the presence of vasculopathy. Higher gestational weight gain (GWG) was associated with PE, and this association remained significant after adjustment for first trimester body mass index (1.14, 1.02-1.28, P = 0.02). Both systolic and diastolic blood pressure assessed in the first trimester were significant determinants of PE; however, this association was no longer observed after adjustment for the presence of chronic hypertension. Glycated hemoglobin (HbA1c) levels from all 3 trimesters were significantly associated with PE (first trimester: 1.38, 1.01-1.87, P = 0.04; second trimester: 2.76, 1.43-5.31, P = 0.002; third trimester: 2.42, 1.30-4.51, P = 0.005). There was a negative association between eGDR and PE (0.66, 0.50-0.87, P = 0.003). Among lipids, triglycerides (TG) in all 3 trimesters were positively associated with PE, and this association was independent of HbA1c levels (first trimester: 5.32, 1.65-17.18, P = 0.005; second trimester: 2.52, 1.02-6.26, P = 0.05; third trimester: 2.28, 1.39-3.74, P = 0.001. We did not find any predictors of GH in the regression analysis among all analyzed factors. CONCLUSIONS Primiparity and diabetic vasculopathy seem to be the strongest risk factors for PE in women with type 1 diabetes. However, preexisting hypertension and higher GWG were also associated with PE in women with T1DM. Among laboratory results, higher HbA1c and TG levels in all 3 trimesters were associated with PE. The association between higher IR and PE in women with T1DM needs further study.
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Affiliation(s)
- Paweł Gutaj
- Division of Reproduction, Department of Obstetrics, Gynecology and Gynecological Oncology, Poznan University of Medical Sciences, 33 Polna St, 60-535, Poznań, Poland.
| | - Agnieszka Zawiejska
- Division of Reproduction, Department of Obstetrics, Gynecology and Gynecological Oncology, Poznan University of Medical Sciences, 33 Polna St, 60-535, Poznań, Poland
| | - Urszula Mantaj
- Division of Reproduction, Department of Obstetrics, Gynecology and Gynecological Oncology, Poznan University of Medical Sciences, 33 Polna St, 60-535, Poznań, Poland
| | - Ewa Wender-Ożegowska
- Division of Reproduction, Department of Obstetrics, Gynecology and Gynecological Oncology, Poznan University of Medical Sciences, 33 Polna St, 60-535, Poznań, Poland
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180
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Kalagiri RR, Vora N, Wilson JL, Afroze SH, Raju VN, Govande V, Beeram MR, Kuehl TJ, Uddin MN. Diabetes and pre-eclampsia affecting pregnancy: a retrospective cross-sectional study. J Investig Med 2017; 66:728-732. [PMID: 29170244 DOI: 10.1136/jim-2017-000537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 12/16/2022]
Abstract
The interaction between pre-eclampsia and diabetes mellitus (DM) is far from being completely understood. In this study, we compared normal pregnancies with those complicated with pre-eclampsia, gestational DM, and/or pre-existing diabetes to assess the effects of hyperglycemia on placental development. AnInstitutional Review Board (IRB) approved retrospective cross-sectional study with 621 subjects was performed. Statistical analysis was performed using Duncan's post hoc test and analysis of variance. Regardless of diabetes status, patients with pre-eclampsia delivered prematurely. Patients in the group with pre-eclampsia and pregestational diabetes delivered much earlier, at 35.0±0.4 weeks, when compared with the patients that had pre-eclampsia with gestational diabetes and pre-eclampsia with no diabetes (*P<0.05 for each). Additionally, patients with pre-existing diabetes who developed pre-eclampsia delivered smaller babies than those with pre-existing diabetes without pre-eclampsia (1.00±0.03, P<0.05 for each). Pre-existing diabetes with added insult of pre-eclampsia led to fetal growth restriction. This outcome validates the understanding that elevated glucose earlier in pregnancy alters placentogenesis and leads to fetal growth restriction.
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Affiliation(s)
- Ram R Kalagiri
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Niraj Vora
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Jessica L Wilson
- College of Medicine, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Syeda H Afroze
- Department of Medical Physiology, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Venkata N Raju
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Vinayak Govande
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Madhava R Beeram
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA.,College of Medicine, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Thomas J Kuehl
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA.,College of Medicine, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA.,Obstetrics and Gynecology, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Mohammad Nasir Uddin
- Medical Physiology, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
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181
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Prakash GT, Das AK, Habeebullah S, Bhat V, Shamanna SB. Maternal and Neonatal Outcome in Mothers with Gestational Diabetes Mellitus. Indian J Endocrinol Metab 2017; 21:854-858. [PMID: 29285448 PMCID: PMC5729673 DOI: 10.4103/ijem.ijem_66_17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is common and is accompanied with other comorbidities. Challenges to treatment exist at our institute as it serves women with low income. This study assessed the burden of comorbidities and the outcome of GDM. METHODS This was a prospective, observational study of women with gestational diabetes attending the obstetrics department from September 2012 to April 2014. GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Groups criteria. Medical comorbidities were noted, and lipid profile was done. All the women were followed up till delivery, and the complications were recorded. Age- and parity-matched pregnant women with normal oral glucose tolerance test were recruited as controls. RESULTS One hundred and thirty-nine women were followed up till delivery. The average age was 28 years. Eighteen percent had bad obstetric history. The average body mass index was 28.8. Twenty-five percent had gestational hypertension (HTN), and 6.4% had chronic HTN. Thirty percent had hypothyroidism. 65% women received insulin. The glucose values were within the recommended range in 60% of the women. Maternal hypoglycemia occurred in 7 (5%) women. Forty-four percent of the women required cesarean section and 34% had complications either during pregnancy or labor. Three neonates had macrosomia. Twenty-six neonates (20%) required admission to the Neonatal Intensive Care Unit. Four neonates (3%) died. Newborns of mothers whose GDM optimally treated had less complications. CONCLUSION Gestational diabetes is associated with HTN, hypothyroidism, obesity, and lipid abnormalities. The majority of women required insulin for treatment and optimal control of blood glucose resulted in lower neonatal complications.
