1
|
Mao B, Chen L. Pregnancy outcomes of foetal reduction from twin to singleton gestation compared to ongoing twin gestations: a systematic review and meta-analysis. J OBSTET GYNAECOL 2024; 44:2371955. [PMID: 38973678 DOI: 10.1080/01443615.2024.2371955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/13/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Foetal reduction, which involves selectively terminating one or more foetuses in a multiple gestation pregnancy, has become more common. This systematic review and meta-analysis aims to assess and compare pregnancy outcomes of foetal reduction from twin to singleton gestation to ongoing twin gestations. METHODS A comprehensive search of electronic databases (MEDLINE, EMbase, Cochrane Library, CINAHL and PsycINFO) was done for studies published until 15 April 2023. The outcomes analysed included gestational diabetes mellitus (DM), hypertension, caesarean delivery, foetal loss, perinatal death, preterm birth (PTB), intrauterine growth restriction (IUGR), preterm prelabour rupture of membranes (PPROM) and birth weight. RESULTS A total of 13 studies comprising 1241 cases of twin to singleton foetal reduction gestation were compared to 20,693 ongoing twin gestations. Our findings indicate that foetal reduction was associated with a significantly lower risk of developing maternal gestational DM (odds ratio [OR] = 0.40, 95% confidence interval [CI] 0.27-0.59) and hypertension (OR = 0.36, 95% CI 0.23-0.57) compared to the control group. Incidence rate of caesarean delivery (OR = 0.65, 95% CI 0.53-0.81) after foetal reduction was significantly lower compared to ongoing twin gestations. There was a 63% lower chance of PTB before 37 weeks of pregnancy. However, there was no significant association between foetal reduction and outcomes such as foetal loss, perinatal death, IUGR and PPROM. CONCLUSIONS Our findings suggest that foetal twin to singleton reduction entails potential benefits as compared to ongoing twin gestations. Further well planned studies are needed to explore underlying mechanisms to understanding of the outcomes associated with foetal reduction procedures and inform clinical decision-making for pregnant individuals and healthcare providers alike.
Collapse
Affiliation(s)
- Bijun Mao
- Reproductive Medicine Centre, Huzhou Maternity & Child Health Care Hospital, Huzhou City, China
| | - Li Chen
- Reproductive Medicine Centre, Huzhou Maternity & Child Health Care Hospital, Huzhou City, China
| |
Collapse
|
2
|
Wang T, Jiang R, Yao Y, Xu T, Li N. Anti-hypertensive therapy for preeclampsia: a network meta-analysis and systematic review. Hypertens Pregnancy 2024; 43:2329068. [PMID: 38488570 DOI: 10.1080/10641955.2024.2329068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Preeclampsia (PE) is a pregnancy disorder that represents a major cause of maternal and perinatal morbidity and mortality. METHODS This network meta-analysis was registered with PROSPERO. We searched the PubMed, ClinicalTrials.gov. and Embase databases for studies published from inception to the 31st of March 2023. RevMan5.3 software provided by the Cochrane Collaboration was used for direct meta-analysis (DMA) statistical analysis. Funnel maps, network meta-analysis (NMA), the surface under the cumulative ranking curve (SUCRA) to rank the different interventions and publication bias were generated by STATA 17.0 software. RESULTS We included eight randomized controlled trials (RCTs) involving a total of 1192 women with PE; two studies were of high quality and six were of moderate quality. Eight interventions were addressed in the NMA. In the DMA, we found that blood pressure in the Ketanserin group were significantly higher than those in the Nicardipine group. NMA showed that blood pressure in the Dihydralazine group was significantly higher than that in the Methyldopa, Labetalol, Nicardipine and Diltiazem groups. And the blood pressure in the Labetalol group was significantly lower than that in the Nicardipine group. SUCRA values showed that Diltiazem was more effective in lowering blood pressure than other drugs looked at in this study. CONCLUSION According to the eight RCTs included in this study, Diltiazem was the most effective in reducing blood pressure in PE patients; Labetalol and Nicardipine also had good effects. Diltiazem is preferred for the treatment of patients with severe PE and high blood pressure.
Collapse
Affiliation(s)
- Ting Wang
- Department of Obstetrics and Gynecology, Women's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Ruoan Jiang
- Department of Obstetrics and Gynecology, Women's Hospital Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
- Traditional Chinese Medicine for Reproductive Health Key Laboratory of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yingsha Yao
- Department of Obstetrics and Gynecology, Women's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Xu
- Department of Obstetrics and Gynecology, Women's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Na Li
- Department of Obstetrics and Gynecology, Women's Hospital Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
3
|
Nema J, Sundrani D, Randhir K, Deshpande J, Lalwani S, Wagh G, Gupte S, Joshi S. Maternal angiogenic factor disruptions prior to clinical diagnosis of preeclampsia: insights from the REVAMP study. Hypertens Res 2024:10.1038/s41440-024-01775-8. [PMID: 38965425 DOI: 10.1038/s41440-024-01775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/12/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024]
Abstract
Preeclampsia is characterized by impaired angiogenesis and assessment of angiogenic factors can play a crucial role in the early diagnosis of preeclampsia. The current study reports the levels of angiogenic factors longitudinally from early pregnancy in women with preeclampsia and in the subtypes of preeclampsia, to identify their role in early prediction of preeclampsia. A total of 1154 women with singleton pregnancies were recruited in early pregnancy from 2 hospitals. Blood samples were collected, plasma samples were separated and stored at four time points across gestation: V1 = 11-14 weeks, V2 = 18-22 weeks, V3 = 26-28 weeks, and V4 = at delivery. The current study includes a total of 108 women developed preeclampsia (PE), and 216 matched controls. Angiogenic factors were estimated using commercially available ELISA kits. Receiver operating characteristic (ROC) curves were used to evaluate the potential diagnostic value in the prediction of PE. Lower levels of VEGF, PlGF, and higher levels of sEng and sEng/PlGF ratio (p < 0.05 for all) predate clinical diagnosis in women with preeclampsia. sEng levels and sEng/PlGF ratio showed significant correlation with odds of preeclampsia at all the timepoints. This study identifies a cut off of 33.5 for sFlt-1/PlGF and 25.9 for sEng/PlGF for prediction of early onset preeclampsia. This study reports various angiogenic factors serially across gestation in a general population to identify women at risk of developing preeclampsia and its subtypes. The study also reports a potential biomarker and a pragmatic window for estimation of angiogenic markers to identify women at risk.
Collapse
Affiliation(s)
- Juhi Nema
- Mother and Child Health, ICMR- Collaborating Centre of Excellence (ICMR-CCoE), Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Deepali Sundrani
- Mother and Child Health, ICMR- Collaborating Centre of Excellence (ICMR-CCoE), Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Karuna Randhir
- Mother and Child Health, ICMR- Collaborating Centre of Excellence (ICMR-CCoE), Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Juilee Deshpande
- Mother and Child Health, ICMR- Collaborating Centre of Excellence (ICMR-CCoE), Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - Girija Wagh
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - Sanjay Gupte
- Gupte Hospital and Research Centre, Pune, 411004, India
| | - Sadhana Joshi
- Mother and Child Health, ICMR- Collaborating Centre of Excellence (ICMR-CCoE), Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India.
| |
Collapse
|
4
|
Yuan F, Li Z, Chen S, He Y, Chen Q, Lv J, Zhao M. Risk prediction for preeclampsia in CKD patients: development of a model in a retrospective cohort. J Nephrol 2024:10.1007/s40620-024-02010-w. [PMID: 38965198 DOI: 10.1007/s40620-024-02010-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 06/13/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) may affect women of childbearing age and may lead to substantial maternal and foetal morbidity and mortality in pregnancy. There is a lack of prediction models for preeclampsia and adverse pregnancy outcomes in pregnant women with CKD. This study aimed to create a prediction nomogram for these issues. METHODS This retrospective cohort study included clinical data from 627 women with CKD and their 627 pregnancies at Peking University First Hospital between January 1, 2009, and December 31, 2022. Multivariate logistic regression analysis was conducted to identify independent prognostic factors and develop a nomogram for predicting the occurrence of preeclampsia. The identified risk factors were utilised to construct the nomogram, which was subsequently internally validated using receiver operating characteristic (ROC) analysis and calibration curve assessment. RESULTS According to our multivariate analysis, age, blood urea nitrogen (BUN), serum creatinine (Scr), mean arterial pressure (MAP), 24-h proteinuria, and CKD stage were identified as predictors of preeclampsia. Additionally, Scr, MAP, BUN, and 24-h proteinuria were found to be predictors of adverse pregnancy outcomes. The nomogram for predicting preeclampsia had an area under the ROC curve of 0.910, while the nomogram for predicting adverse pregnancy outcomes had an area under the ROC curve of 0.906. Both models demonstrated excellent discriminatory ability. CONCLUSIONS A nomogram based on 24-h proteinuria, serum creatinine, serum urea and age, and MAP allows predicting the occurrence of preeclampsia and other adverse pregnancy-related outcomes in CKD patients.
Collapse
Affiliation(s)
- Fangchen Yuan
- Department of Obstetrics and Gynecology, First Hospital, Peking University, Beijing, 100034, People's Republic of China
| | - Zheng Li
- Department of Obstetrics and Gynecology, First Hospital, Peking University, Beijing, 100034, People's Republic of China
| | - Shi Chen
- Department of Obstetrics and Gynecology, First Hospital, Peking University, Beijing, 100034, People's Republic of China
| | - Yingdong He
- Department of Obstetrics and Gynecology, First Hospital, Peking University, Beijing, 100034, People's Republic of China.
| | - Qian Chen
- Department of Obstetrics and Gynecology, First Hospital, Peking University, Beijing, 100034, People's Republic of China
| | - Jicheng Lv
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, People's Republic of China
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, People's Republic of China
| |
Collapse
|
5
|
Cuenca-Gómez D, De Paco Matallana C, Rolle V, Mendoza M, Valiño N, Revello R, Adiego B, Casanova MC, Molina FS, Delgado JL, Wright A, Figueras F, Nicolaides KH, Santacruz B, Gil MM. Comparison of different methods of first-trimester screening for preterm pre-eclampsia: cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:57-64. [PMID: 38411276 DOI: 10.1002/uog.27622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To compare the predictive performance of three different mathematical models for first-trimester screening of pre-eclampsia (PE), which combine maternal risk factors with mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF), and two risk-scoring systems. METHODS This was a prospective cohort study performed in eight fetal medicine units in five different regions of Spain between September 2017 and December 2019. All pregnant women with singleton pregnancy and a non-malformed live fetus attending their routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation were invited to participate in the study. Maternal characteristics and medical history were recorded and measurements of MAP, UtA-PI, serum PlGF and pregnancy-associated plasma protein-A (PAPP-A) were converted into multiples of the median (MoM). Risks for term PE, preterm PE (< 37 weeks' gestation) and early PE (< 34 weeks' gestation) were calculated according to the FMF competing-risks model, the Crovetto et al. logistic regression model and the Serra et al. Gaussian model. PE classification was also performed based on the recommendations of the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG). We estimated detection rates (DR) with their 95% CIs at a fixed 10% screen-positive rate (SPR), as well as the area under the receiver-operating-characteristics curve (AUC) for preterm PE, early PE and all PE for the three mathematical models. For the scoring systems, we calculated DR and SPR. Risk calibration was also assessed. RESULTS The study population comprised 10 110 singleton pregnancies, including 32 (0.3%) that developed early PE, 72 (0.7%) that developed preterm PE and 230 (2.3%) with any PE. At a fixed 10% SPR, the FMF, Crovetto et al. and Serra et al. models detected 82.7% (95% CI, 69.6-95.8%), 73.8% (95% CI, 58.7-88.9%) and 79.8% (95% CI, 66.1-93.5%) of early PE; 72.7% (95% CI, 62.9-82.6%), 69.2% (95% CI, 58.8-79.6%) and 74.1% (95% CI, 64.2-83.9%) of preterm PE; and 55.1% (95% CI, 48.8-61.4%), 47.1% (95% CI, 40.6-53.5%) and 53.9% (95% CI, 47.4-60.4%) of all PE, respectively. The best correlation between predicted and observed cases was achieved by the FMF model, with an AUC of 0.911 (95% CI, 0.879-0.943), a slope of 0.983 (95% CI, 0.846-1.120) and an intercept of 0.154 (95% CI, -0.091 to 0.397). The NICE criteria identified 46.7% (95% CI, 35.3-58.0%) of preterm PE at 11% SPR and ACOG criteria identified 65.9% (95% CI, 55.4-76.4%) of preterm PE at 33.8% SPR. CONCLUSIONS The best performance of screening for preterm PE is achieved by mathematical models that combine maternal factors with MAP, UtA-PI and PlGF, as compared to risk-scoring systems such as those of NICE and ACOG. While all three algorithms show similar results in terms of overall prediction, the FMF model showed the best performance at an individual level. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- D Cuenca-Gómez
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - C De Paco Matallana
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - V Rolle
- Biostatistics and Clinical Research Unit, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - M Mendoza
- Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebrón, Barcelona, Catalonia, Spain
| | - N Valiño
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario A Coruña, A Coruña, Galicia, Spain
| | - R Revello
- Department of Obstetrics and Gynecology, Hospital Universitario Quirón, Pozuelo de Alarcón, Madrid, Spain
| | - B Adiego
- Department of Obstetrics and Gynecology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain
| | - M C Casanova
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - F S Molina
- Department of Obstetrics and Gynecology, Hospital Universitario San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - J L Delgado
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - F Figueras
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital San Joan de Deu, Barcelona, Spain
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - B Santacruz
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - M M Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| |
Collapse
|
6
|
Tiruneh SA, Vu TTT, Rolnik DL, Teede HJ, Enticott J. Machine Learning Algorithms Versus Classical Regression Models in Pre-Eclampsia Prediction: A Systematic Review. Curr Hypertens Rep 2024; 26:309-323. [PMID: 38806766 PMCID: PMC11199280 DOI: 10.1007/s11906-024-01297-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Machine learning (ML) approaches are an emerging alternative for healthcare risk prediction. We aimed to synthesise the literature on ML and classical regression studies exploring potential prognostic factors and to compare prediction performance for pre-eclampsia. RECENT FINDINGS From 9382 studies retrieved, 82 were included. Sixty-six publications exclusively reported eighty-four classical regression models to predict variable timing of onset of pre-eclampsia. Another six publications reported purely ML algorithms, whilst another 10 publications reported ML algorithms and classical regression models in the same sample with 8 of 10 findings that ML algorithms outperformed classical regression models. The most frequent prognostic factors were age, pre-pregnancy body mass index, chronic medical conditions, parity, prior history of pre-eclampsia, mean arterial pressure, uterine artery pulsatility index, placental growth factor, and pregnancy-associated plasma protein A. Top performing ML algorithms were random forest (area under the curve (AUC) = 0.94, 95% confidence interval (CI) 0.91-0.96) and extreme gradient boosting (AUC = 0.92, 95% CI 0.90-0.94). The competing risk model had similar performance (AUC = 0.92, 95% CI 0.91-0.92) compared with a neural network. Calibration performance was not reported in the majority of publications. ML algorithms had better performance compared to classical regression models in pre-eclampsia prediction. Random forest and boosting-type algorithms had the best prediction performance. Further research should focus on comparing ML algorithms to classical regression models using the same samples and evaluation metrics to gain insight into their performance. External validation of ML algorithms is warranted to gain insights into their generalisability.
Collapse
Affiliation(s)
- Sofonyas Abebaw Tiruneh
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Tra Thuan Thanh Vu
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Daniel Lorber Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| |
Collapse
|
7
|
Sun L, Shi M, Wang J, Han X, Wei J, Huang Z, Yang X, Ding Y, Zhang P, He A, Liu M, Yan R, Yang X, Li R, Wang G. Overexpressed Trophoblast Glycoprotein Contributes to Preeclampsia Development by Inducing Abnormal Trophoblast Migration and Invasion Toward the Uterine Spiral Artery. Hypertension 2024; 81:1524-1536. [PMID: 38716674 DOI: 10.1161/hypertensionaha.124.22923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/22/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Preeclampsia is a significant pregnancy disorder with an unknown cause, mainly attributed to impaired spiral arterial remodeling. METHODS Using RNA sequencing, we identified key genes in placental tissues from healthy individuals and preeclampsia patients. Placenta and plasma samples from pregnant women were collected to detect the expression of TPBG (trophoblast glycoprotein). Pregnant rats were injected with TPBG-carrying adenovirus to detect preeclamptic features. HTR-8/SVneo cells transfected with a TPBG overexpression lentiviral vector were used in cell function experiments. The downstream molecular mechanisms of TPBG were explored using RNA sequencing and single-cell RNA sequencing data. TPBG expression was knocked down in the lipopolysaccharide-induced preeclampsia-like rat model to rescue the preeclampsia features. We also assessed TPBG's potential as an early preeclampsia predictor using clinical plasma samples. RESULTS TPBG emerged as a crucial differentially expressed gene, expressed specifically in syncytiotrophoblasts and extravillous trophoblasts. Subsequently, we established a rat model with preeclampsia-like phenotypes by intravenously injecting TPBG-expressing adenoviruses, observing impaired spiral arterial remodeling, thus indicating a causal correlation between TPBG overexpression and preeclampsia. Studies with HTR-8/SVneo cells, chorionic villous explants, and transwell assays showed TPBG overexpression disrupts trophoblast/extravillous trophoblast migration/invasion and chemotaxis. Notably, TPBG knockdown alleviated the lipopolysaccharide-induced preeclampsia-like rat model. We enhanced preeclampsia risk prediction in early gestation by combining TPBG expression with established clinical predictors. CONCLUSIONS These findings are the first to show that TPBG overexpression contributes to preeclampsia development by affecting uterine spiral artery remodeling. We propose TPBG levels in maternal blood as a predictor of preeclampsia risk. The proposed mechanism by which TPBG overexpression contributes to the occurrence of preeclampsia via its disruptive effect on trophoblast and extravillous trophoblast migration/invasion on uterine spiral artery remodeling, thereby increasing the risk of preeclampsia.
