Association of biochemical markers with the severity of pre-eclampsia

High sensitivity C-reactive protein in pre-eclamptic women living with HIV at a tertiary hospital in Zambia: a preliminary study

Introduction

pre-eclampsia affects an estimated 8% of pregnant women and contributes to over 12% of global maternal deaths. High-sensitivity C-reactive protein (hs-CRP) is a potential marker of pre-eclampsia. However, little is known about hs-CRP levels in women with pre-eclampsia in Zambia. This study examined whether hs-CRP levels differ between women who develop pre-eclampsia compared with controls overall and in subgroups of women living with and without HIV.

Methods

a case-control study was conducted among 40 pregnant women who developed preeclampsia (cases) and 40 normotensive pregnant women (controls) living with (n=20) and without HIV (n=20) at women and newborn hospital from February to May 2022. Standard ELISA kits were used to determine hs-CRP levels. The conditional logistic regression model calculated the odds ratios for hs-CRP and other predictor variables with their 95% confidence intervals.

Results

the median hs-CRP levels were higher among the cases than controls (7.84mg/ml vs 6.13mg/ml, p<0.001). Similar hs-CRP levels were observed among pre-eclamptic women living with HIV on antiretroviral therapy (ART) compared to HIV-negative women (7.92mg/ml vs 7.17mg/ml, p=0.862). On the other hand, normotensive women living with HIV on ART had different hs-CRP levels than HIV-negative women (6.60mg/ml vs 3.96mg/ml, p<0.001). Multivariable conditional logistic regression showed that pregnant women with higher levels of hs-CRP (AOR=1.01, 95% CI=1.01, 1.01) were more likely to have pre-eclampsia after adjusting for significant predictors. Pre-eclampsia was less likely among women living with HIV on ART (AOR=0.26, 95% CI=0.07, 0.99), married (AOR=0.15, 95% CI=0.03, 0.71), and multiparous (AOR=0.16, 95% CI=0.03, 0.80).

Conclusion

high-sensitivity C-reactive protein levels were higher among the cases than controls. However, similar levels were observed in the subgroup of women living with HIV on ART. Participants with high hs-CRP levels had the highest odds of preeclampsia, suggesting that hs-CRP may be useful in predicting preeclampsia.

Platelet count in preeclampsia: a systematic review and meta-analysis

OBJECTIVE

Many studies have reported the association between platelets and preeclampsia. However, sample sizes were small, and their findings were inconsistent. We conducted a systematic review and meta-analysis to evaluate the association in pooled samples and in detail.

DATA SOURCES

A systematic literature search was performed using Medline, Embase, ScienceDirect, Web of Science, Cochrane Library, NICHD-DASH, LILACS, and Scopus from inception to April 22, 2022.

STUDY ELIGIBILITY CRITERIA

Observational studies comparing platelet count between women with preeclampsia and normotensive pregnant women were included.

METHODS

The mean differences with 95% confidence interval in platelet count were calculated. Heterogeneity was assessed using I2 statistics. Sensitivity and subgroup analyses were conducted. Statistical analysis was performed using RevMan 5.3 and ProMeta 3 software.

RESULTS

A total of 56 studies comprising 4892 preeclamptic and 9947 normotensive pregnant women were included. Meta-analysis showed that platelet count was significantly lower in women with preeclampsia than in normotensive controls (overall: mean difference, -32.83; 95% confidence interval, -40.13 to -25.52; P<.00001; I2=92%; mild preeclampsia: mean difference, -18.65; 95% confidence interval, -27.17 to -10.14; P<.00001; I2=84%; severe preeclampsia: mean difference, -42.61; 95% confidence interval, -57.53 to -27.68; P<.00001; I2=94%). Significantly lower platelet count was also observed in the second trimester (mean difference, -28.84; 95% confidence interval, -44.59 to -13.08; P=.0003; I2=93%), third trimester (mean difference, -40.67; 95% confidence interval, -52.14 to -29.20; P<.00001; I2=92%), and before the diagnosis of preeclampsia (mean difference, -18.81; 95% confidence interval, -29.98 to -7.64; P=.009; I2=87%), but not in the first trimester (mean difference, -15.14; 95% confidence interval, -37.71 to 7.43; P=.19; I2=71%). Overall, the pooled sensitivity and specificity of platelet count were 0.71 and 0.77, respectively. The area under the curve was 0.80.