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Affiliation(s)
| | - Ashok Kumar Das
- Department of Medicine, Pondicherry Institute of Medical Sciences, Kalapet, India
| | - Syed Habeebullah
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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182
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Padmanabhan S, Lee VW, Mclean M, Athayde N, Lanzarone V, Khoshnow Q, Peek MJ, Cheung NW. The Association of Falling Insulin Requirements With Maternal Biomarkers and Placental Dysfunction: A Prospective Study of Women With Preexisting Diabetes in Pregnancy. Diabetes Care 2017; 40:1323-1330. [PMID: 28798085 DOI: 10.2337/dc17-0391] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/09/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the association of falling insulin requirements (FIR) among women with preexisting diabetes with adverse obstetric outcomes and maternal biomarkers longitudinally in pregnancy. RESEARCH DESIGN AND METHODS A multicenter prospective cohort study of 158 women (41 with type 1 diabetes and 117 with type 2 diabetes) was conducted. Women with FIR of ≥15% from the peak total daily dose after 20 weeks' gestation were considered case subjects (n = 32). The primary outcome was a composite of clinical markers of placental dysfunction (preeclampsia, small for gestational age [≤5th centile], stillbirth, premature delivery [<30 weeks], and placental abruption). Maternal circulating angiogenic markers (placental growth factor [PlGF] and soluble fms-like tyrosine kinase 1 [sFlt-1]), placental hormones (human placental lactogen, progesterone, and tumor necrosis factor-α), HbA1c, and creatinine were studied serially during pregnancy. RESULTS FIR ≥15% were associated with an increased risk of the composite primary outcome (odds ratio [OR] 4.38 [95% CI 1.9-10.3]; P < 0.001), preeclampsia (OR 6.76 [95% CI 2.7-16.7]; P < 0.001), and was more common among women with type 1 diabetes (36.6 vs. 14.5%; P = 0.002). Creatinine was modestly elevated among women with FIR ≥15%; however, there was no difference in HbA1c. The ratio of sFlt-1 to PlGF was significantly higher among women with FIR at 25, 30, and 36 weeks, with differences maintained in the subgroup that developed preeclampsia. There was no difference in placental hormones between the groups. CONCLUSIONS This is the first prospective study to associate FIR with altered expression of placental antiangiogenic factors and preeclampsia. FIR are an important clinical sign, among women with preexisting diabetes, that should alert the clinician to investigate underlying placental dysfunction.
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Affiliation(s)
- Suja Padmanabhan
- Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia .,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Vincent W Lee
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Mark Mclean
- Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Diabetes and Endocrinology, Blacktown Hospital, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia
| | - Neil Athayde
- Obstetric Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Valeria Lanzarone
- Obstetric Medicine, Nepean Hospital, Sydney, New South Wales, Australia
| | - Qemer Khoshnow
- Obstetric Medicine, Nepean Hospital, Sydney, New South Wales, Australia
| | - Michael J Peek
- College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - N Wah Cheung
- Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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183
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Emerging role for dysregulated decidualization in the genesis of preeclampsia. Placenta 2017; 60:119-129. [PMID: 28693893 DOI: 10.1016/j.placenta.2017.06.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/10/2017] [Accepted: 06/07/2017] [Indexed: 12/31/2022]
Abstract
In normal human placentation, uterine invasion by trophoblast cells and subsequent spiral artery remodeling depend on cooperation among fetal trophoblasts and maternal decidual, myometrial, immune and vascular cells in the uterine wall. Therefore, aberrant function of anyone or several of these cell-types could theoretically impair placentation leading to the development of preeclampsia. Because trophoblast invasion and spiral artery remodeling occur during the first half of pregnancy, the molecular pathology of fetal placental and maternal decidual tissues following delivery may not be informative about the genesis of impaired placentation, which transpired months earlier. Therefore, in this review, we focus on the emerging prospective evidence supporting the concept that deficient or defective endometrial maturation in the late secretory phase and during early pregnancy, i.e., pre-decidualization and decidualization, respectively, may contribute to the genesis of preeclampsia. The first prospectively-acquired data directly supporting this concept were unexpectedly revealed in transcriptomic analyses of chorionic villous samples (CVS) obtained during the first trimester of women who developed preeclampsia 5 months later. Additional supportive evidence arose from investigations of Natural Killer cells in first trimester decidua from elective terminations of women with high resistance uterine artery indices, a surrogate for deficient trophoblast invasion. Last, circulating insulin growth factor binding protein-1, which is secreted by decidual stromal cells was decreased during early pregnancy in women who developed preeclampsia. We conclude this review by making recommendations for further prospectively-designed studies to corroborate the concept of endometrial antecedents of preeclampsia. These studies could also enable identification of women at increased risk for developing preeclampsia, unveil the molecular mechanisms of deficient or defective (pre)decidualization, and lead to preventative strategies designed to improve (pre)decidualization, thereby reducing risk for preeclampsia development.