Collapse
Affiliation(s)
- Lu Sun
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Meiting Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Jian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Xiaoxue Han
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Jiachun Wei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Zhengrui Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Xiaofeng Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, School of Medicine (P.Z., X.Y., G.W.), Jinan University, Guangzhou, China
| | - Yuzhen Ding
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Ping Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, School of Medicine (P.Z., X.Y., G.W.), Jinan University, Guangzhou, China
| | - Andong He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Mengyuan Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Ruiling Yan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Xuesong Yang
- Key Laboratory for Regenerative Medicine of the Ministry of Education (X.Y., G.W.), Jinan University, Guangzhou, China
- Clinical Research Center, Clifford Hospital, Guangzhou, China (X.Y.)
| | - Ruiman Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University (L.S., M.S., J.W., X.H., J.W., Z.H., X.Y., Y.D., P.Z., A.H., M.L., R.Y., R.L.), Jinan University, Guangzhou, China
| | - Guang Wang
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, School of Medicine (P.Z., X.Y., G.W.), Jinan University, Guangzhou, China
- Key Laboratory for Regenerative Medicine of the Ministry of Education (X.Y., G.W.), Jinan University, Guangzhou, China
- Guangdong-Hong Kong Metabolism & Reproduction Joint Laboratory, Guangdong Second Provincial General Hospital, School of Medicine (G.W.), Jinan University, Guangzhou, China
| |
Collapse
|
8
|
Akbar MIA, Azis MA, Riu DS, Wawengkang E, Ernawati E, Bachnas MA, Sulistyowati S, Dachlan EG, Mose JC, Dekker G. INOVASIA Study: A Multicenter Randomized Clinical Trial of Pravastatin to Prevent Preeclampsia in High-Risk Patients. Am J Perinatol 2024; 41:1203-1211. [PMID: 35292944 DOI: 10.1055/a-1798-1925] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Our objective was to determine if treatment with pravastatin prevents preeclampsia in pregnant patients at risk of preeclampsia. MATERIALS AND METHODS The study was performed in four major tertiary hospitals in Surabaya, Bandung, and Makassar between 2017 and 2021. Pregnant women at high risk of developing preeclampsia were recruited and randomized into an intervention group and control group. The control group received low-dose aspirin (80 mg) and calcium (1 g) daily, while the intervention group received additional pravastatin (20 mg twice daily) starting from 14 to 20 weeks' gestation until delivery. The pregnancy was followed until delivery, and the clinical data were collected. The primary outcome was the occurrence of preeclampsia. RESULT A total of 173 people participated in this study, including 86 in the control group and 87 in the pravastatin group. The pravastatin group had a significantly lower rate of preterm preeclampsia (13.8 vs. 26.7%; p = 0.034; odds ratio [OR] = 0.034, 95% confidence interval [CI] = 0.202-0.905) and preterm birth (16.1 vs. 36%; p = 0.003; OR = 0.340, 95% CI = 0.165-0.7), mostly indicated preterm birth. Preeclampsia occurred later in the pravastatin group than in the control group (36.39 + 2.32 vs. 34.89 + 3.38 weeks, p = 0.048). Overall, the pravastatin group showed better perinatal outcomes. Neonates with low Apgar scores (<7) at 1 minute (5.7 vs. 25.6%, p = 0.000) and 5 minutes (2.3 vs. 25.6%, p = 0.028) were significantly less common in the pravastatin group. Additionally, the rate of low birthweight babies (<2,500 g) was lower in the pravastatin group (27.6 vs. 40.7%; p = 0.069). CONCLUSION Pravastatin (20 mg bid) significantly reduces the risk of preterm preeclampsia and preterm birth in women at a high risk of developing preeclampsia. KEY POINTS · This is an open-label multicenter RCT to evaluate pravastatin effect to prevent preeclampsia.. · Pravastatin significantly reduces the risk of preterm preeclampsia (PE) and preterm birth in high risk PE women.. · Pravastatin had a beneficial effect on perinatal outcomes, including Apgar scores and birth weight..
Collapse
Affiliation(s)
- Muhammad Ilham Aldika Akbar
- Faculty of Medicine Universitas Airlangga, Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Alamsyah Azis
- Faculty of Medicine Universitas Padjajaran, Department Obstetrics and Gynecology, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Deviana Soraya Riu
- Faculty of Medicine Universitas Hasanudin, Department Obstetrics and Gynecology, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
| | - Ellen Wawengkang
- Faculty of Medicine Universitas Hasanudin, Department Obstetrics and Gynecology, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
| | - Ernawati Ernawati
- Faculty of Medicine Universitas Airlangga, Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Adrianes Bachnas
- Faculty of Medicine Universitas Sebelas Maret, Department Obstetrics and Gynecology, Dr. Moewardi General Hospital, Surakarta, Indonesia
| | - Sri Sulistyowati
- Faculty of Medicine Universitas Sebelas Maret, Department Obstetrics and Gynecology, Dr. Moewardi General Hospital, Surakarta, Indonesia
| | - Erry Gumilar Dachlan
- Faculty of Medicine Universitas Airlangga, Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Johanes Cornelius Mose
- Faculty of Medicine Universitas Padjajaran, Department Obstetrics and Gynecology, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Gus Dekker
- Faculty of Medicine Universitas Airlangga, Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
- Department Obstetrics and Gynecology, Lyell McEwin Hospital, The University of Adelaide, Adelaide, South Australia
| |
Collapse
|
9
|
Guerby P, Audibert F, Johnson JA, Okun N, Giguère Y, Forest JC, Chaillet N, Mâsse B, Wright D, Ghesquiere L, Bujold E. Prospective Validation of First-Trimester Screening for Preterm Preeclampsia in Nulliparous Women (PREDICTION Study). Hypertension 2024; 81:1574-1582. [PMID: 38708601 DOI: 10.1161/hypertensionaha.123.22584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/05/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Fetal Medicine Foundation (FMF) studies suggest that preterm preeclampsia can be predicted in the first trimester by combining biophysical, biochemical, and ultrasound markers and prevented using aspirin. We aimed to evaluate the FMF preterm preeclampsia screening test in nulliparous women. METHODS We conducted a prospective multicenter cohort study of nulliparous women recruited at 11 to 14 weeks. Maternal characteristics, mean arterial blood pressure, PAPP-A (pregnancy-associated plasma protein A), PlGF (placental growth factor) in maternal blood, and uterine artery pulsatility index were collected at recruitment. The risk of preterm preeclampsia was calculated by a third party blinded to pregnancy outcomes. Receiver operating characteristic curves were used to estimate the detection rate (sensitivity) and the false-positive rate (1-specificity) for preterm (<37 weeks) and for early-onset (<34 weeks) preeclampsia according to the FMF screening test and according to the American College of Obstetricians and Gynecologists criteria. RESULTS We recruited 7554 participants including 7325 (97%) who remained eligible after 20 weeks of which 65 (0.9%) developed preterm preeclampsia, and 22 (0.3%) developed early-onset preeclampsia. Using the FMF algorithm (cutoff of ≥1 in 110 for preterm preeclampsia), the detection rate was 63.1% for preterm preeclampsia and 77.3% for early-onset preeclampsia at a false-positive rate of 15.8%. Using the American College of Obstetricians and Gynecologists criteria, the equivalent detection rates would have been 61.5% and 59.1%, respectively, for a false-positive rate of 34.3%. CONCLUSIONS The first-trimester FMF preeclampsia screening test predicts two-thirds of preterm preeclampsia and three-quarters of early-onset preeclampsia in nulliparous women, with a false-positive rate of ≈16%. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02189148.
Collapse
Affiliation(s)
- Paul Guerby
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
- Department of Gynecology and Obstetrics, Infinity CNRS, Inserm UMR 1291, CHU Toulouse, France (P.G.)
| | - Francois Audibert
- Department of Obstetrics and Gynecology, CHU Ste-Justine Research Center, Université de Montréal, Canada (F.A.)
| | - Jo-Ann Johnson
- Department of Obstetrics and Gynaecology, University of Calgary, AB, Canada (J.-A.J.)
| | - Nanette Okun
- Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada (N.O.)
| | - Yves Giguère
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology (Y.G., J.-C.F.), Université Laval, Canada
| | - Jean-Claude Forest
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology (Y.G., J.-C.F.), Université Laval, Canada
| | - Nils Chaillet
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
| | - Benoit Mâsse
- École de Santé Publique de l'Université de Montréal, QC, Canada (B.M.)
| | - David Wright
- École de Santé Publique de l'Université de Montréal, QC, Canada (B.M.)
- Institute of Health Research, University of Exeter, United Kingdom (D.W.)
| | - Louise Ghesquiere
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
- Department of Obstetrics, Université de Lille, CHU de Lille, France (L.G.)
| | - Emmanuel Bujold
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
- Department of Gynecology, Obstetrics and Reproduction (E.B.), Université Laval, Canada
| |
Collapse
|
10
|
Queirós A, Gomes L, Pereira I, Charepe N, Plancha M, Rodrigues S, Cohen Á, Alves M, Papoila AL, Simões T. First-trimester serum biomarkers in twin pregnancies and adverse obstetric outcomes-a single center cohort study. Arch Gynecol Obstet 2024; 310:315-325. [PMID: 38734998 PMCID: PMC11169060 DOI: 10.1007/s00404-024-07547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE This study aimed to determine the association of first-trimester maternal serum biomarkers with preterm birth (PTB), fetal growth restriction (FGR) and hypertensive disorders of pregnancy (HDP) in twin pregnancies. METHODS This is a retrospective cohort study of twin pregnancies followed at Maternidade Dr. Alfredo da Costa, Lisbon, Portugal, between January 2010 and December 2022. We included women who completed first-trimester screening in our unit and had ongoing pregnancies with two live fetuses, and delivered after 24 weeks. Maternal characteristics, pregnancy-associated plasma protein-A (PAPP-A) and β-human chorionic gonadotropin (β-hCG) levels were analyzed for different outcomes: small for gestational age (SGA), gestational hypertension (GH), early and late-onset pre-eclampsia (PE), as well as the composite outcome of PTB associated with FGR and/or HDP. Univariable, multivariable logistic regression analyses and receiver-operating characteristic curve were used. RESULTS 466 twin pregnancies met the inclusion criteria. Overall, 185 (39.7%) pregnancies were affected by SGA < 5th percentile and/or HDP. PAPP-A demonstrated a linear association with gestational age at birth and mean birth weight. PAPP-A proved to be an independent risk factor for SGA and PTB (< 34 and < 36 weeks) related to FGR and/or HDP. None of the women with PAPP-A MoM > 90th percentile developed early-onset PE or PTB < 34 weeks. CONCLUSION A high serum PAPP-A (> 90th percentile) ruled out early-onset PE and PTB < 34 weeks. Unless other major risk factors for hypertensive disorders are present, these women should not be considered candidates for aspirin prophylaxis. Nevertheless, close monitoring of all TwP for adverse obstetric outcomes is still recommended.
Collapse
Affiliation(s)
- Alexandra Queirós
- Fetal Medicine and Surgery Center, Maternidade Dr. Alfredo da Costa, Unidade Local de Saúde de São José, Lisbon, Portugal.
- Maternal and Fetal Medicine Unit, Maternidade Dr. Alfredo da Costa, Unidade Local de Saúde de São José, Lisbon, Portugal.
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
| | - Laura Gomes
- Maternal and Fetal Medicine Unit, Maternidade Dr. Alfredo da Costa, Unidade Local de Saúde de São José, Lisbon, Portugal
| | - Inês Pereira
- Maternal and Fetal Medicine Unit, Maternidade Dr. Alfredo da Costa, Unidade Local de Saúde de São José, Lisbon, Portugal
| | - Nádia Charepe
- Maternal and Fetal Medicine Unit, Maternidade Dr. Alfredo da Costa, Unidade Local de Saúde de São José, Lisbon, Portugal
| | - Marta Plancha
- Maternal and Fetal Medicine Unit, Maternidade Dr. Alfredo da Costa, Unidade Local de Saúde de São José, Lisbon, Portugal
| | - Sofia Rodrigues
- Maternal and Fetal Medicine Unit, Maternidade Dr. Alfredo da Costa, Unidade Local de Saúde de São José, Lisbon, Portugal
| | - Álvaro Cohen
- Fetal Medicine and Surgery Center, Maternidade Dr. Alfredo da Costa, Unidade Local de Saúde de São José, Lisbon, Portugal
| | - Marta Alves
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Epidemiology and Statistics Unit, Unidade Local de Saúde de São José, Lisbon, Portugal
- Centre of Statistics and Its Applications, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Luísa Papoila
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Epidemiology and Statistics Unit, Unidade Local de Saúde de São José, Lisbon, Portugal
- Centre of Statistics and Its Applications, Universidade de Lisboa, Lisbon, Portugal
| | - Teresinha Simões
- Maternal and Fetal Medicine Unit, Maternidade Dr. Alfredo da Costa, Unidade Local de Saúde de São José, Lisbon, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
11
|
KAN Y, PENG YL, ZHAO ZH, DONG ST, XU YX, MA XT, LIU XL, LIU YY, ZHOU YJ. The impact of female sex hormones on cardiovascular disease: from mechanisms to hormone therapy. J Geriatr Cardiol 2024; 21:669-681. [PMID: 38973823 PMCID: PMC11224657 DOI: 10.26599/1671-5411.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Cardiovascular disease remains the leading cause of mortality in women, yet it has not raised the awareness from the public. The pathogenesis of cardiovascular disease differs significantly between females and males concerning the effect of sex hormones. Estrogen and progestogen impact cardiovascular system through genomic and non-genomic effects. Before menopause, cardiovascular protective effects of estrogens have been well described. Progestogens were often used in combination with estrogens in hormone therapy. Fluctuations in sex hormone levels, particularly estrogen deficiency, were considered the specific risk factor in women's cardiovascular disease. However, considerable heterogeneity in the impact of hormone therapy was observed in clinical trials. The heterogeneity is likely closely associated with factors such as the initial time, administration route, dosage, and formulation of hormone therapy. This review will delve into the pathogenesis and hormone therapy, summarizing the effect of female sex hormones on hypertension, pre-eclampsia, coronary heart disease, heart failure with preserved ejection fraction, and cardiovascular risk factors specific to women.
Collapse
Affiliation(s)
- Yi KAN
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yu-Lu PENG
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Ze-Hao ZHAO
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Shu-Tong DONG
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yin-Xiao XU
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Xiao-Teng MA
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Xiao-Li LIU
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yu-Yang LIU
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yu-Jie ZHOU
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| |
Collapse
|
12
|
Gumilar KE, Rauf KBA, Akbar MIA, Imanadha NC, Atmojo S, Putri AY, Dachlan EG, Dekker G. Connecting the Dots: Exploring the Interplay Between Preeclampsia and Peripartum Cardiomyopathy. J Pregnancy 2024; 2024:7713590. [PMID: 38957710 PMCID: PMC11219213 DOI: 10.1155/2024/7713590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 07/04/2024] Open
Abstract
Preeclampsia and peripartum cardiomyopathy (PPCM) are significant obstetric problems that can arise during or after pregnancy. Both are known to be causes of maternal mortality and morbidity. Several recent studies have suggested a link between preeclampsia and the pathophysiology of PPCM. However, the common thread that connects the two has yet to be thoroughly and fully articulated. Here, we investigate the complex dynamics of preeclampsia and PPCM in this review. Our analysis focuses mainly on inflammatory and immunological responses, endothelial dysfunction as a shared pathway, and potential genetic predisposition to both diseases. To begin, we will look at how excessive inflammatory and immunological responses can lead to clinical symptoms of both illnesses, emphasizing the role of proinflammatory cytokines and immune cells in modifying vascular and tissue responses. Second, we consider endothelial dysfunction to be a crucial point at which endothelial damage and activation contribute to pathogenesis through increased vascular permeability, vascular dysfunction, and thrombus formation. Finally, we examine recent information suggesting genetic predispositions to preeclampsia and PPCM, such as genetic variants in genes involved in the management of blood pressure, the inflammatory response, and heart structural integrity. With this synergistic study, we seek to encourage more research and creative therapy solutions by emphasizing the need for an interdisciplinary approach to understanding and managing the connection between preeclampsia and PPCM.