CONCLUSION

This meta-analysis confirmed that platelet count was significantly lower in preeclamptic women, irrespective of severity and presence or absence of associated complications, even before the onset of preeclampsia and in the second trimester of pregnancy. Our findings suggest that platelet count may be a potential marker to identify and predict preeclampsia.

Maternal serum uric acid, creatinine and blood urea levels in the prediction of pre-eclampsia among pregnant women attending ANC and delivery services at Bahir Dar city public hospitals, northwest Ethiopia: A case-control study

Background

Pre-eclampsia (PE) is a metabolic disorder that adversely affects the lives of mother and their infants. Even though, several studies have been conducted on PE, no effective diagnostic and therapeutic agents were developed so far. Hence, this study was designed to evaluate serum uric acid, blood urea and creatinine levels in the prediction of PE.

Methods

A hospital-based case-control study was conducted among pregnant women. A simple random sampling technique was applied to select study participants. The socio-demographic and clinical data were collected using an interview-administered questionnaire. Serum samples were used to determine the maternal uric acid, urea and creatinine levels via an automated chemistry analyzer. Independent sample t-test, Pearson correlation test and receiver operating characteristic (ROC) curve analysis were performed to check the association and diagnostic accuracy of variables to PE.

Results

The mean ages (in years) of the case and control groups were 27.98 ± 5.64 and 27.33 ± 4.45, respectively. The mean serum uric acid and blood urea levels were significantly higher in pre-eclamptic women than in normotensive pregnant women (6.27 ± 0.20 vs 4.43 ± 0.15, and 8.50 ± 3.99 vs 5.67 ± 2.19), respectively but the serum creatinine level is non-significantly increased in cases as compared to controls (0.70 ± 0.05 vs 0.50 ± 0.01). The areas under the ROC curve of serum uric acid, creatinine and blood urea levels were 0.785, 0.735 and 0.764 (sensitivity: 69%, 60.7%, 67.9%; specificity: 73.8%, 75%, 71.4%) with the cutoff points of ≥5.25 mg/dL, ≥0.565 mg/dL and ≥6.5 mg/dL, respectively.

Conclusion

In this study, we observed a significantly higher concentration of serum uric acid and blood urea values in pre-eclampsia as compared with normotensive pregnant women. Therefore, this suggested that serum uric acid; blood urea and creatinine values can be associated with PE. Moreover, serum uric acid, blood urea and creatinine levels could be carefully utilized as a diagnostic marker for PE, but their inclusion in routine diagnostic test to PE requires large-scale multi-center prospective studies that corroborate our findings.

Angiogenic markers predict kidney injury and obstetric complications in women with preeclampsia and pregnancy-related acute kidney injury

Pregnancy-related acute kidney injury (PRAKI) particularly on top of preeclampsia (PE) represents a major cause of maternal and fetal morbidity and mortality. Reliable diagnostic tools are needed to further evaluate the diagnosis and prognosis of PRAKI. Our objective was to study the diagnostic and prognostic value of angiogenic markers (e.g., stromal cell-derived factor 1 (SDF-1), vascular endothelial growth factor (VEGF), alarmins as uric acid) in women with PE and PRAKI. This prospective study included three groups; PRAKI, PE patients, and healthy controls that were compared regarding serum levels of the studied markers correlated to renal, maternal, and fetal outcomes. SDF-1, VEGF, and uric acid levels were significantly different between the three included groups and predicted PRAKI diagnosis. Patients with hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome exhibited the highest titers of SDF-1 and VEGF. A positive correlation was found between SDF-1 and renal recovery. Conclusively, serum assays of SDF-1, VEGF, and uric acid may add a diagnostic value in PRAKI and PE.