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184
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Vestgaard M, Sommer MC, Ringholm L, Damm P, Mathiesen ER. Prediction of preeclampsia in type 1 diabetes in early pregnancy by clinical predictors: a systematic review. J Matern Fetal Neonatal Med 2017; 31:1933-1939. [DOI: 10.1080/14767058.2017.1331429] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Marianne Vestgaard
- Center of Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Miriam Colstrup Sommer
- Center of Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Lene Ringholm
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Center of Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth R. Mathiesen
- Center of Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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185
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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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186
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Ringholm L, Damm JA, Vestgaard M, Damm P, Mathiesen ER. Diabetic Nephropathy in Women With Preexisting Diabetes: From Pregnancy Planning to Breastfeeding. Curr Diab Rep 2016; 16:12. [PMID: 26803648 DOI: 10.1007/s11892-015-0705-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In women with preexisting diabetes and nephropathy or microalbuminuria, it is important to deliver careful preconception counselling to assess the risk for the mother and the foetus, for optimizing glycaemic status and to adjust medical treatment. If serum creatinine is normal in early pregnancy, kidney function is often preserved during pregnancy, but complications such as severe preeclampsia and preterm delivery are still common. Perinatal mortality is now comparable with that in women with diabetes and normal kidney function. Besides strict glycaemic control before and during pregnancy, early and intensive antihypertensive treatment is important to optimize pregnancy outcomes. Methyldopa, labetalol, nifedipine and diltiazem are considered safe, whereas angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers should be stopped before or at confirmation of pregnancy. Supplementation with folic acid in early pregnancy and low-dose aspirin from 10 to 12 weeks reduces the risk of adverse pregnancy outcomes. During breastfeeding, several ACE inhibitors are considered safe.
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Affiliation(s)
- Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Steno Diabetes Center, Niels Steensens Vej 2, 2820, Gentofte, Denmark.
| | - Julie Agner Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Marianne Vestgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark.
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark.
- Department of Obstetrics, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark.
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187
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Majali-Martinez A, Hiden U, Ghaffari-Tabrizi-Wizsy N, Lang U, Desoye G, Dieber-Rotheneder M. Placental membrane-type metalloproteinases (MT-MMPs): Key players in pregnancy. Cell Adh Migr 2016; 10:136-46. [PMID: 26745344 DOI: 10.1080/19336918.2015.1110671] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Membrane-type matrix metalloproteinases (MT-MMPs) are a sub-family of zinc-dependent endopeptidases involved in the degradation of the extracellular matrix. Although MT-MMPs have been mainly characterized in tumor biology, they also play a relevant role during pregnancy. Placental MT-MMPs are required for cytotrophoblast migration and invasion of the uterine wall and in the remodeling of the spiral arteries. They are involved in the fusion of cytotrophoblasts to form the syncytiotrophoblast as well as in angiogenesis. All these processes are crucial for establishing and maintaining a successful pregnancy and, thus, MT-MMP activity has to be tightly regulated in time and space. Indeed, a de-regulation of MT-MMP expression has been linked with pregnancy complications such as preeclampsia (PE), fetal growth restriction (FGR), gestational diabetes mellitus (GDM) and was also found in maternal obesity. Here we review what is currently known about MT-MMPs in the placenta, with a focus on their general features, their localization and their involvement in pregnancy disorders.
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Affiliation(s)
| | - Ursula Hiden
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
| | | | - Uwe Lang
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
| | - Gernot Desoye
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
| | - Martina Dieber-Rotheneder
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria.,c Institute of Pathology, Medical University of Graz , Graz , Austria
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188
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Staff AC, Redman CWG, Williams D, Leeson P, Moe K, Thilaganathan B, Magnus P, Steegers EAP, Tsigas EZ, Ness RB, Myatt L, Poston L, Roberts JM. Pregnancy and Long-Term Maternal Cardiovascular Health: Progress Through Harmonization of Research Cohorts and Biobanks. Hypertension 2015; 67:251-60. [PMID: 26667417 DOI: 10.1161/hypertensionaha.115.06357] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Anne Cathrine Staff
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Christopher W G Redman
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - David Williams
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Paul Leeson
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Kjartan Moe
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Basky Thilaganathan
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Per Magnus
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Eric A P Steegers
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Eleni Z Tsigas
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Roberta B Ness
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Leslie Myatt
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Lucilla Poston
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - James M Roberts
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
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