Collapse
Affiliation(s)
- Khanisyah Erza Gumilar
- Department of Obstetrics and GynecologyFaculty of MedicineUniversitas Airlangga, Surabaya, Indonesia
- Department of Obstetrics and GynecologyHospital of Universitas Airlangga, Surabaya, Indonesia
| | | | - Muhammad Ilham Aldika Akbar
- Department of Obstetrics and GynecologyFaculty of MedicineUniversitas Airlangga, Surabaya, Indonesia
- Department of Obstetrics and GynecologyHospital of Universitas Airlangga, Surabaya, Indonesia
| | - Nareswari Cininta Imanadha
- Department of Obstetrics and GynecologyFaculty of MedicineUniversitas Airlangga, Surabaya, Indonesia
- Department of Obstetrics and GynecologyDr Soetomo General Hospital, Surabaya, Indonesia
| | - Susetyo Atmojo
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Alisia Yuana Putri
- Department of CardiologyFaculty of MedicineUniversitas Airlangga, Surabaya, Indonesia
| | - Erry Gumilar Dachlan
- Department of Obstetrics and GynecologyFaculty of MedicineUniversitas Airlangga, Surabaya, Indonesia
- Department of Obstetrics and GynecologyDr Soetomo General Hospital, Surabaya, Indonesia
| | - Gus Dekker
- Women's and Children's DivisionLyell McEwin HospitalMedical School NorthUniversity of Adelaide, Adelaide, Australia
| |
Collapse
|
13
|
Ma Y, Hou B, Zong J, Liu S. Potential molecular mechanisms and clinical implications of piRNAs in preeclampsia: a review. Reprod Biol Endocrinol 2024; 22:73. [PMID: 38915084 PMCID: PMC11194991 DOI: 10.1186/s12958-024-01247-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024] Open
Abstract
Preeclampsia is a multisystem progressive condition and is one of the most serious complications of pregnancy. Owing to its unclear pathogenesis, there are no precise and effective therapeutic targets for preeclampsia, and the only available treatment strategy is to terminate the pregnancy and eliminate the clinical symptoms. In recent years, non-coding RNAs have become a hotspot in preeclampsia research and have shown promise as effective biomarkers for the early diagnosis of preeclampsia over conventional biochemical markers. PIWI-interacting RNAs, novel small non-coding RNA that interact with PIWI proteins, are involved in the pathogenesis of various diseases at the transcriptional or post-transcriptional level. However, the mechanisms underlying the role of PIWI-interacting RNAs in the pathogenesis of preeclampsia remain unclear. In this review, we discuss the findings of existing studies on PIWI-interacting RNA biogenesis, functions, and their possible roles in preeclampsia, providing novel insights into the potential application of PIWI-interacting RNAs in the early diagnosis and clinical treatment of preeclampsia.
Collapse
Affiliation(s)
- Yuanxuan Ma
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, Shandong, China
- Department of Medical Genetics, the Affiliated Hospital of Qingdao University, Qingdao , Shandong, 266003, China
| | - Bo Hou
- Department of Cardiology, the Affiliated Hospital of Qingdao University, Qingdao , Shandong, 266003, China
| | - Jinbao Zong
- Department of Laboratory, Qingdao Hiser Hospital Affliated of Qingdao University (Oingdao Traditional Chinese Medicine Hospital), 4 Renmin Road, Qingdao, 266033, China.
| | - Shiguo Liu
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, Shandong, China.
- Department of Medical Genetics, the Affiliated Hospital of Qingdao University, Qingdao , Shandong, 266003, China.
- Medical Genetic Department, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China.
| |
Collapse
|
14
|
He A, Yip KC, Lu D, Liu J, Zhang Z, Wang X, Liu Y, Wei Y, Zhang Q, Yan R, Gao F, Li R. Construction of a pathway-level model for preeclampsia based on gene expression data. Hypertens Res 2024:10.1038/s41440-024-01753-0. [PMID: 38914704 DOI: 10.1038/s41440-024-01753-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024]
Abstract
Preeclampsia (PE) is a heterogeneous disease that seriously affects the health of mothers and fetuses. Lack of detection assays, its diagnosis and intervention are often delayed when the clinical symptoms are atypical. Using personalized pathway-based analysis and machine learning algorithms, we built a PE diagnosis model consisting of nine core pathways using multiple cohorts from the Gene Expression Omnibus database. The model showed an area under the receiver operating characteristic (AUROC) curve of 0.959 with the data from the placental tissue samples in the development cohort. In the two validation cohorts, the AUROCs were 0.898 and 0.876, respectively. The model also performed well with the maternal plasma data in another validation cohort (AUROC: 0.815). Moreover, we identified tyrosine-protein kinase Lck (LCK) as the hub gene in this model and found that LCK and pLCK proteins were downregulated in placentas from PE patients. The pathway-level model for PE can provide a novel direction to develop molecular diagnostic assay and investigate potential mechanisms of PE in future studies.
Collapse
Affiliation(s)
- Andong He
- Department of Obstetrics and Gynecology, Jinan University First Affiliated Hospital, Guangzhou, 510630, China
| | - Ka Cheuk Yip
- Department of Obstetrics and Gynecology, Jinan University First Affiliated Hospital, Guangzhou, 510630, China
| | - Daiqiang Lu
- Institute of Molecular and Medical Virology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Jia Liu
- Department of Obstetrics and Gynecology, Jinan University First Affiliated Hospital, Guangzhou, 510630, China
| | - Zunhao Zhang
- Department of Pathology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xiufang Wang
- Department of Obstetrics and Gynecology, Jinan University First Affiliated Hospital, Guangzhou, 510630, China
| | - Yifeng Liu
- Institute of Molecular and Medical Virology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Yiling Wei
- Department of Obstetrics and Gynecology, Jinan University First Affiliated Hospital, Guangzhou, 510630, China
| | - Qiao Zhang
- Institute of Molecular and Medical Virology, School of Medicine, Jinan University, Guangzhou, 510632, China.
| | - Ruiling Yan
- Department of Obstetrics and Gynecology, Jinan University First Affiliated Hospital, Guangzhou, 510630, China.
| | - Feng Gao
- Institute of Molecular and Medical Virology, School of Medicine, Jinan University, Guangzhou, 510632, China.
| | - Ruiman Li
- Department of Obstetrics and Gynecology, Jinan University First Affiliated Hospital, Guangzhou, 510630, China.
| |
Collapse
|
15
|
Soundararajan R, Khan T, Dadelszen PV. Pre-eclampsia challenges and care in low and middle-income countries: Understanding diagnosis, management, and health impacts in remote and developing regions. Best Pract Res Clin Obstet Gynaecol 2024:102525. [PMID: 38964990 DOI: 10.1016/j.bpobgyn.2024.102525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/20/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
As an example of a low- and middle-income country (LMIC), India ranks pre-eclampsia among the top three causes of maternal mortality, following haemorrhage and infections. It is one of the primary concerns for maternal and perinatal health in LMICs. Many LMICs lack clear consensus and guidelines for the prevention, diagnosis, and management of hypertensive disorders in pregnancy, including pre-eclampsia. The International Society for the Study of Hypertension in Pregnancy 2021 guidelines address LMIC applications, offering customisable solutions. Atypical presentations of pre-eclampsia contribute to diagnostic delays, resulting in additional adverse maternal and perinatal outcomes. Implementing management strategies faces challenges in both urban and rural settings. Adapting global research involving local populations is imperative, with the potential for cost-effective adoption of international guidelines. Prevention, early diagnosis, and education dissemination are essential, involving healthcare providers and advocacy initiatives. Encouraging government investment in pre-eclampsia management as a public health initiative is important. This article explores socio-economic, cultural, and legislative factors influencing the management of pre-eclampsia in LMICs, addressing emerging challenges and potential partnerships for healthcare provision.
Collapse
Affiliation(s)
- Revathi Soundararajan
- Chief Consultant [Maternal Fetal Medicine], Managing Director, Mirror Health, Secretary, SMFM (I), Co-Chair, PEN (I), Bengaluru, India.
| | - Tamkin Khan
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
| | | |
Collapse
|
16
|
Huang Y, Sun Q, Zhou B, Peng Y, Li J, Li C, Xia Q, Meng L, Shan C, Long W. Lipidomic signatures in patients with early-onset and late-onset Preeclampsia. Metabolomics 2024; 20:65. [PMID: 38879866 PMCID: PMC11180640 DOI: 10.1007/s11306-024-02134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/22/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Preeclampsia is a pregnancy-specific clinical syndrome and can be subdivided into early-onset preeclampsia (EOPE) and late-onset preeclampsia (LOPE) according to the gestational age of delivery. Patients with preeclampsia have aberrant lipid metabolism. This study aims to compare serum lipid profiles of normal pregnant women with EOPE or LOPE and screening potential biomarkers to diagnose EOPE or LOPE. METHODS Twenty normal pregnant controls (NC), 19 EOPE, and 19 LOPE were recruited in this study. Untargeted lipidomics based on ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was used to compare their serum lipid profiles. RESULTS The lipid metabolism profiles significantly differ among the NC, EOPE, and LOPE. Compared to the NC, there were 256 and 275 distinct lipids in the EOPE and LOPE, respectively. Furthermore, there were 42 different lipids between the LOPE and EOPE, of which eight were significantly associated with fetal birth weight and maternal urine protein. The five lipids that both differed in the EOPE and LOPE were DGTS (16:3/16:3), LPC (20:3), LPC (22:6), LPE (22:6), PC (18:5e/4:0), and a combination of them were a potential biomarker for predicting EOPE or LOPE. The receiver operating characteristic analysis revealed that the diagnostic power of the combination for distinguishing the EOPE from the NC and for distinguishing the LOPE from the NC can reach 1.000 and 0.992, respectively. The association between the lipid modules and clinical characteristics of EOPE and LOPE was investigated by the weighted gene co-expression network analysis (WGCNA). The results demonstrated that the main different metabolism pathway between the EOPE and LOPE was enriched in glycerophospholipid metabolism. CONCLUSIONS Lipid metabolism disorders may be a potential mechanism of the pathogenesis of preeclampsia. Lipid metabolites have the potential to serve as biomarkers in patients with EOPE or LOPE. Furthermore, lipid metabolites correlate with clinical severity indicators for patients with EOPE and LOPE, including fetal birth weight and maternal urine protein levels.
Collapse
Affiliation(s)
- Yu Huang
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123rd Tianfei Street, Mochou Road, Nanjing, 210004, China
| | - Qiaoqiao Sun
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123rd Tianfei Street, Mochou Road, Nanjing, 210004, China
| | - Beibei Zhou
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123rd Tianfei Street, Mochou Road, Nanjing, 210004, China
| | - Yiqun Peng
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123rd Tianfei Street, Mochou Road, Nanjing, 210004, China
| | - Jingyun Li
- Nanjing Maternal and Child Health Institute, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Chunyan Li
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123rd Tianfei Street, Mochou Road, Nanjing, 210004, China
| | - Qing Xia
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123rd Tianfei Street, Mochou Road, Nanjing, 210004, China
| | - Li Meng
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123rd Tianfei Street, Mochou Road, Nanjing, 210004, China
| | - Chunjian Shan
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123rd Tianfei Street, Mochou Road, Nanjing, 210004, China
| | - Wei Long
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123rd Tianfei Street, Mochou Road, Nanjing, 210004, China.
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China.
| |
Collapse
|
17
|
Li T, Xu M, Wang Y, Wang Y, Tang H, Duan H, Zhao G, Zheng M, Hu Y. Prediction model of preeclampsia using machine learning based methods: a population based cohort study in China. Front Endocrinol (Lausanne) 2024; 15:1345573. [PMID: 38919479 PMCID: PMC11198873 DOI: 10.3389/fendo.2024.1345573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Preeclampsia is a disease with an unknown pathogenesis and is one of the leading causes of maternal and perinatal morbidity. At present, early identification of high-risk groups for preeclampsia and timely intervention with aspirin is an effective preventive method against preeclampsia. This study aims to develop a robust and effective preeclampsia prediction model with good performance by machine learning algorithms based on maternal characteristics, biophysical and biochemical markers at 11-13 + 6 weeks' gestation, providing an effective tool for early screening and prediction of preeclampsia. Methods This study included 5116 singleton pregnant women who underwent PE screening and fetal aneuploidy from a prospective cohort longitudinal study in China. Maternal characteristics (such as maternal age, height, pre-pregnancy weight), past medical history, mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein A, and placental growth factor were collected as the covariates for the preeclampsia prediction model. Five classification algorithms including Logistic Regression, Extra Trees Classifier, Voting Classifier, Gaussian Process Classifier and Stacking Classifier were applied for the prediction model development. Five-fold cross-validation with an 8:2 train-test split was applied for model validation. Results We ultimately included 49 cases of preterm preeclampsia and 161 cases of term preeclampsia from the 4644 pregnant women data in the final analysis. Compared with other prediction algorithms, the AUC and detection rate at 10% FPR of the Voting Classifier algorithm showed better performance in the prediction of preterm preeclampsia (AUC=0.884, DR at 10%FPR=0.625) under all covariates included. However, its performance was similar to that of other model algorithms in all PE and term PE prediction. In the prediction of all preeclampsia, the contribution of PLGF was higher than PAPP-A (11.9% VS 8.7%), while the situation was opposite in the prediction of preterm preeclampsia (7.2% VS 16.5%). The performance for preeclampsia or preterm preeclampsia using machine learning algorithms was similar to that achieved by the fetal medicine foundation competing risk model under the same predictive factors (AUCs of 0.797 and 0.856 for PE and preterm PE, respectively). Conclusions Our models provide an accessible tool for large-scale population screening and prediction of preeclampsia, which helps reduce the disease burden and improve maternal and fetal outcomes.
Collapse
Affiliation(s)
- Taishun Li
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Medical Statistics and Analysis Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Mingyang Xu
- Information Management Division, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yuan Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ya Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Huirong Tang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Honglei Duan
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Guangfeng Zhao
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Mingming Zheng
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| |
Collapse
|
18
|
Sobieray NL, Carvalho NS, Klas CF, Furuie IN, Chiste JA, Fugaça CA, Longo JS, Oliveira JD, Padilha SL. Preeclampsia in pregnant women with COVID-19: a prospective cohort study from two tertiary hospitals in Southern Brazil. PeerJ 2024; 12:e17481. [PMID: 38881857 PMCID: PMC11177852 DOI: 10.7717/peerj.17481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024] Open
Abstract
Background COVID-19 is an infectious pathology that shows vascular changes during pregnancy, as well as in the placentas. The main objectives of this study were to estimate the prevalence and the risk factors for preeclampsia in hospitalized pregnant women with COVID-19. As well as comparing maternal and perinatal outcomes in hospitalized pregnant women with COVID-19 and preeclampsia with those without preeclampsia. Methods Prospective cohort study of 100 hospitalized pregnant women from two tertiary hospitals, diagnosed with COVID-19, and divided into two groups: PE+ group (pregnant women with COVID-19 and preeclampsia) and PE- group (pregnant women with COVID-19 without preeclampsia). These pregnant women had prevalence, risk factors, maternal and perinatal data analyzed. Results The prevalence of preeclampsia was 11%. Severe COVID-19 was the main risk factor for preeclampsia (OR = 8.18 [CI 1.53-43.52]), as well as fetal growth restriction was the main perinatal outcome (OR = 8.90 [CI 1.52-38.4]). Comorbidities were more frequent in the PE+ group (63.6% vs 31.5%, p = 0.03), as well as prematurity (81.8% vs 41.6%, p = 0.02), low birth weight (63.6% vs 24.7%, p = 0.01), and the need for neonatal intensive care admission of the newborn (63.6% vs 27.0%, p = 0.03). Pregnant women with PE had twice as long a length of stay in the intensive care unit (RR = 2.35 [CI 1.34-4.14]). Although maternal mortality was more frequent among pregnant women with PE, it was not statistically significant. Conclusions Prevalence of preeclampsia in hospitalized pregnant women with COVID-19 was 11%. Severe COVID-19 was the main risk factor for preeclampsia and associated comorbidities increased the risk for developing preeclampsia. Long length of stay in the intensive care unit was the main maternal outcome and fetal growth restriction was the main perinatal outcome of preeclampsia.
Collapse
Affiliation(s)
- Narcizo Lec Sobieray
- Department of Obstetrics and Gynecology and Postgraduate Program in Internal Medicine and Health Sciences, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Newton S Carvalho
- Department of Obstetrics and Gynecology and Postgraduate Program in Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Cynthia F Klas
- Department of Obstetrics and Gynecology, Hospital of Clinics Complex-CHC-UFPR-EBSERH, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Isabella N Furuie
- Department of Obstetrics and Gynecology, Hospital of Clinics Complex-CHC-UFPR-EBSERH, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Jullie A Chiste
- Department of Obstetrics and Gynecology, Hospital of Clinics Complex-CHC-UFPR-EBSERH, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Cyllian A Fugaça
- Department of Obstetrics and Gynecology, Hospital of Clinics Complex-CHC-UFPR-EBSERH, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Jessica S Longo
- Department of Obstetrics and Gynecology, Hospital of Clinics Complex-CHC-UFPR-EBSERH, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Juliana D Oliveira
- Department of Obstetrics and Gynecology, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
| | - Sérgio L Padilha
- Department of Internal Medicine and Postgraduate Program in Internal Medicine and Helath Sciences, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| |
Collapse
|
19
|
de Melo NC, Sampaio E Souza PC, Marques RC, Bernardi JVE, Bastos WR, Cunha MPL. Environmental exposure to metal(loid)s and hypertensive disorders of pregnancy: A systematic review. ENVIRONMENTAL RESEARCH 2024; 257:119391. [PMID: 38857855 DOI: 10.1016/j.envres.2024.119391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Environmental exposure to metal(loid)s has been associated with adverse effects on human health, but the systemic repercussion of these elements on the development of hypertensive disorders of pregnancy (HDP) is still poorly understood. OBJECTIVE To summarize evidence published about the influence of environmental exposure to aluminum, arsenic, barium, cadmium, lead, strontium and mercury on the development of HDP. METHODS We conducted a systematic literature review according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search strategy was validated by the Peer Review of Electronic Search Strategies. We searched for articles published up to February 2023 in seven databases without language restriction. Two researchers conducted the steps for selection, data extraction and evaluation of the methodological quality of the instruments for epidemiological studies of the Joanna Briggs Institute. Any disagreements were resolved by a third researcher. RESULTS We obtained 5076 records, of which 37 articles met the inclusion criteria moderate to high methodological quality. Single exposure to metal(loid)s was predominant, and the leading biological matrix analyzed to detect the concentrations from exposure was maternal blood. Lead was the metal investigated the most, and had the largest number of studies showing positive association with HDP. In relation to the other metal(loid)s, higher levels were found in women with HDP in comparison with healthy women, but the finding of a cause-effect relationship was inconsistent. CONCLUSIONS Although we found evidence of harmful effects of the metal(loid)s studied on human health, the results were inconclusive with regard to HDP. Longitudinal studies that consider prospective investigation, adjustment of confounding factors and the interference of other contaminants in the exacerbation of oxidative stress in women from the preconception phase to the puerperal period should be encouraged.