The value of fetal Doppler indices as predictors of perinatal outcome in women with preeclampsia with severe features

Objective: To evaluate the diagnostic performance of Doppler sonography of umbilical artery (UA), fetal middle cerebral artery (MCA), ductus venosus (DV) & umbilical vein (UV) for prediction of adverse perinatal outcome.Material and Methods: A prospective cohort study conducted on 60 women diagnosed  with preeclampsia with severe features divided into two groups based on adverse perinatal outcome.Results: Statistically Significant differences were demonstrated UA PI (1.28 ± 0.23 vs. 0.96 ± 0.21, P <0.001), UA RI (0.78 ± 0.09 vs. 0.62 ± 0.09, P <0.001), MCA PI (1.27 ± 0.28 vs. 1.45±0.20, P 0.005), MCA RI (0.67 ± 0.10 vs. 0.76 ± 0.08, P<0.001), Cerebroplacental ratio (1.01 ± 0.36 vs. 1.57 ± 0.35, P <0.001), DV PVIV (0.67 ± 0.20 vs. 0.51 ± 0.14, P= 0.004), DV PSV (54.74 ± 17.11 vs. 42.15 ± 9.42, P= 0.004)  and abnormal DV a wave (23.8 vs. 0%, P = 0.004) in women with adverse and normal perinatal outcome respectively. UA PI and CPR had the highest specificity while UA RI had the highest sensitivity for detection of adverse perinatal outcome.Conclusion: CPR < 1 can be used to identify fetuses at risk of morbidity and mortality among such cases.

Maternal, fetal, and neonatal outcomes among different types of hypertensive disorders associating pregnancy needing intensive care management

Objective: To assess the relationship between maternal, fetal, and neonatal outcomes and different forms of hypertensive disorders associating pregnancy in women needed intensive care units (ICUs) admission.Methods: A prospective case control study was conducted on 1238 women admitted to hypertensive ICU at three university hospitals. They were classified into four groups. Group I included 472 women with severe preeclampsia (PE), Group II included 243 women with eclampsia (E), Group III included 396 women diagnosed with E associated with HELLP syndrome, and Group IV included 127 women diagnosed as HELLP syndrome. All women received magnesium sulfate to prevent and/or control convulsions and nifedipine to control their blood pressure. Primary outcome parameter was maternal mortality. Other outcomes included maternal morbidities, fetal, and neonatal outcomes.Results: There was a significant difference among the study groups regarding the need for blood transfusion (58.1%, 70%, 84.3%, and 42.5% respectively, p < .001), number of transferred units (2.4 ± 1, 2.9 ± 0.9, 3.4 ± 1.1, and 3.5 ± 0.8 respectively, p < .001), placental abruption (23.3%, 16.5%, 30.3%, and 19.7% respectively, p < .001), pulmonary edema (14.8%, 22.6%, 19.9%, and 34.6% respectively, p < .001), multiple complications (12.5%, 12.3%, 19.9%, and 26% respectively, p < .001), and maternal mortality (1.9%, 4.1%, 6.1%, and 5.5% respectively, p < .001). Regarding fetal and neonatal outcomes, there was a significant difference among the four groups regarding Apgar score at 1 and 5 min, neonatal birth weight, neonatal intensive care unit (NICU) admission, NICU admission days, intrauterine growth restriction, perinatal death, respiratory distress syndrome, intraventricular hemorrhage, sepsis, and the need for mechanical ventilation (p < .001). Higher rate of vaginal delivery was reported in women with HELLP (40.9%) and severe PE (39.8%) and higher rates of performing cesarean section (CS) in women with eclampsia (77.8%). Maternal mortality is significantly related to delivery with CS, younger maternal age with lower parity, and the presence of placental abruption or pulmonary edema. For Groups III and IV, which included HELLP cases, there are significant differences between both groups as regards HELLP classes according to Mississippi classification, also significant differences were seen between both groups as regards, maternal mortality, abruptio placenta, pulmonary edema, multiple organ damage, NICU admission, perinatal deaths, and need for mechanical ventilation.Conclusion: Both maternal mortality and morbidity (placental abruption and need for blood transfusion) are significantly higher in women with HELLP syndrome worsens to become class 1 regardless of whether eclampsia is present or not.Synopsis: Maternal mortality and unfavorable outcome are significantly higher in women with HELLP syndrome whether it was associated with eclampsia or not.

