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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.
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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.
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Palacios-Verdú MG, Rodríguez-Melcón A, Rodríguez I, Racca A, Serra B, Albaiges G, Parriego M, Prats P. Prenatal screening after preimplantation genetic testing for aneuploidy: time to evaluate old strategies. Reprod Biomed Online 2024; 48:103761. [PMID: 38603981 DOI: 10.1016/j.rbmo.2023.103761] [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: 06/21/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 04/13/2024]
Abstract
RESEARCH QUESTION How does first-trimester aneuploidy screening perform in pregnancies achieved through IVF with preimplantation genetic testing for aneuploidy (PGT-A) in a medical setting? DESIGN This retrospective cohort study was undertaken in a single tertiary care centre between January 2013 and June 2022. In total, 20,237 women had prenatal follow-up at the study centre and were included in the study. The women were divided into three groups: singleton pregnancies conceived through the transfer of a PGT-A-screened euploid embryo (n = 510); singleton pregnancies conceived through IVF without PGT-A (n = 3291); and singleton pregnancies conceived naturally (n = 16,436). RESULTS The conventional combined screening test for pregnancies conceived through IVF with PGT-A had specificity of 91%; sensitivity could not be calculated as there were no cases of fetal aneuploidy in this group. In 89.1% of pregnancies conceived through IVF with PGT-A with high risk for trisomy 21, 18 or 13, the result was related to advanced maternal age (>35 years at time of screening). CONCLUSIONS The current screening strategy for trisomies 21, 18 and 13 can generate unnecessary tests in pregnancies achieved through IVF with PGT-A. A new protocol is needed for these patients, with greater weight given to ultrasound markers.
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Affiliation(s)
- María Gabriela Palacios-Verdú
- Unit of Genomic Medicine, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain.
| | - Alberto Rodríguez-Melcón
- Obstetrics Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Ignacio Rodríguez
- Epidemiological Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Annalisa Racca
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Bernat Serra
- Obstetrics Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Gerard Albaiges
- Obstetrics Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Mónica Parriego
- Reproductive Medicine Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Pilar Prats
- Obstetrics Service, Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
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Yan Q, Blue NR, Truong B, Zhang Y, Guerrero RF, Liu N, Honigberg MC, Parry S, McNeil RB, Simhan HN, Chung J, Mercer BM, Grobman WA, Silver R, Greenland P, Saade GR, Reddy UM, Wapner RJ, Haas DM. Genetic Associations with Placental Proteins in Maternal Serum Identify Biomarkers for Hypertension in Pregnancy. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.05.25.23290460. [PMID: 37398343 PMCID: PMC10312829 DOI: 10.1101/2023.05.25.23290460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Preeclampsia is a complex syndrome that accounts for considerable maternal and perinatal morbidity and mortality. Despite its prevalence, no effective disease-modifying therapies are available. Maternal serum placenta-derived proteins have been in longstanding use as markers of risk for aneuploidy and placental dysfunction, but whether they have a causal contribution to preeclampsia is unknown. Objective We aimed to investigate the genetic regulation of serum placental proteins in early pregnancy and their potential causal links with preeclampsia and gestational hypertension. Study design This study used a nested case-control design with nulliparous women enrolled in the nuMoM2b study from eight clinical sites across the United States between 2010 and 2013. The first- and second-trimester serum samples were collected, and nine proteins were measured, including vascular endothelial growth factor (VEGF), placental growth factor, endoglin, soluble fms-like tyrosine kinase-1 (sFlt-1), a disintegrin and metalloproteinase domain-containing protein 12 (ADAM-12), pregnancy-associated plasma protein A, free beta-human chorionic gonadotropin, inhibin A, and alpha-fetoprotein. This study used genome-wide association studies to discern genetic influences on these protein levels, treating proteins as outcomes. Furthermore, Mendelian randomization was used to evaluate the causal effects of these proteins on preeclampsia and gestational hypertension, and their further causal relationship with long-term hypertension, treating proteins as exposures. Results A total of 2,352 participants were analyzed. We discovered significant associations between the pregnancy zone protein locus and concentrations of ADAM-12 (rs6487735, P= 3.03×10 -22 ), as well as between the vascular endothelial growth factor A locus and concentrations of both VEGF (rs6921438, P= 7.94×10 -30 ) and sFlt-1 (rs4349809, P= 2.89×10 -12 ). Our Mendelian randomization analyses suggested a potential causal association between first-trimester ADAM-12 levels and gestational hypertension (odds ratio=0.78, P= 8.6×10 -4 ). We also found evidence for a potential causal effect of preeclampsia (odds ratio=1.75, P =8.3×10 -3 ) and gestational hypertension (odds ratio=1.84, P =4.7×10 -3 ) during the index pregnancy on the onset of hypertension 2-7 years later. The additional mediation analysis indicated that the impact of ADAM-12 on postpartum hypertension could be explained in part by its indirect effect through gestational hypertension (mediated effect=-0.15, P= 0.03). Conclusions Our study discovered significant genetic associations with placental proteins ADAM-12, VEGF, and sFlt-1, offering insights into their regulation during pregnancy. Mendelian randomization analyses demonstrated evidence of potential causal relationships between the serum levels of placental proteins, particularly ADAM-12, and gestational hypertension, potentially informing future prevention and treatment investigations.
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Fang Y, Liu H, Li Y, Cheng J, Wang X, Shen B, Chen H, Wang Q. A Prediction Model of Preeclampsia in Hyperglycemia Pregnancy. Diabetes Metab Syndr Obes 2024; 17:1321-1333. [PMID: 38525162 PMCID: PMC10959306 DOI: 10.2147/dmso.s453204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose To investigate the risk factors associated with preeclampsia in hyperglycemic pregnancies and develop a predictive model based on routine pregnancy care. Patients and Methods The retrospective collection of clinical data was performed on 951 pregnant women with hyperglycemia, including those diagnosed with diabetes in pregnancy (DIP) and gestational diabetes mellitus (GDM), who delivered after 34 weeks of gestation at the Maternal and Child Health Hospital Affiliated to Anhui Medical University between January 2017 and December 2019. Observation indicators included liver and kidney function factors testing at 24-29+6 weeks gestation, maternal age, and basal blood pressure. The indicators were screened univariately, and the "rms" package in R language was applied to explore the factors associated with PE in HIP pregnancy by stepwise regression. Multivariable logistic regression analysis was used to develop the prediction model. Based on the above results, a nomogram was constructed to predict the risk of PE occurrence in pregnant women with HIP. Then, the model was evaluated from three aspects: discrimination, calibration, and clinical utility. The internal validation was performed using the bootstrap procedure. Results Multivariate logistic regression analysis showed that cystatin C, uric acid, glutamyl aminotransferase, blood urea nitrogen, and basal systolic blood pressure as predictors of PE in pregnancy with HIP. The predictive model yielded an area under curve (AUC) value of 0.8031 (95% CI: 0.7383-0.8679), with an optimal threshold of 0.0805, at which point the sensitivity was 0.8307 and specificity of 0.6604. Hosmer-Lemeshow test values were P = 0.3736, Brier score value was 0.0461. After 1000 Bootstrap re-samplings for internal validation, the AUC was 0.7886, the Brier score was 0.0478 and the predicted probability of the calibration curve was similar to the actual probability. A nomogram was constructed based on the above to visualize the model. Conclusion This study developed a model for predicting PE in pregnant women with HIP, achieving high predictive performance of PE risk through the information of routine pregnancy care.