Collapse
Affiliation(s)
- Nayra Carla de Melo
- Postgraduate Program in Regional Development and Environment, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76801-059, Brazil; WCP Environmental Biogeochemistry Laboratory, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76815-800, Brazil.
| | - Priscilla Cristovam Sampaio E Souza
- Postgraduate Program in Regional Development and Environment, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76801-059, Brazil
| | - Rejane Correa Marques
- Postgraduate Program in Environmental Sciences and Conservation, Federal University of Rio de Janeiro Janeiro (UFRJ), Macaé, Rio de Janeiro, 27965-045, Brazil
| | - José Vicente Elias Bernardi
- Geostatistics and Geodesy Laboratory, UnB Planaltina College, University of Brasília, Planaltina, Federal District, 73345-010, Brazil
| | - Wanderley Rodrigues Bastos
- Postgraduate Program in Regional Development and Environment, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76801-059, Brazil; WCP Environmental Biogeochemistry Laboratory, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76815-800, Brazil
| | - Mônica Pereira Lima Cunha
- Postgraduate Program in Regional Development and Environment, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76801-059, Brazil; WCP Environmental Biogeochemistry Laboratory, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76815-800, Brazil
| |
Collapse
|
20
|
Gholizadeh Ghozloujeh Z, Singh T, Jhaveri KD, Shah S, Lerma E, Abdipour A, Norouzi S. Lupus nephritis: management challenges during pregnancy. FRONTIERS IN NEPHROLOGY 2024; 4:1390783. [PMID: 38895665 PMCID: PMC11183321 DOI: 10.3389/fneph.2024.1390783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024]
Abstract
Lupus nephritis (LN), a severe complication of systemic lupus erythematosus (SLE), leads to significant kidney inflammation and damage and drastically increases mortality risk. Predominantly impacting women in their reproductive years, LN poses specific risks during pregnancy, including pre-eclampsia, growth restrictions, stillbirth, and preterm delivery, exacerbated by lupus activity, specific antibodies, and pre-existing conditions like hypertension. Effective management of LN during pregnancy is crucial and involves carefully balancing disease control with the safety of the fetus. This includes pre-conception counseling and a multidisciplinary approach among specialists to navigate the complexities LN patients face during pregnancy, such as distinguishing LN flare-ups from pregnancy-induced conditions. This review focuses on exploring the complex dynamics between pregnancy and LN, emphasizing the management difficulties and the heightened risks pregnant women with LN encounter.
Collapse
Affiliation(s)
- Zohreh Gholizadeh Ghozloujeh
- Department of Medicine, Division of Nephrology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Tripti Singh
- Department of Medicine, Division of Nephrology, University of Wisconsin, Madison, WI, United States
| | - Kenar D. Jhaveri
- Department of Medicine, Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, United States
| | - Silvi Shah
- Department of Medicine, Division of Nephrology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Edgar Lerma
- Department of Medicine, Division of Nephrology, Advocate Christ Medical Center, University of Illinois at Chicago, Oak Lawn, IL, United States
| | - Amir Abdipour
- Department of Medicine, Division of Nephrology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Sayna Norouzi
- Department of Medicine, Division of Nephrology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| |
Collapse
|
21
|
Shi H, Wang W, Li F, Guo A, Liu T. Model construction and application for predicting pre-eclampsia by Sonoclot coagulation analyzer. Noncoding RNA Res 2024; 9:288-293. [PMID: 38505305 PMCID: PMC10945131 DOI: 10.1016/j.ncrna.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 03/21/2024] Open
Abstract
Maternal age has significantly increased among Chinese women, thereby posing risk of pregnancy-related complications. Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality, and coagulation analysis in conjunction with clinical signs and symptoms are generally used for its diagnosis with limited efficacy. Sonoclot coagulation analyzer is effective in assessing coagulation function used during cerebral surgery and cardiovascular surgery. However, its use has not been explored in preeclampsia. Here, we investigated the potential use of Sonoclot in diagnosing preeclampsia in obstetrics cases. Subjects meeting the screening criteria were divided either into a test group or a control group, according to whether they were preeclamptic or not. We recorded the Sonoclot-derived coagulation and the routine coagulation parameters including platelet function (PF), activated clotting time (ACT) and clot rate (CR), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), and platelet count. Regression analysis was done on the relevant parameters to assess the feasibility of Sonoclot analyzer in preeclampsia diagnosis. In parallel, changes in preeclampsia lncRNAs was also evaluated. Significant differences were recorded in PT and ACT between the two groups. In the monovariant logistic regression, PT and ACT appeared to be reliable predictor variables. In the multinomial logistic regression, a total of five regression steps were performed with decreasing AIC values. The K-fold cross validation resulted in an accuracy rate (ACC) of 77.5%, a false positive rate of 16.4%, and a false negative rate of 33.2%. lncRNAs ANRIL and HOXD-AS1 were found deregulated. Our findings indicate that Sonoclot may be useful for diagnosis of preeclampsia in obstetrics.
Collapse
Affiliation(s)
- Hongyu Shi
- Endoscopic Center of the First Hospital of Jilin University, China
| | - Weijie Wang
- Department of Gastroenterology, First Hospital of Jilin University, China
| | - Fan Li
- Department of Gastroenterology, First Hospital of Jilin University, China
| | - Ao Guo
- Anesthesiology Department of Jilin University Second Hospital, Changchun, China
| | - Tiecheng Liu
- Anesthesiology Department of Jilin University Second Hospital, Changchun, China
| |
Collapse
|
22
|
Li N, Fan L, Cai H, Pan D, Shi W, Shi J, Wang H. Luteal phase support of intramuscular progesterone associated with lower hypertensive disorders of pregnancy as compared to vaginal progesterone: A cohort study. Int J Gynaecol Obstet 2024; 165:1277-1284. [PMID: 38217105 DOI: 10.1002/ijgo.15347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To compare the hypertensive disorders of pregnancy (HDP) risk between vaginal and intramuscular (IM) progesterone in programmed frozen-thawed embryo transfer (FET) cycles. METHODS This was a retrospective cohort study at a tertiary hospital, and only women who achieved ongoing pregnancy after programmed FET between January 2018 and June 2022 were included. Women with chronic hypertension before pregnancy or with history of gestational hypertension or pre-eclampsia in previous pregnancies were excluded. All women were divided into IM progesterone or vaginal progesterone groups according to the route of progesterone supplementation. Follow-up information on obstetric complications and neonatal outcomes were obtained by telephonic interviews. The primary outcome was HDP. Association between routes of progesterone supplementation and HDP was assessed by subgroup analysis and multivariable logistic regression. RESULTS A total of 5891 programmed FET cycles (3196 IM progesterone cycles and 2695 vaginal progesterone cycles) were included in the analysis. The prevalence of HDP in the IM progesterone group was significantly lower than that of the vaginal progesterone group (6.54% vs 9.17%, P < 0.001). Therein, the prevalence of gestational hypertension (3.57% vs 4.94%, P = 0.009) and pre-eclampsia (2.97% vs 4.23%, P = 0.009) in the IM progesterone group were all significantly lower as compared to the vaginal progesterone group. According to subgroup analysis, IM progesterone was associated with lower HDP risk in all subgroups. The logistic regression analysis showed that the IM progesterone cycles were associated with lower risk of HDP compared to vaginal progesterone cycles (adjusted odds ratio 0.66, 95% CI: 0.54-0.80, P < 0.001). CONCLUSION Among women undergoing programmed FET cycles, progesterone supplementation with IM progesterone was associated with reduced HDP risk compared to vaginal progesterone.
Collapse
Affiliation(s)
- Na Li
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Lijuan Fan
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - He Cai
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Dan Pan
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Wenhao Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Hui Wang
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| |
Collapse
|
23
|
Ngene NC, Moodley J. Preventing maternal morbidity and mortality from preeclampsia and eclampsia particularly in low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 94:102473. [PMID: 38513504 DOI: 10.1016/j.bpobgyn.2024.102473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/15/2023] [Accepted: 02/05/2024] [Indexed: 03/23/2024]
Abstract
Preeclampsia (PE) is a complex heterogeneous disorder with overlapping clinical phenotypes that complicate diagnosis and management. Although several pathophysiological mechanisms have been proposed, placental dysfunction due to inadequate remodelling of uterine spiral arteries leading to mal-perfusion and syncytiotrophoblast stress is recognized as the unifying characteristic of early-onset PE. Placental overgrowth and or premature senescence are probably the causes of late-onset PE. The frequency of PE has increased over the last few decades due to population-wide increases in risk factors viz. obesity, diabetes, multifetal pregnancies and pregnancies at an advanced maternal age. Whilst multimodal tools with components comprising risk factors, biomarkers and sonography are used for predicting PE, aspirin is most effective in preventing early-onset PE. The incidence and clinical consequences of PE and eclampsia are influenced by socioeconomic and cultural factors, therefore management strategies should involve multi-sector partnerships to mitigate the adverse outcomes.
Collapse
Affiliation(s)
- Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, Johannesburg, Gauteng, South Africa; Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynecology, School of Clinical Medicine, Faculty of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa.
| |
Collapse
|
24
|
Shi Y, Shen F, Chen X, Sun M, Zhang P. Current understanding of circular RNAs in preeclampsia. Hypertens Res 2024; 47:1607-1619. [PMID: 38605141 DOI: 10.1038/s41440-024-01675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/28/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
Preeclampsia (PE) is a multiple organ and system disease that seriously threatens the safety of the mother and infant during pregnancy, and has a profound impact on the morbidity and mortality of the mother and new babies. Presently, there are no remedies for cure of PE as to the mechanisms of PE are still unclear, and the only way to eliminate the symptoms is to deliver the placenta. Thus, new therapeutic targets for PE are urgently needed. Approximately 95% of human transcripts are thought to be non-coding RNAs, and the roles of them are to be increasingly recognized of great importance in various biological processes. Circular RNAs (circRNAs) are a class of non-coding RNAs, with no 5' caps and 3' polyadenylated tails, commonly produced by back-splicing of exons. The structure of circRNAs makes them more stable than their counterparts. Increasing evidence shows that circRNAs are involved in the pathogenesis of PE, but the biogenesis, functions, and mechanisms of circRNAs in PE are poorly understood. In the present review, we mainly summarize the biogenesis, functions, and possible mechanisms of circRNAs in the development and progression of PE, as well as opportunities and challenges in the treatment and prevention of PE.
Collapse
Affiliation(s)
- Yajun Shi
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fangrong Shen
- Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xionghui Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
- Institute of Trauma Medicine, Soochow University, Suzhou, China.
- Jiangsu Provincial Medical Innovation Center of Trauma Medicine, Suzhou, China.
| | - Miao Sun
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Pengjie Zhang
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China.
| |
Collapse
|
25
|
Chen H, Luo S, Deng X, Li S, Mao Y, Yan J, Cheng Y, Liu X, Pan J, Huang H. Pre-eclamptic foetal programming predisposes offspring to hepatic steatosis via DNA methylation. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167189. [PMID: 38648899 DOI: 10.1016/j.bbadis.2024.167189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/01/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Gamete and embryo-foetal origins of adult diseases hypothesis proposes that adulthood chronic disorders are associated with adverse foetal and early life traits. Our study aimed to characterise developmental changes and underlying mechanisms of metabolic disorders in offspring of pre-eclampsia (PE) programmed pregnancy. METHODS Nω-Nitro-l-arginine methyl ester hydrochloride (L-NAME) induced pre-eclampsia-like C57BL/6J mouse model was used. Lipid profiling, histological morphology, indirect calorimetry, mRNA sequencing, and pyrosequencing were performed on PE offspring of both young and elderly ages. RESULTS PE offspring exhibited increased postnatal weight gain, hepatic lipid accumulation, enlarged adipocytes, and impaired energy balance that continued to adulthood. Integrated RNA sequencing of foetal and 52-week-old livers revealed that the differentially expressed genes were mainly enriched in lipid metabolism, including glycerol-3-phosphate acyl-transferase 3 (Gpat3), a key enzyme for de novo synthesis of triglycerides (TG), and carnitine palmitoyltransferase-1a (Cpt1a), a key transmembrane enzyme that mediates fatty acid degradation. Pyrosequencing of livers from PE offspring identified hypomethylated and hypermethylated regions in Gpat3 and Cpt1a promoters, which were associated with upregulated and downregulated expressions of Gpat3 and Cpt1a, respectively. These epigenetic alterations are persistent and consistent from the foetal stage to adulthood in PE offspring. CONCLUSION These findings suggest a methylation-mediated epigenetic mechanism for PE-induced intergenerational lipid accumulation, impaired energy balance and obesity in offspring, and indicate the potential benefits of early interventions in offspring exposed to maternal PE to reduce their susceptibility to metabolic disorder in their later life.
Collapse
Affiliation(s)
- Huixi Chen
- The International Peace Maternal and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200000, China; Shanghai Key Laboratory of Reproduction and Development, Shanghai 200011, China; Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China; Key Laboratory of Reproductive Genetics (Ministry of Education), Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China; State Key Laboratory of Cardiology, Shanghai 200000, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Sisi Luo
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China; Shanghai Key Laboratory of Reproduction and Development, Shanghai 200011, China
| | - Xiuyu Deng
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200000, China; Shanghai Key Laboratory of Reproduction and Development, Shanghai 200011, China
| | - Sisi Li
- Shanghai Key Laboratory of Reproduction and Development, Shanghai 200011, China; Reproductive Medicine Center, International Institutes of Medicine, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, China
| | - Yiting Mao
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China; Shanghai Key Laboratory of Reproduction and Development, Shanghai 200011, China
| | - Jing Yan
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China; Shanghai Key Laboratory of Reproduction and Development, Shanghai 200011, China
| | - Yi Cheng
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China; Shanghai Key Laboratory of Reproduction and Development, Shanghai 200011, China
| | - Xia Liu
- The International Peace Maternal and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200000, China; Shanghai Key Laboratory of Reproduction and Development, Shanghai 200011, China
| | - Jiexue Pan
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China; Shanghai Key Laboratory of Reproduction and Development, Shanghai 200011, China; Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China.
| | - Hefeng Huang
- The International Peace Maternal and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200000, China; Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China; Shanghai Key Laboratory of Reproduction and Development, Shanghai 200011, China; Reproductive Medicine Center, International Institutes of Medicine, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, China; Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China; Key Laboratory of Reproductive Genetics (Ministry of Education), Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China; State Key Laboratory of Cardiology, Shanghai 200000, China.
| |
Collapse
|
26
|
Sinkey RG, Blanchard CT, Sanusi A, Elkins C, Szychowski JM, Harper LM, Tita AT. Physiologic blood pressure patterns in pregnancies with mild chronic hypertension. Pregnancy Hypertens 2024; 36:101118. [PMID: 38460322 PMCID: PMC11162940 DOI: 10.1016/j.preghy.2024.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/25/2023] [Accepted: 02/27/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES To assess physiologic blood pressure (BP) changes throughout pregnancy in patients with mild chronic hypertension (CHTN) who do and do not develop preeclampsia (PEC), compared to patients with normal BP. STUDY DESIGN Retrospective cohort of singleton gestations with CHTN at a single tertiary center from 2000 to 2014 and a randomly selected cohort of patients without CHTN and normal pregnancy outcomes (NML) in the same time period with BP measurements available <12 weeks gestational age. MAIN OUTCOME MEASURES The primary outcome was gestational age (GA) at nadir of systolic and diastolic BP. Secondary outcomes included perinatal death, umbilical cord pH, maternal and neonatal length of stay, GA at delivery, and mode of delivery. Quadratic mixed models were used to estimate SBP and DBP throughout gestation. RESULTS Of 367 pregnancies with CHTN, 268 (73%) had CHTN without PEC and 99 (27%) had CHTN with PEC; 198 NML pregnancies were used as a comparison group. The median GA nadir for patients in the NML, CHTN without PEC, and CHTN with PEC for SBP were 20, 24, and 21, respectively. For DBP, the median GA nadir were 22, 24, and 21 for patients in the NML, CHTN without PEC, and CHTN with PEC cohorts, respectively. Adverse secondary outcomes were more frequent in patients with CHTN who developed PEC. CONCLUSIONS BP trajectories in pregnancy are different between patients with CHTN with PEC, CHTN without PEC, and patients with normal BP. These findings may be useful in assessing patients' risks for developing preeclampsia during pregnancy.