Study on Hematological and Biochemical Characters of Cloned Duroc Pigs and Their Progeny

Simple Summary

Cloning is the most promising technique for passing the excellent phenotypes of the best individuals in the population. Here we studied the effects of cloning on Duroc pig, which is the most popular sire used in pig production due to its good growth and meat quality. Understanding the changes of cloned Duroc pigs and their progenies is of great importance for animal breeding and public acceptance. The results of this study suggested that there were no difference in blood parameters between the cloned Duroc and the conventionally bred Duroc and their progenies.

Abstract

To increase public understanding in cloned animals produced by somatic cell nuclear transfer technology, our previous study investigated the carcass trait and meat quality of the clones (paper accepted), and this study we further evaluate differences by investigating the blood parameters in cloned pigs and their progeny. We collected blood samples from the clones and conventionally bred non-clones and their progeny, and investigated their hematological and blood biochemical characters. Our results supported the hypothesis that there was no significant difference between clones and non-clones, or their progeny. Taken together, the data demonstrated that the clones or their progeny were similar with their controls in terms of blood parameters, although there were still other kinds of disorders, such as abnormal DNA methylation or histone modifications that needs further investigation. The data in this study agreed that cloning technique could be used to preserve and enlarge the genetics of the superior boars in pig breeding industry, especially in facing of the deadly threat of African Swine fever happened in China.

Inflammation throughout pregnancy and fetal growth restriction in rural Nepal

Maternal systemic inflammation during pregnancy may restrict embryo−fetal growth, but the extent of this effect remains poorly established in undernourished populations. In a cohort of 653 maternal−newborn dyads participating in a multi-armed, micronutrient supplementation trial in southern Nepal, we investigated associations between maternal inflammation, assessed by serum α₁-acid glycoprotein and C-reactive protein, in the first and third trimesters of pregnancy, and newborn weight, length and head and chest circumferences. Median (IQR) maternal concentrations in α₁-acid glycoprotein and C-reactive protein in the first and third trimesters were 0.65 (0.53–0.76) and 0.40 (0.33–0.50) g/l, and 0.56 (0.25–1.54) and 1.07 (0.43–2.32) mg/l, respectively. α₁-acid glycoprotein was inversely associated with birth size: weight, length, head circumference and chest circumference were lower by 116 g (P = 2.3 × 10⁻⁶), and 0.45 (P = 3.1 × 10⁻⁵), 0.18 (P = 0.0191) and 0.48 (P = 1.7 × 10⁻⁷) cm, respectively, per 50% increase in α₁-acid glycoprotein averaged across both trimesters. Adjustment for maternal age, parity, gestational age, nutritional and socio-economic status and daily micronutrient supplementation failed to alter any association. Serum C-reactive protein concentration was largely unassociated with newborn size. In rural Nepal, birth size was inversely associated with low-grade, chronic inflammation during pregnancy as indicated by serum α₁-acid glycoprotein.

Antepartum and postpartum uterine artery impedance in women with pre-eclampsia: a case control study