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Affiliation(s)
- Yan Fang
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, People’s Republic of China
| | - Huali Liu
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, People’s Republic of China
| | - Yuan Li
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, People’s Republic of China
| | - Ji Cheng
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
| | - Xia Wang
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
| | - Bing Shen
- School of Basic Medicine, Anhui Medical University, Hefei, People’s Republic of China
| | - Hongbo Chen
- Department of Obstetrics and Gynaecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, People’s Republic of China
| | - Qunhua Wang
- Department of Obstetrics and Gynaecology, the First Affiliated Hospital of USTC, Hefei, People’s Republic of China
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Chen L, Wu M, Zhou Y. HSPB8 binding to c-Myc alleviates hypoxia/reoxygenation-induced trophoblast cell dysfunction. Exp Ther Med 2024; 27:114. [PMID: 38361516 PMCID: PMC10867730 DOI: 10.3892/etm.2024.12402] [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: 08/09/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024] Open
Abstract
Preeclampsia (PE) is a pregnancy-specific syndrome with complex pathogenesis. The present study aimed to explore the role of heat shock protein B8 (HSPB8) and c-Myc in trophoblast cell dysfunction using a hypoxia/reoxygenation (H/R)-treated HTR8/SVneo cell model. HSPB8 expression in tissues of patients with PE was analyzed using the Gene Expression Omnibus database. Following detection of HSPB8 expression in H/R-stimulated HTR8/SVneo cells, HSPB8 was overexpressed by transfection of the gene with a HSPB8-specific plasmid. Cell Counting Kit-8, wound healing and Transwell assays were used to evaluate the proliferation, migration and invasion of HTR8/SVneo cells exposed to H/R conditions. Reactive oxygen species (ROS) were determined by 2,7-dichlorodihydrofluorescein diacetate staining. 5,5',6,6'-tetrachloro-1,1',3,3'-tetraethylbenzimidazolocarbo-cyanine iodide (JC-1) staining was applied to assess mitochondrial membrane potential. Malondialdehyde (MDA) and superoxide dismutase (SOD) levels were detected using the corresponding commercial kits. In addition, the induction of apoptosis was assessed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. Moreover, the Biogrid database predicted that HSPB8 was bound to c-Myc, and a co-immunoprecipitation (Co-IP) assay was used to verify this interaction. Subsequently, c-Myc expression was silenced to conduct rescue experiments in HTR8/SVneo cells exposed to H/R conditions and upregulated HSPB8 expression. Notably, reduced HSPB8 expression was noted in PE tissues and H/R-stimulated HTR8/SVneo cells. HSPB8 enforced expression promoted the proliferation, migration and invasion of HTR8/SVneo cells. Moreover, H/R caused an increase in ROS and MDA levels as well as in TUNEL staining and a decrease in aggregated JC-1 fluorescence and SOD activity levels, which were restored following HSPB8 overexpression. Co-IP confirmed the interaction between HSPB8 and c-Myc. Moreover, knockdown of c-Myc expression compromised the effects of HSPB8 upregulation on trophoblast cell dysfunction following induction of H/R. Collectively, the data indicated that HSPB8 could improve mitochondrial oxidative stress by binding to c-Myc to alleviate trophoblast cell dysfunction. The findings may provide new insights into the pathogenesis of PE and highlight the role of HSPB8/c-Myc in the prevention and treatment of PE in the future.
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Affiliation(s)
- Ling Chen
- Department of Gynecology and Obstetrics, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Meiting Wu
- Department of Gynecology and Obstetrics, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Yu Zhou
- Department of Gynecology and Obstetrics, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, P.R. China
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Lee NMW, Chaemsaithong P, Poon LC. Prediction of preeclampsia in asymptomatic women. Best Pract Res Clin Obstet Gynaecol 2024; 92:102436. [PMID: 38056380 DOI: 10.1016/j.bpobgyn.2023.102436] [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: 06/27/2023] [Revised: 07/21/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023]
Abstract
Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. It is important to identify women who are at high risk of developing this disorder in their first trimester of pregnancy to allow timely therapeutic intervention. The use of low-dose aspirin initiated before 16 weeks of gestation can significantly reduce the rate of preterm preeclampsia by 62 %. Effective screening recommended by the Fetal Medicine Foundation (FMF) consists of a combination of maternal risk factors, mean arterial pressure, uterine artery pulsatility index (UtA-PI) and placental growth factor (PLGF). The current model has detection rates of 90 %, 75 %, and 41 % for early, preterm, and term preeclampsia, respectively at 10 % false-positive rate. Similar risk assessment can be performed during the second trimester in all pregnant women irrespective of first trimester screening results. The use of PLGF, UtA-PI, sFlt-1 combined with other investigative tools are part of risk assessment.