Collapse
Affiliation(s)
- Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Christina T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ayodeji Sanusi
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cooper Elkins
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; University of Alabama Heersink School of Medicine, Birmingham, AL, USA
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lorie M Harper
- Department of Obstetrics and Gynecology, University of Texas at Austin, Austin, TX, USA
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
27
|
Oğuz Y, Ağaoğlu RT, Ulusoy CO, Öztürk Ö, Özgürlük İ, Soysal Ç, Yılmaz Vural Z, Yakut Yücel K. A new Doppler index, cerebro-placental-uterine ratio, and fetal cardiac parameters in early onset preeclampsia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:558-565. [PMID: 38538067 DOI: 10.1002/jcu.23659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Our aim was to investigate the significance of cerebro-placento-uterine ratio CPUR, a new Doppler index, and fetal cardiac parameters (Mod MPI, EFT) in early-onset preeclampsia (EOPE) and to examine whether these parameters are related to perinatal outcome. STUDY DESIGN Forty participants diagnosed with EOPE (preeclampsia cases diagnosed before 34 weeks of gestation) and 40 healthy pregnant women were included in this study. Demographic data were recorded. Doppler parameters such as middle cerebral artery (MCA), umbilical artery (UA), and uterine artery (Ut-A), and left modified myocardial performance index (Mod-MPI) and epicardial fat thickness (EFT) were measured. Cerebroplacental ratio (CPR) was determined by dividing MCA pulsatility index (PI) by UA PI. CPUR was calculated as the ratio of CPR to mean UtA-PI (CPUR = CPR/UtA-PI). All parameters were compared between the EOPE and control groups. Correlation tests were used to examine the relationship between Doppler parameters and perinatal outcome. p values less than 0.05 were considered statistically significant. RESULTS The pulsatility index of the middle cerebellar artery, CPUR and CPR values were statistically lower in the EOPE group than in the control group (p = 0.002; p = <0.001; p = <0.001; respectively). No statistical differences were found between groups for isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), ejection time (ET), left mod-MPI, EFT (p = 0.117; p = 0.093; p = 0.398; p = 0.882; p = 0.202, respectively). Umbilical artery Doppler pulsatility index (PI), mean uterine artery Doppler pulsatility index (PI), were higher in the EOPE group than in the control group (p = 0.006; and p = <0.001, respectively). The CPUR value for predicting EOPE was ≤1.3652 with 74. 4% sensitivity and 94.9% specificity. Positive correlations were found between CPUR, CPR, and some neonatal parameters. CONCLUSION CPUR, a new index combining fetal and uterine Doppler indices, may add contribution to predict adverse perinatal outcome and EOPE.
Collapse
Affiliation(s)
- Yüksel Oğuz
- Perinatology Department Ankara, Ministry of Health, Etlik City Hospital, Ankara, Turkey
| | - Recep Taha Ağaoğlu
- Perinatology Department Ankara, Ministry of Health, Etlik City Hospital, Ankara, Turkey
| | - Can Ozan Ulusoy
- Perinatology Department Ankara, Ministry of Health, Etlik City Hospital, Ankara, Turkey
| | - Özge Öztürk
- Perinatology Department Ankara, Ministry of Health, Etlik City Hospital, Ankara, Turkey
| | - İzzet Özgürlük
- Department of Obstetrics and Gynecology, Ministry of Health, Etlik City Hospital, Ankara, Turkey
| | - Çağanay Soysal
- Department of Obstetrics and Gynecology, Ministry of Health, Etlik City Hospital, Ankara, Turkey
| | - Zehra Yılmaz Vural
- Perinatology Department Ankara, Ministry of Health, Etlik City Hospital, Ankara, Turkey
| | - Kadriye Yakut Yücel
- Perinatology Department Ankara, Ministry of Health, Etlik City Hospital, Ankara, Turkey
| |
Collapse
|
28
|
Nyakio O, Cakwira H, Masimango G, Kena L, Narayan G, Naaz F, Mugenyi N, Cyubahiro VK, Amani T, Balagizi F, Suvvari TK, Oduoye MO, Akilimali A. The silent threat: investigating the incidence and clinical characteristics of pre-eclampsia and eclampsia in women from tertiary care hospitals of the Democratic Republic of Congo. Ann Med Surg (Lond) 2024; 86:3267-3272. [PMID: 38846848 PMCID: PMC11152814 DOI: 10.1097/ms9.0000000000002087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 06/09/2024] Open
Abstract
Background Pre-eclampsia and eclampsia are medical conditions that can cause severe complications, such as maternal and foetal morbidity and mortality. This study aimed to assess the incidence and characteristics of pre-eclampsia and eclampsia. Methods From July 2021 to July 2022, the authors conducted a retrospective, cross-sectional, descriptive study in the Department of Obstetrics and Gynaecology of a tertiary care hospital in the Democratic Republic of the Congo (DR Congo). Out of 1236 total deliveries, 40 patients aged 18-35 years with pre-eclampsia and/or eclampsia with complete data in medical records were studied. Results In the studied group, 3.23% of women (40 cases) experienced pre-eclampsia or eclampsia, with the majority (75%, 30 cases) occurring before childbirth. Among these, 62.5% (25 cases) were first-time mothers. The main complications observed in the mothers included HELLP syndrome and placental abruption, whereas their newborns frequently exhibited delayed in-utero growth. Caesarean delivery was the prevalent birthing method, and the treatments most often used for effective management were magnesium sulfate and nicardipine. Conclusion The research highlights the common occurrence of eclampsia among patients in the DRC and stresses the critical need for prompt detection of hypertensive complications during pregnancy, aiming to reduce negative health impacts on both mothers and their children.
Collapse
Affiliation(s)
- Olivier Nyakio
- Faculty of Medicine, Evangelic University in Africa
- Faculty of Medicine, Official University of Bukavu
| | - Hugues Cakwira
- Faculty of Medicine, Catholic University of Bukavu
- Department of research, Medical Research Circle (MedReC), Bukavu
| | - Gaston Masimango
- Faculty of Medicine, Official University of Bukavu
- Department of research, Medical Research Circle (MedReC), Bukavu
| | - Louison Kena
- Department of research, Medical Research Circle (MedReC), Bukavu
- Faculty of Medicine, Université Libre des Pays des Grands Lacs, Goma, DR Congo
| | - Gaurang Narayan
- Department of Obstetrics and Gynecology, Indira Gandhi Government Medical College, Nagpur
| | - Farheen Naaz
- Medical college, Deccan College of Medical Sciences, Hyderabad
| | - Nathan Mugenyi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Toussaint Amani
- Department of research, Medical Research Circle (MedReC), Bukavu
- Faculty of Medicine, Université Libre des Pays des Grands Lacs, Goma, DR Congo
| | - Fabien Balagizi
- Department of research, Medical Research Circle (MedReC), Bukavu
| | - Tarun Kumar Suvvari
- Department of Surgery, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
| | | | - Aymar Akilimali
- Department of research, Medical Research Circle (MedReC), Bukavu
- Society for Maternal-Fetal Medicine (SMFM), SW, Washington, DC
- Department of research, East Africa Medical Students Association, Nairobi, Kenya
| |
Collapse
|
29
|
Lamsal R, Yeh EA, Pullenayegum E, Ungar WJ. A Systematic Review of Methods and Practice for Integrating Maternal, Fetal, and Child Health Outcomes, and Family Spillover Effects into Cost-Utility Analyses. PHARMACOECONOMICS 2024:10.1007/s40273-024-01397-5. [PMID: 38819718 DOI: 10.1007/s40273-024-01397-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Maternal-perinatal interventions delivered during pregnancy or childbirth have unique characteristics that impact the health-related quality of life (HRQoL) of the mother, fetus, and newborn child. However, maternal-perinatal cost-utility analyses (CUAs) often only consider either maternal or child health outcomes. Challenges include, but are not limited to, measuring fetal, newborn, and infant health outcomes, and assessing their impact on maternal HRQoL. It is also important to recognize the impact of maternal-perinatal health on family members' HRQoL (i.e., family spillover effects) and to incorporate these effects in maternal-perinatal CUAs. OBJECTIVE The aim was to systematically review the methods used to include health outcomes of pregnant women, fetuses, and children and to incorporate family spillover effects in maternal-perinatal CUAs. METHODS A literature search was conducted in Medline, Embase, EconLit, Cochrane Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Network of Agencies for Health Technology Assessment (INAHTA), and the Pediatric Economic Database Evaluation (PEDE) databases from inception to 2020 to identify maternal-perinatal CUAs that included health outcomes for pregnant women, fetuses, and/or children. The search was updated to December 2022 using PEDE. Data describing how the health outcomes of mothers, fetuses, and children were measured, incorporated, and reported along with the data on family spillover effects were extracted. RESULTS Out of 174 maternal-perinatal CUAs identified, 62 considered the health outcomes of pregnant women, and children. Among the 54 quality-adjusted life year (QALY)-based CUAs, 12 included fetal health outcomes, the impact of fetal loss on mothers' HRQoL, and the impact of neonatal demise on mothers' HRQoL. Four studies considered fetal health outcomes and the effects of fetal loss on mothers' HRQoL. One study included fetal health outcomes and the impact of neonatal demise on maternal HRQoL. Furthermore, six studies considered the impact of neonatal demise on maternal HRQoL, while four included fetal health outcomes. One study included the impact of fetal loss on maternal HRQoL. The remaining 26 only included the health outcomes of pregnant women and children. Among the eight disability-adjusted life year (DALY)-based CUAs, two measured fetal health outcomes. Out of 174 studies, only one study included family spillover effects. The most common measurement approach was to measure the health outcomes of pregnant women and children separately. Various approaches were used to assess fetal losses in terms of QALYs or DALYs and their impact on HRQoL of mothers. The most common integration approach was to sum the QALYs or DALYs for pregnant women and children. Most studies reported combined QALYs and incremental QALYs, or DALYs and incremental DALYs, at the family level for pregnant women and children. CONCLUSIONS Approximately one-third of maternal-perinatal CUAs included the health outcomes of pregnant women, fetuses, and/or children. Future CUAs of maternal-perinatal interventions, conducted from a societal perspective, should aim to incorporate health outcomes for mothers, fetuses, and children when appropriate. The various approaches used within these CUAs highlight the need for standardized measurement and integration methods, potentially leading to rigorous and standardized inclusion practices, providing higher-quality evidence to better inform decision-makers about the costs and benefits of maternal-perinatal interventions. Health Technology Assessment agencies may consider providing guidance for interventions affecting future lives in future updates.
Collapse
Affiliation(s)
- Ramesh Lamsal
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada.
| |
Collapse
|
30
|
Chien MC, Huang CY, Wang JH, Shih CL, Wu P. Effects of vitamin D in pregnancy on maternal and offspring health-related outcomes: An umbrella review of systematic review and meta-analyses. Nutr Diabetes 2024; 14:35. [PMID: 38816412 PMCID: PMC11139885 DOI: 10.1038/s41387-024-00296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Vitamin D deficiency has been linked with several adverse maternal and fetal outcomes. OBJECTIVE To summarize systematic reviews and meta-analyses evaluating the effects of vitamin D deficiency and of vitamin D supplementation in pregnancy on maternal and offspring health-related outcomes. METHODS Prior to conducting this umbrella review, we registered the protocol in PROSPERO (CRD42022368003). We conducted searches in PubMed, Embase, and Cochrane Library for systematic reviews and meta-analyses on vitamin D in pregnancy, from database inception to October 2, 2023. All outcomes related to vitamin D in pregnancy obtained from the systematic reviews and meta-analyses were extracted. DATA EXTRACTION Two reviewers independently chose studies and collected information on health outcomes. The quality of the included articles' methodology was assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews-2). RESULTS We identified 16 eligible systematic reviews and meta-analyses, which included 250,569 women. Our results demonstrated that vitamin D deficiency in pregnancy is associated with increased risk of preterm birth, small-for gestational age/low birth weight infants, recurrent miscarriage, bacterial vaginosis and gestational diabetes mellitus. Vitamin D supplementation in pregnancy increases birth weight, and reduces the risk of maternal pre-eclampsia, miscarriage, and vitamin D deficiency, fetal or neonatal mortality, as well as attention-deficit hyperactivity disorder, and autism spectrum disorder in childhood. In women with gestational diabetes mellitus, vitamin D supplementation in pregnancy can reduce the risk of maternal hyperbilirubinemia, polyhydramnios, macrosomia, fetal distress, and neonatal hospitalization. CONCLUSION Due to the association with adverse maternal and offspring health outcomes, we recommend the vitamin D status in pregnancy should be monitored, particularly in women at high risk of vitamin D deficiency. It is suggested that pregnant women take a dose of >400 IU/day of vitamin D supplementation during pregnancy to prevent certain adverse outcomes.
Collapse
Affiliation(s)
- Mei-Chun Chien
- Department of Rehabilitation, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
| | - Chueh-Yi Huang
- Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
| | - Jie-Huei Wang
- Department of Mathematics, National Chung Cheng University, Chia-Yi, Taiwan.
| | - Chia-Lung Shih
- Clinical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan.
| | - Pensee Wu
- School of Medicine, Keele University, Staffordshire, UK
- Academic Department of Obstetrics and Gynaecology, University Hospital of North Midlands, Stoke-on-Trent, UK
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
31
|
Queirós A, Domingues S, Gomes L, Pereira I, Brito M, Cohen Á, Alves M, Papoila AL, Simões T. First-trimester uterine artery Doppler and hypertensive disorders in twin pregnancies: Use of twin versus singleton references. Int J Gynaecol Obstet 2024. [PMID: 38800867 DOI: 10.1002/ijgo.15706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/13/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To determine the association of first-trimester uterine artery Doppler with hypertensive disorders of pregnancy in twin pregnancies. METHODS This was a retrospective cohort study of twin pregnancies followed at the University Hospital Center of Central Lisbon, Portugal, between January 2010 and December 2022. First-trimester uterine artery pulsatility index (UtA-PI) was determined and compared between twin pregnancies (n = 454) and singleton pregnancies (n = 908), matched to maternal and pregnancy characteristics. Maternal characteristics and mean UtA-PI were analyzed for gestational age, birth weight, gestational hypertension, early- and late-onset pre-eclampsia, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, and preterm birth. Univariable and multivariable logistic regression models were used. RESULTS The mean first-trimester UtA-PI was significantly lower in dichorionic twins than in singletons (P < 0.001). To study hypertensive disorders of pregnancy in twins, 390 pregnancies were included: 311 (79.7%) dichorionic and 79 (20.3%) monochorionic twins. The observed rates of early- and late-onset pre-eclampsia, gestational hypertension, and HELLP syndrome were 1.0%, 4.4%, 7.4%, and 1.5%, respectively. We achieved a 100% detection rate for early-onset pre-eclampsia using the UtA-PI 90th centile for twins. However, when singleton references were considered, the detection rate decreased to 50%. UtA-PI at or above the 95th centile was associated with increased odds for preterm birth before 32 weeks (adjusted odds ratio 4.1, 95% confidence interval 1.0-16.7, P = 0.043). CONCLUSIONS Unless other major risk factors for hypertensive disorders are present, women with low UtA-PI will probably not benefit from aspirin prophylaxis. Close monitoring of all twin pregnancies for hypertensive disorders is still recommended.
Collapse
Affiliation(s)
- Alexandra Queirós
- Fetal Medicine and Surgery Center, University Hospital Center of Central Lisbon, Centro Clínico Académico de Lisboa, Lisbon, Portugal
- Maternal and Fetal Medicine Unit, University Hospital Center of Central Lisbon, Centro Clínico Académico de Lisboa, Lisbon, Portugal
- Nova Medical School, Nova University Lisbon, Lisbon, Portugal
| | - Sofia Domingues
- Obstetrics and Gynecology Unit, Setubal Hospital Center, Setubal, Portugal
| | - Laura Gomes
- Maternal and Fetal Medicine Unit, University Hospital Center of Central Lisbon, Centro Clínico Académico de Lisboa, Lisbon, Portugal
| | - Inês Pereira
- Maternal and Fetal Medicine Unit, University Hospital Center of Central Lisbon, Centro Clínico Académico de Lisboa, Lisbon, Portugal
| | - Marta Brito
- Maternal and Fetal Medicine Unit, University Hospital Center of Central Lisbon, Centro Clínico Académico de Lisboa, Lisbon, Portugal
| | - Álvaro Cohen
- Fetal Medicine and Surgery Center, University Hospital Center of Central Lisbon, Centro Clínico Académico de Lisboa, Lisbon, Portugal
| | - Marta Alves
- Nova Medical School, Nova University Lisbon, Lisbon, Portugal
- Epidemiology and Statistics Unit, University Hospital Center of Central Lisbon, Lisbon, Portugal
- University of Lisbon Center of Statistics and Its Applications, Lisbon, Portugal
| | - Ana Luísa Papoila
- Nova Medical School, Nova University Lisbon, Lisbon, Portugal
- Epidemiology and Statistics Unit, University Hospital Center of Central Lisbon, Lisbon, Portugal
- University of Lisbon Center of Statistics and Its Applications, Lisbon, Portugal
| | - Teresinha Simões
- Maternal and Fetal Medicine Unit, University Hospital Center of Central Lisbon, Centro Clínico Académico de Lisboa, Lisbon, Portugal
- Nova Medical School, Nova University Lisbon, Lisbon, Portugal
| |
Collapse
|
32
|
Salmeri N, Alteri A, Farina A, Pozzoni M, Vigano' P, Candiani M, Cavoretto PI. Preterm birth in singleton pregnancies conceived by in vitro fertilization or intracytoplasmic sperm injection: an overview of systematic reviews. Am J Obstet Gynecol 2024:S0002-9378(24)00623-9. [PMID: 38796038 DOI: 10.1016/j.ajog.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND The rate of preterm birth of singletons conceived through in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is increased, being as high as 15% to 16% across Europe and the United States. However, the underlying etiology, phenotype, and mechanisms initiating preterm birth (PTB) are poorly understood. OBJECTIVE To quantify the PTB risk and examine supposed etiology in IVF/ICSI singleton pregnancies compared to naturally conceived. STUDY DESIGN Overview of reviews including all available systematic reviews with meta-analysis comparing PTB risk in IVF/ICSI and naturally conceived singletons. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases was performed up to December 31, 2023. Information available on etiology, phenotype, initiation of PTB, and relevant moderators was retrieved and employed for subgroup analyses. Random-effects meta-analysis models were used for pooling effect measures. Estimates were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The extent of overlap in the original studies was measured using the corrected covered area assessment. The quality of the included reviews was evaluated with the AMSTAR 2 tool. The Grading of Recommendations Assessment, Development and Evaluation approach was applied to rate evidence certainty. The protocol was registered on PROspective Register of Systematic Reviews (CRD42023411418). RESULTS Twelve meta-analyses (16,522,917 pregnancies; ˃433,330 IVF/ICSI) were included. IVF/ICSI singletons showed a significantly higher PTB risk compared to natural conception (PTB ˂37 weeks: OR: 1.72, 95% CI: 1.57-1.89; PTB<32 weeks: OR: 2.19, 95% CI: 1.82-2.64). Influential analysis reinforced the strength of this association. Subgroup analyses investigating supposed etiology revealed a comparable risk magnitude for spontaneous PTB (OR: 1.79, 95% CI: 1.56-2.04) and a greater risk for iatrogenic PTB (OR: 2.28, 95% CI: 1.72-3.02). PTB risk was consistent in the subgroup of conventional IVF (OR: 1.95, 95% CI: 1.76-2.15) and higher in the subgroup of fresh only (OR: 1.79, 95% CI: 1.55-2.07) vs frozen-thawed embryo transfers (OR: 1.39, 95% CI: 1.34-1.43). There was minimal study overlap (13%). The certainty of the evidence was graded as low to very low. CONCLUSION Singletons conceived through IVF/ICSI have a 2-fold increased risk of PTB compared to natural conception, despite the low certainty of the evidence. There is paucity of available data on PTB etiology, phenotype, or initiation. The greater risk increase is observed in fresh embryo transfers and involves iatrogenic PTB and PTB ˂32 weeks, likely attributable to placental etiology. Future studies should collect data on PTB etiology, phenotype, and initiation. IVF/ICSI pregnancies should undertake specialistic care with early screening for placental disorders, cervical length, and growth abnormalities, allowing appropriate timely follow-up, preventive measures, and therapeutic interventions strategies.
