Preeclampsia in Different Maternal Age Groups-Is There an Association with Pregnancy Outcomes and Placental Pathology?

Advanced maternal age (AMA) and pregnancy: a feasible but problematic event

This narrative review aimed to summarize all adverse outcomes of pregnancy in advanced maternal age (AMA) to assess the age of the mother as a potentially crucial risk factor. AMA refers to women older than 35 years. While expectations and the role of women in society have undergone significant changes today, the biology of aging remains unchanged. Various pathologic changes occur in the human body with age, including chronic noncommunicable diseases, as well as notable changes in reproductive organs, that significantly affect fertility. Despite substantial advancements in technology and medicine, pregnancy in AMA remains a formidable challenge. Although there are some advantages to postponing childbirth, they primarily relate to maternal maturity and economic stability. However, regrettably, there are also many adverse aspects of pregnancy at advanced ages. These include complications affecting both the mother and the fetus. Pregnants in AMA were more prone to suffer from gestational diabetes mellitus, preeclampsia, and eclampsia during pregnancy compared to younger women. In addition, miscarriages and ectopic pregnancies were more prevalent. Delivery was more frequently completed via cesarean section, and postpartum complications and maternal mortality were also higher. Unfortunately, there were also complications concerning the fetus, such as chromosomal abnormalities, premature birth, low birth weight, admission to the neonatal intensive care unit, and stillbirth.

Expression of IMP3 and LIN28A RNA-Binding Proteins in Placentas of Patients with Pre-Eclampsia with and without Severe Features

BACKGROUND

this study aimed to determine the expression of RNA-binding oncofetal proteins IMP3 and LIN28A in extravillous (EVT) and villous trophoblast (VT) cells of placentas from pre-eclamptic (PE) pregnancies to better understand the pathogenesis of PE.

METHODS

placental tissue of 10 patients with PE with severe features, 10 patients with PE without severe features and 20 age-matched healthy pregnancy controls were analyzed by immunohistochemistry, double immunofluorescence and qPCR.

RESULTS

We found a decreased percentage of IMP3-positive EVT cells in PE with and without severe features compared to that of the healthy control (p < 0.001). IMP3 expression was significantly low in VT of PE placentas compared to that of the healthy control (p = 0.002). There was no significant difference in LIN28A expression between groups of PE and the control group. Additionally, we noticed the trend toward downregulation of IMP3 mRNA and LIN28A mRNA in severe PE compared to that of healthy controls.

CONCLUSIONS

We demonstrated that IMP3 expression is decreased in EVT and VT cells of placentas from pregnancies complicated with both PE with and without severe features. However, additional functional investigations are needed to clarify the role of IMP3 as a potential therapeutic target in the management of PE.

Improved neonatal outcomes in pregnancies with coexisting gestational diabetes and preeclampsia in normal birthweight neonates- insights from a retrospective cohort study

INTRODUCTION

We aimed to assess neonatal and maternal outcomes in appropriate-for-gestational-weight (AGA) neonates of mothers with both gestational diabetes mellitus (GDM) and preeclampsia (PET).

METHODS

Medical records of women diagnosed with GDM or PET were reviewed. Women with AGA neonates were divided into three groups- GDM, PET, and GDM + PET and maternal neonatal and placental outcomes were compared. The primary outcome was a composite of adverse neonatal outcomes, including intensive care unit admission (NICU), neurological morbidity, hypoglycemia, ventilation, respiratory distress syndrome (RDS), phototherapy, sepsis, blood transfusion, and neonatal death. Post-hoc analysis was performed to determine between-group significance.

RESULTS

Composite adverse neonatal outcomes are significantly lower in women with multiple morbidities compared to women with confined PET (p = 0.015), and a similar trend is observed when comparing neonatal outcomes between women with GDM to those with GDM + PET, yet these results are underpowered (18.9 % vs. 12.8 % respectively, p = 0.243). Placentas of women with GDM + PET were larger, with a lower rate of placentas below the 10th percentile as compared to placentas of women with isolated PET (p < 0.001), but with similar rates of MVM lesions.

DISCUSSION

While maternal and placental outcomes in patients of the GDM + PET group resemble the characteristics of the PET group, surprisingly, the neonatal outcomes in this group are significantly better compared to isolated morbidities. The paradoxical benefit attributed to the coexistence of GDM + PET may be explained by a balance of the opposing trends characterizing these morbidities-the reduced blood and nutrient supply characterizing PET vs. chronic overflow and abundance typical of GDM.

CLINICAL TRIAL REGISTRATION

approval of local ethics committee WOMC-19-0152.

Risk factors combine in a complex manner in assessment for macrosomia

BACKGROUND

Macrosomia is a serious public health concern. This study aimed to examine the combined effects of various risk factors on macrosomia.

METHODS

The China Labor and Delivery Survey was a multicenter cross-sectional study that included 96 hospitals. Logistic regression analysis was performed to examine the combined effects of the risk factors for macrosomia. The population attributable risk percentage (PAR%) was calculated for the risk factors.

RESULTS

A total of 64,735 live births, including 3,739 neonates with macrosomia, were used for the analysis. The weighted prevalence of macrosomia was 5.8%. Pre-pregnancy overweight/obesity, diabetes, and gestational hypertension have a synergistic effect on increasing the rate of macrosomia in mothers aged < 36 years. The highest odds ratio (36.15, 95% CI: 34.38-38.02) was observed in female fetuses whose mothers had both gestational hypertension and diabetes. However, in mothers aged ≥ 36 years, the synergistic effect of gestational hypertension and other factors did not exist, and the risk for macrosomia was reduced by 70% in female fetuses of mothers with both gestational hypertension and overweight/obesity. Pre-pregnancy risk factors (pre-pregnancy overweight/obesity and advanced maternal age) contributed the most to macrosomia (23.36% of the PAR%), and the single largest risk factor was pre-pregnancy overweight/obesity (17.43% of the PAR%).

CONCLUSION

Macrosomia was related to several common, modifiable risk factors. Some factors have combined effects on macrosomia (e.g., pre-pregnancy overweight/obesity and diabetes), whereas gestational hypertension varies by maternal age. Strategies based on pre-pregnancy risk factors should be given more attention to reduce the burden of macrosomia.

Urinary iodine as an important indicator for preeclampsia: a Polish perspective

Preeclampsia (PE) is one of the leading causes of perinatal and maternal morbidity. Although subclinical hypothyroidism in pregnancy is one of the established risk factors for PE, the link between iodine deficiency and PE is not fully understood. The aim of our study was to assess urinary iodine concentration (UIC), serum thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) levels in Polish women with PE (PE group, n=78) compared with healthy non-pregnant women (CNP group, n=30), and healthy pregnant women (CP group, n=46). The UIC was determined by inductively coupled plasma mass spectrometry (ICP-MS). Both the mean UIC of 144.6±36.4 μg/L in the CP group and the mean of 125.8±33.6 μg/L in the PE group, respectively, were lower compared to non-pregnant women (149.8±28.8 μg/L), and the difference between the PE and CNP groups was statistically significant. TSH values were the highest in the PE group, while the lowest average level was for the CNP group. The fT3 and fT4 values in the PE group were significantly lower compared to the CNP and CP groups. Despite iodine supplementation during pregnancy, the UIC was lower compared to non-pregnant women, while in women with PE it was at a significantly lower level. To reduce the incidence of possible health complications, proper iodine supplementation and monitoring of the UIC is recommended for pregnant women suffering from PE or at risk of developing PE.