This is a cohort study which included 100 cases with pre-eclampsia (PE) and 100 controls, done to compare the antepartum and postpartum uterine artery (UtA) Doppler velocimetry between them. UtA PI and RI were measured before and within 48-72 h after delivery. There was a highly significant difference between the cases and controls, regarding the UtA RI (0.70 ± 0.10 and 0.72 ± 0.10, versus 0.59 ± 0.12 and 0.60 ± 0.11) and PI (1.41 ± 0.89 and 1.45 ± 0.90 versus 0.85 ± 0.30 and 0.90 ± 0.34) measured at the antepartum and postpartum periods, respectively. Age and gestational age were significantly related to the postpartum and changes in the UtA PI. The gestational age was also correlated to UtA RI changes. Both the antepartum and postpartum mean blood pressure were correlated with postpartum UtA RI and PI and PI changes after delivery. We concluded that uterine artery Doppler indices changes are more common in women with PE, than in normotensive women with significant correlations with age and gestational age. Impact statement What is already known on this subject? After delivery, the haemodynamic changes that occurred with pregnancy reverse. Both the heart rate and the cardiac output decreased to reach the non-pregnant state. Impedance to flow in the uterine artery rises as the nutritional needs are decreased abruptly. What do the results of this study add? Both the antepartum and postpartum measurement of uterine artery Doppler indices is significantly higher in women with PE when compared to control women. The persistent uterine artery impedance is a result of inadequate trophoblastic invasion within the basal part of the decidua basalis and myometrium or persistently increased maternal vascular tone. What are the implications of these findings for clinical practice and/or further research? The uterine artery Doppler parameters return to the non-pregnant values in normal pregnancies. Knowing such information may help in understanding the haemodynamics of the uterine vasculature during puerperium in hypertensive patients.

MMP-9 and TIMP-1 in placenta of hypertensive disorder complicating pregnancy

Expression and characteristics of matrix metalloproteinase-9 (MMP-9) and TIMP metallopeptidase inhibitor-1 (TIMP-1) in the placenta of pregnancy induced hypertension (PIH) were detected in Uygur to analyze its correlation with PIH, and to provide a theoretical basis for clinical work. Ninety cases of placental tissue patients who were hospitalized in the Department of Obstetrics of People's Hospital of Xinjiang Uygur from December 2014 to September 2016 were collected, including 30 cases of severe preeclampsia, 30 cases of mild preeclampsia, and 30 cases of normal group. The distribution of MMP-9 and TIMP-1 in placenta was mainly in the cytoplasm of trophoblast cells, vascular endothelial cells and villous mesenchymal cells. The distribution of MMP-9 positive particles in the placenta tissue of the severe group was significantly reduced. The difference of MMP-9 in the three groups was statistically significant. Severe group was statistically significantly different from normal and mild group. With the aggravation of PIH, positive expression of MMP-9 was gradually decreased. TIMP-1 was expressed in each group, and difference was not statistically significant. Positive expression ratio of MMP-9/TIMP-1 in severe group was lower than that in normal pregnancy and mild group, and positive expression ratio of the two groups became smaller as the condition worsened. Positive expression of MMP-9 in placental tissue of patients with PIH decreased significantly with the severity of PIH. TIMP-1 in placental tissue of PIH patients did not change much in each group, and had no significant correlation with PIH.

Altered Maternal Serum Matrix Metalloproteinases MMP-2, MMP-3, MMP-9, and MMP-13 in Severe Early- and Late-Onset Preeclampsia

OBJECTIVE

The aim of this study was to determine whether maternal serum matrix metalloproteinases 2, 3, 9, and 13 levels differ in early- and late-onset preeclampsia and uncomplicated pregnancies.

PATIENTS AND METHODS

The study was carried out in 125 pregnant women (29 with early-onset preeclampsia; 31 preeclamptic patients with late-onset preeclampsia; and 65 healthy pregnant controls). Levels of MMP-2, MMP-3, MMP-9, and MMP-13 were measured in the maternal serum using an enzyme-linked immunosorbent assay.

RESULTS

Maternal serum MMP-2 levels in both the groups of preeclamptic women were significantly higher than those in the controls. Levels of MMP-3 were significantly higher in preeclamptic patients with early-onset disease; however, the MMP-3 levels in patients with late-onset preeclampsia were similar to those observed in the control subjects. MMP-9 levels were lower whereas the levels of MMP-13 were higher in both preeclamptic groups of pregnant women than in the healthy controls, but these differences were statistically insignificant.

CONCLUSIONS

One important finding of the present study was that MMP-3 appears to be involved solely in early-onset preeclampsia, but not in late-onset preeclampsia. Higher levels of MMP-2 and MMP-13 and lower levels of MMP-9 seem to be related to both early- and late-onset severe preeclampsia.