Collapse
Affiliation(s)
- Noemi Salmeri
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Alteri
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Farina
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mirko Pozzoni
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Vigano'
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Ivo Cavoretto
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| |
Collapse
|
33
|
Borbolla Foster A, Haxton J, Bennett N, Hyett J, Park F. Redesigning antenatal care: Prospective use of an implementation framework to establish a population-based multidisciplinary first-trimester screening, assessment and prevention service. Aust N Z J Obstet Gynaecol 2024. [PMID: 38779915 DOI: 10.1111/ajo.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Australian rates of adverse obstetric outcomes have improved little despite guidelines recommending history-based screening and intervention. The first trimester provides a unique opportunity to predict and prevent complications, yet population-based screening has failed to be translated into broad clinical practice. AIMS This study aimed to redesign antenatal care within an Australian public healthcare centre to align with evidence-based maternity care, including population-based first-trimester screening with early initiation of preventative strategies in high-risk pregnancies. METHODS A five-phase action-process model, sharing key elements with implementation science theory, was used to explore barriers to change in antenatal care, co-design a novel service with consumers and establish a population-based antenatal pathway commencing with a multidisciplinary first-trimester screening, assessment and planning visit. RESULTS The case for change and associated barriers were defined from the perspective of antenatal care stakeholders. Key needs of each group were established, and solutions were created using co-design methodology, allowing the team to create a novel approach to antenatal care which directly addressed identified barriers. Implementation of the service was associated with a fall in the median gestation at first specialist maternity care provider visit from 20 to 13 weeks. CONCLUSIONS This study confirms the feasibility of establishing a comprehensive first-trimester screening program within a public Australian healthcare setting and highlights a co-design process which places individualised assessment at the forefront of antenatal care. This framework may be applicable to most public maternity settings in Australia, with expansion aimed at providing equity of care, including in rural and remote settings.
Collapse
Affiliation(s)
- Ailsa Borbolla Foster
- Department of Maternity and Gynaecology, John Hunter Hospital, New Lambton Hts, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jennifer Haxton
- Department of Maternity and Gynaecology, John Hunter Hospital, New Lambton Hts, New South Wales, Australia
| | - Nicole Bennett
- Department of Maternity and Gynaecology, John Hunter Hospital, New Lambton Hts, New South Wales, Australia
| | - Jon Hyett
- Ingham Institute, Faculty of Medicine, Western Sydney University, Liverpool, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Felicity Park
- Department of Maternity and Gynaecology, John Hunter Hospital, New Lambton Hts, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
34
|
林 婵, 陈 静, 赵 晓. [Genetic Causation Analysis of Hyperandrogenemia Testing Indicators and Preeclampsia]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:566-573. [PMID: 38948277 PMCID: PMC11211795 DOI: 10.12182/20240560106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Indexed: 07/02/2024]
Abstract
Objective Some epidemiological studies have shown that pregnant women who develop preeclampsia (PE) have elevated levels of testosterone in their maternal plasma compared to women with normal blood pressure during pregnancy, revealing a potential association between hyperandrogenism in women and PE. To explore the causal relationship between hyperandrogenism and PE, this study selected total testosterone (TT), bioavailable testosterone (BIOT), and sex hormone binding globulin (SHBG) as exposure factors and PE and chronic hypertension with superimposed PE as disease outcomes. Two-sample Mendelian randomization (MR) analyses were used to genetically dissect the causal relationships between the three exposure factors (TT, BIOT, and SHBG) and the outcomes of PE and chronic hypertension with superimposed PE. Methods Two independent genome-wide association study (GWAS) databases were used for the two-sample MR analysis. In the GWAS data of female participants from the UK Biobank cohort, single nucleotide polymorphisms (SNPs) associated with TT, BIOT, and SHBG were analyzed, involving 230454, 188507, and 188908 samples, respectively. GWAS data on PE and chronic hypertension with superimposed PE from the Finnish database were used to calculate SNP, involving 3556 PE cases and 114735 controls, as well as 38 cases of chronic hypertension with superimposed PE and 114735 controls. To meet the assumptions of instrumental relevance and independence in MR analysis, SNPs associated with exposure were identified at the genome-wide level (P<5.0×10-8), and those in linkage disequilibrium interference were excluded based on clustering thresholds of R 2<0.001 and an allele distance greater than 10000 kb. Known confounding factors, including previous PE, chronic kidney disease, chronic hypertension, diabetes, systemic lupus erythematosus, or antiphospholipid syndrome, were also identified and the relevant SNPs were removed. Finally, we extracted the outcome data based on the exposure-related SNPs in the outcome GWAS, integrating exposure and outcome data, and removing palindromic sequences. Five genetic causal analysis methods, including inverse variance-weighted method (IVW), MR-Egger regression, weighted median method, simple mode method, and weighted mode method, were used to infer causal relationships. In the IVW, it was assumed that the selected SNPs satisfied the three assumptions and provided the most ideal estimate of the effect. IVW was consequently used as the primary analysis method in this study. Considering the potential heterogeneity among the instrumental variables, random-effects IVW was used for MR analysis. The results were interpreted using odds ratios (OR) and the corresponding 95% confidence interval (CI) to explain the impact of exposure factors on PE and chronic hypertension with superimposed PE. If the CI did not include 1 and had a P value less than 0.05, the difference was considered statistically significant. Sensitivity analysis was conducted to assess heterogeneity and pleiotropy. Heterogeneity was examined using Cochran's Q test, and pleiotropy was assessed using MR-Egger intercept analysis. Additionally, leave-one-out analysis was conducted to examine whether individual SNPs were driving the causal associations. To further validate the findings, MR analyses were performed using the same methods and outcome variables, but with different exposure factors, including waist-to-hip ratio adjusted for BMI (WHRadjBMI) and 25-hydroxyvitamin D levels, with MR results for WHRadjBMI and PE serving as the positive controls and MR results for 25-hydroxyvitamin D levels and PE as the negative controls. Results According to the criteria for selecting genetic instrumental variables, 186, 127, and 262 SNPs were identified as genetic instrumental variables significantly associated with testosterone indicators TT, BIOT, and SHBG. MR analysis did not find a causal relationship between the TT, BIOT, and SHBG levels and the risk of developing PE and chronic hypertension with superimposed PE. The IVW method predicted that genetically predicted TT (OR [95% CI]=1.018 [0.897-1.156], P=0.78), BIOT (OR [95% CI]=1.11 [0.874-1.408], P=0.392), and SHBG (OR [95% CI]=0.855 [0.659-1.109], P=0.239) were not associated with PE. Similarly, genetically predicted TT (OR [95% CI]=1.222 [0.548-2.722], P=0.624), BIOT (OR [95% CI]=1.066 [0.242-4.695], P=0.933), and SHBG (OR [95% CI]=0.529 [0.119-2.343], P=0.402) were not significantly associated with chronic hypertension with superimposed PE. Additionally, MR analysis using the MR-Egger method, weighted median method, simple mode method, and weighted mode method yielded consistent results, indicating no significant causal relationship between elevated testosterone levels and PE or chronic hypertension with superimposed PE. Heterogeneity was observed for SHBG in the analysis with PE (Cochran's Q test, P=0.01), and pleiotropy was detected for BIOT in the analysis with PE (MR-Egger intercept analysis, P=0.014), suggesting that the instrumental variables did not affect PE through BIOT. Other instrumental variables did not show significant heterogeneity or pleiotropy. Leave-one-out analysis confirmed that the results of the MR analysis were not driven by individual instrumental variables. Consistent with previous MR studies, the results of the control MR analyses using WHRadjBMI and 25-hydroxyvitamin D levels supported the accuracy of the MR analysis approach and the methods used in this study. Conclusion The MR analysis results suggest that current genetic evidence does not support a causal relationship between TT, BIOT, and SHBG levels and the development of PE and chronic hypertension with superimposed PE. This study suggests that elevated testosterone may be a risk factor for PE but not a direct cause.
Collapse
Affiliation(s)
- 婵余 林
- 广东药科大学 (广州 510006)Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - 静波 陈
- 广东药科大学 (广州 510006)Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - 晓苗 赵
- 广东药科大学 (广州 510006)Guangdong Pharmaceutical University, Guangzhou 510006, China
- 广东省人民医院 (广州 510000)Reproductive Center of Guangdong Provincial People's Hospital, Guangzhou 510000, China
| |
Collapse
|
35
|
Biswas S, Singh R, Radhika AG. Association between migraine and pre-eclampsia among pregnant women: a single hospital-based case-control study in India. BMC Pregnancy Childbirth 2024; 24:373. [PMID: 38755536 PMCID: PMC11100195 DOI: 10.1186/s12884-024-06567-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Pre-eclampsia and migraine share some similar aspects of pathophysiology such as vascular function, platelet activation, and enhanced clotting. A few observational studies from different demographics showed that pregnant women with a history of migraine were at higher risk of developing pre-eclampsia. However, there is no such evidence available from the Indian context. Hence, a hospital-based case-control study was conducted among Indian women to determine the association between migraine and pre-eclampsia. METHOD It was a single-centre case-control study in a tertiary care hospital in India. Cases were pregnant women with clinically diagnosed pre-eclampsia, and controls were normotensive pregnant women. Migraine was diagnosed with a questionnaire adapted from the "International Classification of Headache Disorders (ICHD), 3rd Edition" by the International Headache Society, (IHS). We performed logistic regression to explore the association between migraine and pre-eclampsia. RESULT One hundred sixty-four women (82 women per group) were enrolled. The mean age among the cases (24.5 years, standard deviation of 2.4 years) was slightly higher than the mean age of the controls (23.5 years, standard deviation of 2.5 years) with a p-value of 0.006. We found that women with a history of migraine were more likely to develop pre-eclampsia (Adjusted Odds Ratio 6.17; p-value < 0.001, 95% Confidence Interval of 2.85 to 13.62). CONCLUSION The current findings suggest a significant association between migraine and pre-eclampsia aligning with previous study findings; nevertheless, larger follow-up studies including women from different states in India are needed.
Collapse
Affiliation(s)
| | | | - A G Radhika
- University College of Medical Science & GTB Hospital, Delhi, India
| |
Collapse
|
36
|
Manoharan A, Ballambattu VB, Palani R. Genetic architecture of preeclampsia. Clin Chim Acta 2024; 558:119656. [PMID: 38583550 DOI: 10.1016/j.cca.2024.119656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Aarthi Manoharan
- Department of Medical Biotechnology, Kirumampakkam, Puducherry 607403, India.
| | | | - Ramya Palani
- Department of Obstetrics and Gynecology, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation (DU), Kirumampakkam, Puducherry 607403, India
| |
Collapse
|
37
|
Alemayehu E, Mohammed O, Belete MA, Mulatie Z, Debash H, Gedefie A, Weldehanna DG, Eshetu B, Shibabaw A, Tekele SG, Tilahun M, Ebrahim H. Association of prothrombin time, thrombin time and activated partial thromboplastin time levels with preeclampsia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:354. [PMID: 38741046 DOI: 10.1186/s12884-024-06543-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Preeclampsia (PE), an obstetric disorder, remains one of the leading causes of maternal and infant mortality worldwide. In individuals with PE, the coagulation-fibrinolytic system is believed to be among the most significantly impacted systems due to maternal inflammatory responses and immune dysfunction. Therefore, this systematic review and meta-analysis aimed to assess the association of prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT) levels with preeclampsia. METHODS This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Articles relevant to the study, published from July 26, 2013, to July 26, 2023, were systematically searched across various databases including PubMed, Scopus, Embase, and Hinari. The methodological quality of the articles was evaluated using the Joanna Briggs Institute critical appraisal checklist. Utilizing Stata version 14.0, a random-effects model was employed to estimate the pooled standardized mean difference (SMD) along with the respective 95% CIs. The I2 statistics and Cochrane Q test were utilized to assess heterogeneity, while subgroup analyses were performed to explore its sources. Furthermore, Egger's regression test and funnel plot were employed to assess publication bias among the included studies. RESULTS A total of 30 articles, involving 5,964 individuals (2,883 with PE and 3,081 as normotensive pregnant mothers), were included in this study. The overall pooled SMD for PT, APTT, and TT between PE and normotensive pregnant mothers were 0.97 (95% CI: 0.65-1.29, p < 0.001), 1.05 (95% CI: 0.74-1.36, p < 0.001), and 0.30 (95% CI: -0.08-0.69, p = 0.11), respectively. The pooled SMD indicates a significant increase in PT and APTT levels among PE patients compared to normotensive pregnant mothers, while the increase in TT levels among PE patients was not statistically significant. CONCLUSIONS The meta-analysis underscores the association between PE and prolonged PT and APTT. This suggests that evaluating coagulation parameters like PT, APTT, and TT in pregnant women could offer easily accessible and cost-effective clinical indicators for assessing PE. However, multicenter longitudinal studies are needed to evaluate their effectiveness across various gestational weeks of pregnancy.
Collapse
Affiliation(s)
- Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Ousman Mohammed
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zewudu Mulatie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Daniel Gebretsadik Weldehanna
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bruktawit Eshetu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Agumas Shibabaw
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Saba Gebremichael Tekele
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hussen Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
38
|
Ip PNP, Nguyen-Hoang L, Chaemsaithong P, Guo J, Wang X, Sahota DS, Chung JPW, Poon LCY. Ultrasonographic placental parameters at 11-13+6 weeks' gestation in the prediction of complications in pregnancy after assisted reproductive technology. Taiwan J Obstet Gynecol 2024; 63:341-349. [PMID: 38802197 DOI: 10.1016/j.tjog.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To evaluate the performance of maternal factors, biophysical and biochemical markers at 11-13 + 6 weeks' gestation in the prediction of gestational diabetes mellitus with or without large for gestational age (GDM ± LGA) fetus and great obstetrical syndromes (GOS) among singleton pregnancy following in-vitro fertilisation (IVF)/embryo transfer (ET). MATERIALS AND METHODS A prospective cohort study was conducted between December 2017 and January 2020 including patients who underwent IVF/ET. Maternal mean arterial pressure (MAP), ultrasound markers including placental volume, vascularisation index (VI), flow index (FI) and vascularisation flow index (VFI), mean uterine artery pulsatility index (mUtPI) and biochemical markers including placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured at 11-13 + 6 weeks' gestation. Logistic regression analysis was performed to determine the significant predictors of complications. RESULTS Among 123 included pregnancies, 38 (30.9%) had GDM ± LGA fetus and 28 (22.8%) had GOS. The median maternal height and body mass index were significantly higher in women with GDM ± LGA fetus. Multivariate logistic regression analysis demonstrated that in the prediction of GDM ± LGA fetus and GOS, there were significant independent contributions from FI MoM (area under curve (AUROC) of 0.610, 95% CI 0.492-0.727; p = 0.062) and MAP MoM (AUROC of 0.645, 95% CI 0.510-0.779; p = 0.026), respectively. CONCLUSION FI and MAP are independent predictors for GDM ± LGA fetus and GOS, respectively. However, they have low predictive value. There is a need to identify more specific novel biomarkers in differentiating IVF/ET pregnancies that are at a higher risk of developing complications.
Collapse
Affiliation(s)
- Patricia Nga Ping Ip
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Long Nguyen-Hoang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Mahidol University, Bangkok, Thailand
| | - Jun Guo
- Department of Obstetrics and Gynaecology, Beijing Tongren Hospital, The Capital Medical University, Beijing, China
| | - Xueqin Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Daljit Singh Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Liona Chiu Yee Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
39
|
Hauge MG, Linde JJ, Kofoed KF, Ersbøll AS, Johansen M, Sigvardsen PE, Fuchs A, Mikkelsen AP, Gustafsson F, Damm P. Early-onset vs late-onset preeclampsia and risk of coronary atherosclerosis later in life: a clinical follow-up study. Am J Obstet Gynecol MFM 2024; 6:101371. [PMID: 38588914 DOI: 10.1016/j.ajogmf.2024.101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Younger women with previous preeclampsia have an increased risk of coronary atherosclerosis. It is unknown if this risk is associated with the time of onset of preeclampsia. OBJECTIVE This study aimed to investigate if women with early-onset preeclampsia have a higher risk of coronary atherosclerosis compared with women with late-onset preeclampsia, independent of other perinatal risk factors. STUDY DESIGN A total of 911 women with previous preeclampsia aged 35 to 55 years participated in a clinical follow-up study, including clinical examination, comprehensive questionnaires, and cardiac computed tomography scan 13 years (range, 0-28) after index pregnancy. Early- and late-onset preeclampsia were defined as gestational age at delivery of <34+0 and ≥34+0 gestational weeks, respectively. The primary outcome of the study was the presence of coronary atherosclerosis on the cardiac computed tomography. A logistic regression analysis was performed to investigate the association between time of onset of preeclampsia, perinatal risk factors, and the primary outcome. RESULTS Women with early-onset preeclampsia (N=139) were older (46.2±5.7 vs 44.4±5.5 years; P<.001), more likely to have hypertension (51.1% vs 35.1%; P≤.001), and had a higher body mass index (27.9±6.3 vs 26.9±5.5 kg/m2; P=.051) compared with women with late-onset preeclampsia (N=772) at follow-up. The prevalence of the primary outcome (coronary atherosclerosis) on the cardiac computed tomography among women with early- and late-onset preeclampsia was 28.8% vs 22.2%, respectively (P=.088; adjusted odds ratio, 1.74; 95% confidence interval, 1.01-3.01; P=.045 after adjustment for maternal age at index pregnancy, prepregnancy body mass index, parity, diabetes in pregnancy, smoking in pregnancy, offspring birthweight and sex, and follow-up length). CONCLUSION Women with early-onset preeclampsia had a slightly higher risk of coronary atherosclerosis compared with women with late-onset preeclampsia. However, according to the current evidence, it does not seem indicated to limit screening, diagnostic, and preventive measures for cardiovascular disease only to women with early-onset preeclampsia.
Collapse
Affiliation(s)
- Maria G Hauge
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Hauge, Ersbøll, Johansen, Mikkelsen, and Damm); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Drs Hauge, Kofoed, Gustafsson, and Damm).
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Linde, Kofoed, Sigvardsen, Fuchs, and Gustafsson)
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Linde, Kofoed, Sigvardsen, Fuchs, and Gustafsson); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Drs Hauge, Kofoed, Gustafsson, and Damm); Department of Radiology, The Diagnostic Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Dr Kofoed)
| | - Anne S Ersbøll
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Hauge, Ersbøll, Johansen, Mikkelsen, and Damm)
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Hauge, Ersbøll, Johansen, Mikkelsen, and Damm)
| | - Per E Sigvardsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Linde, Kofoed, Sigvardsen, Fuchs, and Gustafsson)
| | - Andreas Fuchs
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Linde, Kofoed, Sigvardsen, Fuchs, and Gustafsson)
| | - Anders P Mikkelsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Hauge, Ersbøll, Johansen, Mikkelsen, and Damm); Department of Gynaecology and Obstetrics, Herlev-Gentofte University Hospital, Herlev, Denmark (Dr Mikkelsen)
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Linde, Kofoed, Sigvardsen, Fuchs, and Gustafsson); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Drs Hauge, Kofoed, Gustafsson, and Damm)
| | - Peter Damm
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Hauge, Ersbøll, Johansen, Mikkelsen, and Damm); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Drs Hauge, Kofoed, Gustafsson, and Damm)
| |
Collapse
|
40
|
Pimentel VM, Larrea ADA, Renaud SJ, Sloan S, Figueroa R, Wakefield D, Crowell R. Feasibility of Universal Screening for Preeclampsia Risk and Aspirin Recommendation in the Ultrasound Unit. Am J Perinatol 2024; 41:e3187-e3195. [PMID: 38101442 DOI: 10.1055/s-0043-1777445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To evaluate the feasibility and impact of using the first-trimester ultrasound visit to identify and counsel women at increased risk of preeclampsia about the benefits of low-dose aspirin (LDA) for preventing preeclampsia. We also assessed patient-reported utilization of LDA, perceived risk for preeclampsia, and clinical outcomes. STUDY DESIGN Women presenting for routine first-trimester nuchal-translucency (NT) ultrasounds were screened for clinical preeclampsia risks using a self-administered risk assessment. Women at moderate or high risk for preeclampsia were counseled to take LDA, if not already taking it. LDA utilization and perceived risk for preeclampsia were assessed during the second-trimester ultrasound. Factors associated with LDA utilization were analyzed. Pregnancy outcomes were compared between those who used LDA and those who did not. RESULTS Slightly more than 20% of patients (765/3,669) screened at increased risk for developing preeclampsia. Of those, 67.8% (519/765) had not received LDA recommendations from their referring obstetrician and 97 had not been taking LDA despite being advised to do so. Combined, 94.6% (583/616) of these patients eligible to start LDA prophylaxis received the indicated counseling during the ultrasound visit. A total of 61.4% (358/583) of women completed the follow-up form and of those 77.9% (279/358) reported taking LDA. Screening at increased risk for preeclampsia and perception of increased risk were positively associated with LDA utilization, whereas concerns for LDA safety were negatively associated with use. African American/Black patients and Medicaid recipients were less likely to use LDA. Pregnancy outcomes were similar between those who used LDA and those who did not. CONCLUSION Assessing preeclampsia risk and counseling patients about LDA at the time of the NT ultrasound are feasible in the ultrasound unit and led to good LDA utilization among women at increased risk for preeclampsia. This intervention may standardize patient care and help close the disparity in maternal health. KEY POINTS · A simple intervention captured 2/3 of eligible patients.. · Aspirin utilization rate was good after the intervention.. · Screening high risk for preeclampsia and self-perception of risk correlated with aspirin use..
Collapse
Affiliation(s)
- Verónica Maria Pimentel
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford Connecticut
- Department of Obstetrics and Gynecology, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Alexander D Almeida Larrea
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford Connecticut
| | - Sophie J Renaud
- Department of Obstetrics and Gynecology, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Sophie Sloan
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford Connecticut
| | - Reinaldo Figueroa
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford Connecticut
- Department of Obstetrics and Gynecology, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Dorothy Wakefield
- Department of Research, Saint Francis Hospital and Medical Center, Hartford, Connecticut
| | - Rebecca Crowell
- Department of Research, Saint Francis Hospital and Medical Center, Hartford, Connecticut
| |
Collapse
|
41
|
Lian IA, Dypdalsbakk T, Åsberg A. Stability of serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1). Scand J Clin Lab Invest 2024; 84:160-167. [PMID: 38669234 DOI: 10.1080/00365513.2024.2340037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/05/2024] [Indexed: 04/28/2024]
Abstract
Placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) are biomarkers used for diagnosis and risk estimation of preeclampsia. Stability in room temperature (RT) may affect the usefulness of these analyses, as shipping at ambient temperature is the most practical and suitable way to ship samples. To date, scientific studies of such stability are lacking. We aimed to assess the stability of PlGF and sFlt-1 at RT in serum from pregnant women. In addition, a smaller study of stability at 4 °C was performed. Serum was collected from 69 pregnant women and stored at RT or at 4 °C for up to 192 h. Analytes were considered stable if the mean percent change ± 90 confidence interval of the mean was within the baseline concentration ± allowable bias. Allowable bias was calculated from data on biological variation. In addition, an instability equation was calculated to assess loss of stability, in line with recent European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recommendations. The mean percent change was <3.5% for PlGF, <1% for sFlt-1 and <4.5% for sFlt-1/PlGF ratio up to 192 h. PlGF was considered stable for 168 h, and sFlt-1 and sFlt-1/PlGF ratios were considered stable for 192 h at RT. At 4 °C, PlGF was considered stable for 120 h, sFlt-1 for 168 h and sFlt-1/PlGF ratio for 120 h. Both PlGF and sFlt-1 as well as sFlt-1/PlGF ratio show sufficient stability (minimum 168 h) for samples to be shipped at RT.
Collapse
Affiliation(s)
- Ingrid Alsos Lian
- Department of Clinical Chemistry, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone Dypdalsbakk
- Department of Clinical Chemistry, Trondheim University Hospital, Trondheim, Norway
| | - Arne Åsberg
- Department of Clinical Chemistry, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
42
|
Rezende KBDC, Bornia RG, Rolnik DL, Amim J, Ladeira LP, Teixeira VM, da Cunha AJL. Performance of the first-trimester Fetal Medicine Foundation competing risks model for preeclampsia prediction: an external validation study in Brazil. AJOG GLOBAL REPORTS 2024; 4:100346. [PMID: 38694483 PMCID: PMC11061323 DOI: 10.1016/j.xagr.2024.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The current version of the Fetal Medicine Foundation competing risks model for preeclampsia prediction has not been previously validated in Brazil. OBJECTIVE This study aimed (1) to validate the Fetal Medicine Foundation combined algorithm for the prediction of preterm preeclampsia in the Brazilian population and (2) to describe the accuracy and calibration of the Fetal Medicine Foundation algorithm when considering the prophylactic use of aspirin by clinical criteria. STUDY DESIGN This was a cohort study, including consecutive singleton pregnancies undergoing preeclampsia screening at 11 to 14 weeks of gestation, examining maternal characteristics, medical history, and biophysical markers between October 2010 and December 2018 in a university hospital in Brazil. Risks were calculated using the 2018 version of the algorithm available on the Fetal Medicine Foundation website, and cases were classified as low or high risk using a cutoff of 1/100 to evaluate predictive performance. Expected and observed cases with preeclampsia according to the Fetal Medicine Foundation-estimated risk range (≥1 in 10; 1 in 11 to 1 in 50; 1 in 51 to 1 in 100; 1 in 101 to 1 in 150; and <1 in 150) were compared. After identifying high-risk pregnant women who used aspirin, the treatment effect of 62% reduction in preterm preeclampsia identified in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial was used to evaluate the predictive performance adjusted for the effect of aspirin. The number of potentially unpreventable cases in the group without aspirin use was estimated. RESULTS Among 2749 pregnancies, preterm preeclampsia occurred in 84 (3.1%). With a risk cutoff of 1/100, the screen-positive rate was 25.8%. The detection rate was 71.4%, with a false positive rate of 24.4%. The area under the curve was 0.818 (95% confidence interval, 0.773-0.863). In the risk range ≥1/10, there is an agreement between the number of expected cases and the number of observed cases, and in the other ranges, the predicted risk was lower than the observed rates. Accounting for the effect of aspirin resulted in an increase in detection rate and positive predictive values and a slight decrease in the false positive rate. With 27 cases of preterm preeclampsia in the high-risk group without aspirin use, we estimated that 16 of these cases of preterm preeclampsia would have been avoided if this group had received prophylaxis. CONCLUSION In a high-prevalence setting, the Fetal Medicine Foundation algorithm can identify women who are more likely to develop preterm preeclampsia. Not accounting for the effect of aspirin underestimates the screening performance.
Collapse
Affiliation(s)
- Karina Bilda de Castro Rezende
- Clinical Medicine Postgraduate Program, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende and da Cunha)
- Maternity School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende, Bornia, Amim, and Ladeira and XX Teixeira)
- Multidisciplinary Laboratory of Epidemiology and Health – LAMPES, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Rezende and da Cunha)
| | - Rita G. Bornia
- Maternity School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende, Bornia, Amim, and Ladeira and XX Teixeira)
- Professional Master Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Bornia and Amim)
| | - Daniel L. Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia (Drs Rolnik)
| | - Joffre Amim
- Maternity School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende, Bornia, Amim, and Ladeira and XX Teixeira)
- Professional Master Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Bornia and Amim)
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Amim, XX Teixeira, and Dr da Cunha)
| | - Luiza P. Ladeira
- Maternity School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende, Bornia, Amim, and Ladeira and XX Teixeira)
- Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Ladeira)
| | - Valentina M.G. Teixeira
- Maternity School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende, Bornia, Amim, and Ladeira and XX Teixeira)
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Amim, XX Teixeira, and Dr da Cunha)
| | - Antonio Jose L.A. da Cunha
- Clinical Medicine Postgraduate Program, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende and da Cunha)
- Multidisciplinary Laboratory of Epidemiology and Health – LAMPES, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Rezende and da Cunha)
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Amim, XX Teixeira, and Dr da Cunha)
| |
Collapse
|
43
|
Zhang J, Yin B, Xi Y, Bai Y. Triglyceride-glucose index: A promising biomarker for predicting risks of adverse pregnancy outcomes in Hangzhou, China. Prev Med Rep 2024; 41:102683. [PMID: 38524277 PMCID: PMC10957496 DOI: 10.1016/j.pmedr.2024.102683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction The triglyceride-glucose (TyG) index has been recommended as an alternative indicator of insulin resistance (IR). However, the association between the TyG index and adverse pregnancy outcomes remains to be elucidated. Methods The present retrospective study was conducted at Women's Hospital, Zhejiang University School of Medicine and involved a total of 8,514 participants. Maternal fasting lipid profiles and glucose concentrations were measured. Based on the TyG index, the participants were categorized into quartiles. Logistic regression analysis was used to calculate odds ratios (ORs) for each quartile with reference to the first quartile, while receiver operating characteristic (ROC) curve analysis, Hosmer-Lemeshow test, and calibration curve analysis were employed to evaluate the predictive ability of the TyG index for adverse pregnancy outcomes. Results The TyG index was higher in patients with preeclampsia, preterm birth, and macrosomia. On univariate analysis, there was an increased risk of developing adverse pregnancy outcomes with increasing quartiles of the TyG. After adjusting for potential confounders in multivariable logistic regression analysis, a positive independent correlation was found between the TyG index and preeclampsia, preterm birth, and macrosomia. In ROC curve analysis for predicting the risks of preeclampsia, preterm birth, and macrosomia, the area under the curve (AUC) could reach 0.665, 0.588, and 0.606, respectively. These predictive models demonstrated good calibration (all P > 0.05). Conclusions The TyG index showed a good predictive capacity for assessing the risk of adverse pregnancy outcomes, and it should receive sufficient clinical attention.
Collapse
Affiliation(s)
- Jinghua Zhang
- Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Binbin Yin
- Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ya Xi
- Department of Central Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yongying Bai
- Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
44
|
Kupka E, Roberts JM, Mahdy ZA, Escudero C, Bergman L, De Oliveira L. Aspirin for preeclampsia prevention in low- and middle-income countries: mind the gaps. AJOG GLOBAL REPORTS 2024; 4:100352. [PMID: 38694484 PMCID: PMC11061325 DOI: 10.1016/j.xagr.2024.100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Preeclampsia is a syndrome that continues to be a major contributor to maternal and neonatal mortality, especially in low-income countries. Low-dose aspirin reduces the risk of preeclampsia, but the mechanism is still unknown. Risk factors to identify women at risk of preeclampsia are based on clinical characteristics. Women identified as high-risk would benefit from aspirin treatment initiated, preferably at the end of the first trimester. Current efforts have largely focused on developing screening algorithms that incorporate clinical risk factors, maternal biomarkers, and uterine artery Doppler evaluated in the first trimester. However, most studies on preeclampsia are conducted in high-income settings, raising uncertainties about whether the information gained can be totally applied in low-resource settings. In low- and middle-income countries, lack of adequate antenatal care and late commencement of antenatal care visits pose significant challenges for both screening for preeclampsia and initiating aspirin treatment. Furthermore, the preventive effect of first-trimester screening based on algorithms and subsequent aspirin treatment is primarily seen for preterm preeclampsia, and reviews indicate minimal or no impact on reducing the risk of term preeclampsia. The lack of evidence regarding the effectiveness of aspirin in preventing term preeclampsia is a crucial concern, as 75% of women will develop this subtype of the syndrome. Regarding adverse outcomes, low-dose aspirin has been linked to a possible higher risk of postpartum hemorrhage, a condition as deadly as preeclampsia in many low- and middle-income countries. The increased risk of postpartum hemorrhage among women in low-income settings should be taken into consideration when discussing which pregnant women would benefit from the use of aspirin and the ideal aspirin dosage for preventing preeclampsia. In addition, women's adherence to aspirin during pregnancy is crucial for determining its effectiveness and complications, an aspect often overlooked in trials. In this review, we analyze the knowledge gaps that must be addressed to safely increase low-dose aspirin use in low- and middle-income countries, and we propose directions for future research.
Collapse
Affiliation(s)
| | - James M. Roberts
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg (Drs Kupka and Bergman), Sweden
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna (Dr Kupka), Falun, Sweden
- Magee-Womens Research Institute (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynecology, Epidemiology and Clinical and Translational Research, University of Pittsburgh (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynaecology, University Kebangsaan Malaysia Medical Center (Dr Mahdy), Cheras, Malaysia
- Vascular Physiology Laboratory, Basic Sciences Department, Faculty of Sciences, Universidad del Bio-Bio (Dr Escudero), Chillan, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS Health) (Dr Escudero), Chillan, Chile
- Department of Women's and Children's Health, Uppsala University (Dr Bergman), Uppsala, Sweden
- Department of Obstetrics and Gynecology, Stellenbosch University (Dr Bergman), Cape Town, South Africa
- São Paulo State University (UNESP), Medical School (Dr Oliveira), Botucatu
| | - Zaleha A. Mahdy
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg (Drs Kupka and Bergman), Sweden
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna (Dr Kupka), Falun, Sweden
- Magee-Womens Research Institute (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynecology, Epidemiology and Clinical and Translational Research, University of Pittsburgh (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynaecology, University Kebangsaan Malaysia Medical Center (Dr Mahdy), Cheras, Malaysia
- Vascular Physiology Laboratory, Basic Sciences Department, Faculty of Sciences, Universidad del Bio-Bio (Dr Escudero), Chillan, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS Health) (Dr Escudero), Chillan, Chile
- Department of Women's and Children's Health, Uppsala University (Dr Bergman), Uppsala, Sweden
- Department of Obstetrics and Gynecology, Stellenbosch University (Dr Bergman), Cape Town, South Africa
- São Paulo State University (UNESP), Medical School (Dr Oliveira), Botucatu
| | - Carlos Escudero
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg (Drs Kupka and Bergman), Sweden
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna (Dr Kupka), Falun, Sweden
- Magee-Womens Research Institute (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynecology, Epidemiology and Clinical and Translational Research, University of Pittsburgh (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynaecology, University Kebangsaan Malaysia Medical Center (Dr Mahdy), Cheras, Malaysia
- Vascular Physiology Laboratory, Basic Sciences Department, Faculty of Sciences, Universidad del Bio-Bio (Dr Escudero), Chillan, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS Health) (Dr Escudero), Chillan, Chile
- Department of Women's and Children's Health, Uppsala University (Dr Bergman), Uppsala, Sweden
- Department of Obstetrics and Gynecology, Stellenbosch University (Dr Bergman), Cape Town, South Africa
- São Paulo State University (UNESP), Medical School (Dr Oliveira), Botucatu
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg (Drs Kupka and Bergman), Sweden
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna (Dr Kupka), Falun, Sweden
- Magee-Womens Research Institute (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynecology, Epidemiology and Clinical and Translational Research, University of Pittsburgh (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynaecology, University Kebangsaan Malaysia Medical Center (Dr Mahdy), Cheras, Malaysia
- Vascular Physiology Laboratory, Basic Sciences Department, Faculty of Sciences, Universidad del Bio-Bio (Dr Escudero), Chillan, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS Health) (Dr Escudero), Chillan, Chile
- Department of Women's and Children's Health, Uppsala University (Dr Bergman), Uppsala, Sweden
- Department of Obstetrics and Gynecology, Stellenbosch University (Dr Bergman), Cape Town, South Africa
- São Paulo State University (UNESP), Medical School (Dr Oliveira), Botucatu
| | - Leandro De Oliveira
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg (Drs Kupka and Bergman), Sweden
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna (Dr Kupka), Falun, Sweden
- Magee-Womens Research Institute (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynecology, Epidemiology and Clinical and Translational Research, University of Pittsburgh (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynaecology, University Kebangsaan Malaysia Medical Center (Dr Mahdy), Cheras, Malaysia
- Vascular Physiology Laboratory, Basic Sciences Department, Faculty of Sciences, Universidad del Bio-Bio (Dr Escudero), Chillan, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS Health) (Dr Escudero), Chillan, Chile
- Department of Women's and Children's Health, Uppsala University (Dr Bergman), Uppsala, Sweden
- Department of Obstetrics and Gynecology, Stellenbosch University (Dr Bergman), Cape Town, South Africa
- São Paulo State University (UNESP), Medical School (Dr Oliveira), Botucatu
| | - Global Pregnancy Collaboration
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg (Drs Kupka and Bergman), Sweden
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna (Dr Kupka), Falun, Sweden
- Magee-Womens Research Institute (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynecology, Epidemiology and Clinical and Translational Research, University of Pittsburgh (Dr Roberts), Pittsburgh, PA
- Department of Obstetrics and Gynaecology, University Kebangsaan Malaysia Medical Center (Dr Mahdy), Cheras, Malaysia
- Vascular Physiology Laboratory, Basic Sciences Department, Faculty of Sciences, Universidad del Bio-Bio (Dr Escudero), Chillan, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS Health) (Dr Escudero), Chillan, Chile
- Department of Women's and Children's Health, Uppsala University (Dr Bergman), Uppsala, Sweden
- Department of Obstetrics and Gynecology, Stellenbosch University (Dr Bergman), Cape Town, South Africa
- São Paulo State University (UNESP), Medical School (Dr Oliveira), Botucatu
| |
Collapse
|
45
|
Johannesson L, Testa G, Borries TM, Wall A, Ma TW, Eagle EA, Jain A, Taylor SD, dePrisco G, Gregg AR. Doppler Flow Indices and Prediction of Embryo Transfer Success and Pregnancy Outcome in Uterus Transplant Recipients. Am J Perinatol 2024; 41:e1264-e1272. [PMID: 36608701 DOI: 10.1055/a-2008-8361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Doppler velocimetry of the uterine and umbilical arteries is used to predict preeclampsia and monitor fetal outcomes. There have been no reports of Doppler velocimetry indices in pregnancies conceived after uterus transplantation, which differ from traditional pregnancies because of different uterine vascular inflow and outflow and exposure to immunosuppressive agents. We sought to examine whether Doppler indices can be used to predict embryo transfer success after uterus transplantation and whether Doppler indices across pregnancy predict fetal growth restriction. STUDY DESIGN This was a single-center cohort observational study of 14 uterus transplant recipients who underwent embryo transfer. Of these, 12 women successfully delivered 14 babies. Five Doppler investigations were performed within the cohort: (1) prepregnancy; (2) uterine artery assessment across pregnancy; (3) umbilical artery assessment across pregnancy; (4) successive pregnancies; and (5) fetal growth. RESULTS Prepregnancy uterine artery Doppler indices did not correlate with successful implantation after embryo transfer. Uterine artery Doppler indices in uterus transplant recipients decreased across pregnancy as described in pregnancies without uterus transplantation. The umbilical artery systolic/diastolic velocity ratio was lower at all weeks of gestation after uterus transplantation compared with values described in pregnancies without uterus transplantation. In those women who delivered two successive babies after uterus transplant, umbilical artery Doppler indices were significantly lower during the second pregnancy. There was always forward flow throughout diastole in the umbilical arteries, and no babies experienced fetal growth restriction. CONCLUSION In our study, uterus transplantation was not associated with abnormal blood flow indices in either the uterine or umbilical arteries. Although Doppler indices were not predictive of embryo transfer success, they supported the expectation that pregnancies after uterus transplantation at our center result in normally grown babies. KEY POINTS · Uterus transplantation is not associated with abnormal blood flow indices.. · Prepregnancy uterine artery Doppler indices did not correlate with successful embryo implantation.. · Doppler assessment supports the expectation of normal placentation, fetal growth, and healthy live births after uterus transplantation..
Collapse
Affiliation(s)
- Liza Johannesson
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
| | - Giuliano Testa
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Trevor M Borries
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Anji Wall
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Tsung-Wei Ma
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Elizabeth A Eagle
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
| | - Akshaya Jain
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
| | - Sherri D Taylor
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Gregory dePrisco
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Anthony R Gregg
- Department of Obstetrics and Gynecology, Prisma Health, Columbia, South Carolina
| |
Collapse
|
46
|
Damasceno AADA, Matijasevich A, Mosquera PS, Malta MB, Cardoso MA. Hypertensive disorders of pregnancy in Western Brazilian Amazon: Associated factors and neonatal outcomes. Am J Hum Biol 2024; 36:e24026. [PMID: 38041520 DOI: 10.1002/ajhb.24026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/27/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE Hypertensive disorders of pregnancy (HDP) are responsible for several maternal and fetal complications. This study investigated the occurrence of HDP, associated factors, and neonatal complications in women living in the Western Brazilian Amazon. METHODS This is a population-based cross-sectional study with 1521 mother-child pairs enrolled in the Maternal and Child Health and Nutrition in Acre birth cohort (MINA-Brazil study). All parturients with HDP (registered in the medical records) were identified. Crude and adjusted prevalence ratios were calculated in Poisson regression models with robust variance. RESULTS The prevalence of HDP was 11.0% (95% CI: 9.5-12.7). Factors associated with the prevalence of HDP were maternal age ≥ 35 years (PR: 1.9; 95% CI: 1.3-3.0), primigravida status (PR: 2.0; 95% CI: 1.5-2.7), pre-pregnancy obesity (PR: 2.7; 95% CI: 1.9-4.0), higher gestational weight gain (highest quartile RP: 2.5; 95% CI: 1.6-3.8), chronic hypertension (RP: 3.6; 95% CI: 2.7-4.9), and diabetes in pregnancy (RP: 1.9; 95% CI: 1.1-3.2). HDP was associated with risk for caesarean delivery (PR: 1.8; 95% CI: 1.6-2.0) and prematurity (PR: 2.0; 95% CI: 1.3-3.2). Gestational malaria was not associated with HDP in Amazonian pregnant women. CONCLUSIONS Evaluating risk factors before pregnancy and during the prenatal period is essential for reducing adverse maternal and neonatal outcomes.
Collapse
Affiliation(s)
- Ana Alice de Araújo Damasceno
- Programa de pós-graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
- Campus Floresta, Universidade Federal do Acre, Cruzeiro do Su, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paola Soledad Mosquera
- Programa de pós-graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Maíra Barreto Malta
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Marly Augusto Cardoso
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
47
|
Tang H, Tian Y, Fang J, Yuan X, Yao M, Wang Y, Feng Y, Shu J, Ni Y, Yu Y, Wang Y, Liang P, Li X, Bai X. Detection of Urinary Misfolded Proteins for Imminent Prediction of Preeclampsia in Pregnant Women With Suspected Cases: Protocol for a Prospective Noninterventional Study. JMIR Res Protoc 2024; 13:e54026. [PMID: 38669061 PMCID: PMC11087858 DOI: 10.2196/54026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Preeclampsia (PE) is one of the most common hypertensive diseases, affecting 2%-8% of all pregnancies. The high maternal and fetal mortality rates of PE are due to a lack of early identification of affected pregnant women that would have led to closer monitoring and care. Recent data suggest that misfolded proteins might be a promising biomarker for PE prediction, which can be detected in urine samples of pregnant women according to their congophilia (aggregated) characteristic. OBJECTIVE The main purpose of this trial is to evaluate the value of the urine congophilia-based detection of misfolded proteins for the imminent prediction of PE in women presenting with suspected PE. The secondary objectives are to demonstrate that the presence of urine misfolded proteins correlates with PE-related maternal or neonatal adverse outcomes, and to establish an accurate PE prediction model by combining misfolded proteins with multiple indicators. METHODS At least 300 pregnant women with clinical suspicion of PE will be enrolled in this prospective cohort study. Participants should meet the following inclusion criteria in addition to a suspicion of PE: ≥18 years old, gestational week between 20+0 and 33+6, and single pregnancy. Consecutive urine samples will be collected, blinded, and tested for misfolded proteins and other PE-related biomarkers at enrollment and at 4 follow-up visits. Clinical assessments of PE status and related complications for all participants will be performed at regular intervals using strict diagnostic criteria. Investigators and participants will remain blinded to the results. Follow-up will be performed until 42 days postpartum. Data from medical records, including maternal and fetal outcomes, will be collected. The performance of urine misfolded proteins alone and combined with other biomarkers or clinical variables for the prediction of PE will be statistically analyzed. RESULTS Enrollment started in July 2023 and was still open upon manuscript submission. As of March 2024, a total of 251 eligible women have been enrolled in the study and enrollment is expected to continue until August 2024. Results analysis is scheduled to start after all participants reach the follow-up endpoint and complete clinical data are collected. CONCLUSIONS Upon completion of the study, we expect to derive an accurate PE prediction model, which will allow for proactive management of pregnant women with clinical suspicion of PE and possibly reduce the associated adverse pregnancy outcomes. The additional prognostic value of misfolded proteins is also expected to be confirmed. TRIAL REGISTRATION Chinese Clinical Trials Registry ChiCTR2300074878; https://www.chictr.org.cn/showproj.html?proj=202096. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54026.
Collapse
Affiliation(s)
- Haiyang Tang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yijia Tian
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jing Fang
- Department of Obstetrics, Lanxi People's Hospital, Jinhua, China
| | | | - Minli Yao
- Shuwen Biotech Co, Ltd, Hangzhou, China
| | - Yujia Wang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Feng
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jia Shu
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo, China
| | - Yan Ni
- Department of Obstetrics, Quzhou Maternity and Child Health Care Hospital, Quzhou, China
| | - Ying Yu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuanhe Wang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Liang
- Department of Obstetrics, Xinchang People's Hospital, Shaoxing, China
| | | | - Xiaoxia Bai
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Traditional Chinese Medicine for Reproductive Health Key Laboratory of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
- Key Laboratory of Women's Reproductive Health, Hangzhou, China
| |
Collapse
|
48
|
Lin C, Mazzuca MQ, Khalil RA. Increased uterine arterial tone, stiffness and remodeling with augmented matrix metalloproteinase-1 and -7 in uteroplacental ischemia-induced hypertensive pregnancy. Biochem Pharmacol 2024:116227. [PMID: 38643908 DOI: 10.1016/j.bcp.2024.116227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/29/2024] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
Preeclampsia is a pregnancy-related disorder manifested as hypertensive pregnancy (HTN-Preg) and often fetal growth restriction (FGR), but the mechanisms involved are unclear. We have reported enhanced reactivity of systemic vessels in HTN-Preg rats, but the critical changes in the uterine circulation are less clear. We tested whether HTN-Preg involves localized aberrations in uterine arterial tone, stiffness and remodeling by matrix metalloproteinases (MMPs). Blood pressure (BP) and litter size were recorded in normal pregnant (Preg) rats and Preg rats with reduced uteroplacental perfusion pressure (RUPP). Isolated uterine arteries were placed in a pressure myograph for measuring intrinsic and extrinsic tone and arterial stiffness. Arteries were bathed in normal Krebs solution (2.5 mM Ca2+), Ca2+-free (2 mM EGTA) Krebs, treated with sodium nitroprusside (SNP), or endothelium denuded, then pressurized at 10 mmHg steps from 10 to 110 mmHg, and the % change in diameter was analyzed to measure total (active + passive), active Ca2+-dependent myogenic, passive, and endothelium-dependent tone, respectively. BP was higher and the litter size and pup weight were reduced in RUPP vs Preg rats. In normal Krebs, increasing intraluminal pressure caused smaller increments in diameter in arteries of RUPP vs Preg rats, suggesting greater total vascular tone. Arterial incubation in Ca2+-free Krebs, treatment with SNP or endothelium-removal abolished the differences in vascular tone, and subtraction of each of these components from total vascular tone revealed significant active Ca2+-dependent myogenic, passive, and endothelium-dependent tone, respectively, in RUPP vs Preg rats. The total and passive strain-stress curves were shifted leftward in arteries of RUPP vs Preg rats, indicating increased uterine arterial stiffness. Arterial sections showed decreased lumen/total and increased wall/total area, and immunohistochemistry revealed greater MMP-1 and MMP-7 staining particularly in the media, suggesting uterine arterial remodeling by MMPs in RUPP vs Preg rats. The increased uterine arterial active myogenic, passive, and endothelium-dependent tone, arterial stiffness and remodeling by MMPs would further reduce uterine blood flow and exacerbate uteroplacental ischemia, FGR and HTN-Preg.
Collapse
Affiliation(s)
- Chen Lin
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States
| | - Marc Q Mazzuca
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States
| | - Raouf A Khalil
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
49
|
Kasimanickam R, Kasimanickam V. MicroRNAs in the Pathogenesis of Preeclampsia-A Case-Control In Silico Analysis. Curr Issues Mol Biol 2024; 46:3438-3459. [PMID: 38666946 PMCID: PMC11048894 DOI: 10.3390/cimb46040216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Preeclampsia (PE) occurs in 5% to 7% of all pregnancies, and the PE that results from abnormal placentation acts as a primary cause of maternal and neonatal morbidity and mortality. The objective of this secondary analysis was to elucidate the pathogenesis of PE by probing protein-protein interactions from in silico analysis of transcriptomes between PE and normal placenta from Gene Expression Omnibus (GSE149812). The pathogenesis of PE is apparently determined by associations of miRNA molecules and their target genes and the degree of changes in their expressions with irregularities in the functions of hemostasis, vascular systems, and inflammatory processes at the fetal-maternal interface. These irregularities ultimately lead to impaired placental growth and hypoxic injuries, generally manifesting as placental insufficiency. These differentially expressed miRNAs or genes in placental tissue and/or in blood can serve as novel diagnostic and therapeutic biomarkers.
Collapse
Affiliation(s)
- Ramanathan Kasimanickam
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164, USA
| | - Vanmathy Kasimanickam
- Center for Reproductive Biology, College of Veterinary Medicine, Washington State University, Pullman, WA 99164, USA;
| |
Collapse
|
50
|
Lai W, Yu L, Deng Y. PPARγ alleviates preeclampsia development by regulating lipid metabolism and ferroptosis. Commun Biol 2024; 7:429. [PMID: 38594496 PMCID: PMC11004023 DOI: 10.1038/s42003-024-06063-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
The study aims to explore the effect of PPARγ signaling on ferroptosis and preeclampsia (PE) development. Serum and placental tissue are collected from healthy subjects and PE patients. The PPARγ and Nrf2 decreases in the PE. Rosiglitazone intervention reverses hypoxia-induced trophoblast ferroptosis and decreases lipid synthesis by regulating Nfr2 and SREBP1. Compared to the Hypoxia group, the migratory and invasive abilities enhance after rosiglitazone and ferr1 treatment. Rosiglitazone reduces the effect of hypoxia and erastin. The si-Nrf2 treatment attenuats the effects of rosiglitazone on proliferation, migration, and invasion. The si-Nrf2 does not affect SREBP1 expression. PPARγ agonists alleviates ferroptosis in the placenta of the PE rats. The study confirms that PPARγ signaling and ferroptosis-related indicators were dysregulated in PE. PPARγ/Nrf2 signaling affects ferroptosis by regulating lipid oxidation rather than SREBP1-mediated lipid synthesis. In conclusion, our study find that PPARγ can alleviate PE development by regulating lipid oxidation and ferroptosis.
Collapse
Affiliation(s)
- Weisi Lai
- Department of Obstetrics and Gynecology, Second XiangYa Hospital of Central South University, Changsha, China
| | - Ling Yu
- Department of Obstetrics and Gynecology, Second XiangYa Hospital of Central South University, Changsha, China
| | - Yali Deng
- Department of Obstetrics and Gynecology, Second XiangYa Hospital of Central South University, Changsha, China.
| |
Collapse
|