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Affiliation(s)
- Nikki M W Lee
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region of China.
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region of China.
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Bonacina E, Garcia-Manau P, López M, Caamiña S, Vives À, Lopez-Quesada E, Ricart M, Maroto A, de Mingo L, Pintado E, Castillo-Ribelles L, Martín L, Rodriguez-Zurita A, Garcia E, Pallarols M, Vidal-Sagnier L, Teixidor M, Orizales-Lago C, Pérez-Gomez A, Ocaña V, Puerto L, Millán P, Alsius M, Diaz S, Maiz N, Carreras E, Suy A, Mendoza M. Mid-trimester uterine artery Doppler for aspirin discontinuation in pregnancies at high risk for preterm pre-eclampsia: Post-hoc analysis of StopPRE trial. BJOG 2024; 131:334-342. [PMID: 37555464 DOI: 10.1111/1471-0528.17631] [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: 04/28/2023] [Revised: 06/22/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To assess whether aspirin treatment can be discontinued in pregnancies with normal uterine artery pulsatility index (≤90th percentile) at 24-28 weeks. DESIGN Post-hoc analysis of a clinical trial. SETTING Nine maternity hospitals in Spain. POPULATION OR SAMPLE Pregnant individuals at high risk of pre-eclampsia at 11-13 weeks and normal uterine artery Doppler at 24-28 weeks. METHODS All participants received treatment with daily aspirin at a dose of 150 mg. Participants were randomly assigned, in a 1:1 ratio, either to continue aspirin treatment until 36 weeks (control group) or to discontinue aspirin treatment (intervention group), between September 2019 and September 2021. In this secondary analysis, women with a UtAPI >90th percentile at 24-28 weeks were excluded. The non-inferiority margin was set at a difference of 1.9% for the incidence of preterm pre-eclampsia. MAIN OUTCOME MEASURES Incidence of preterm pre-eclampsia. RESULTS Of the 1611 eligible women, 139 were excluded for UtAPI >90th percentile or if UtAPI was not available. Finally, 804 were included in this post-hoc analysis. Preterm pre-eclampsia occurred in three of 409 (0.7%) women in the aspirin discontinuation group and five of 395 (1.3%) women in the continuation group (-0.53; 95% CI -1.91 to 0.85), indicating non-inferiority of aspirin discontinuation. CONCLUSIONS Discontinuing aspirin treatment at 24-28 weeks in women with a UtAPI ≤90th percentile was non-inferior to continuing aspirin treatment until 36 weeks for preventing preterm pre-eclampsia.
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Affiliation(s)
- Erika Bonacina
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo Garcia-Manau
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monica López
- Department of Obstetrics, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Sara Caamiña
- Department of Obstetrics, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Àngels Vives
- Department of Obstetrics, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Eva Lopez-Quesada
- Department of Obstetrics, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Marta Ricart
- Department of Obstetrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Anna Maroto
- Department of Obstetrics, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Laura de Mingo
- Department of Obstetrics, Hospital Universitario Severo Ochoa, Leganés, Spain
| | - Elena Pintado
- Department of Obstetrics, Hospital Universitario de Getafe, Getafe, Spain
| | | | - Lourdes Martín
- Department of Obstetrics, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Alicia Rodriguez-Zurita
- Department of Obstetrics, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Esperanza Garcia
- Department of Obstetrics, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Mar Pallarols
- Department of Obstetrics, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Laia Vidal-Sagnier
- Department of Obstetrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mireia Teixidor
- Department of Obstetrics, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | | | - Adela Pérez-Gomez
- Department of Obstetrics, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Vanesa Ocaña
- Department of Obstetrics, Hospital Universitario de Getafe, Getafe, Spain
| | - Linda Puerto
- Department of Obstetrics, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Pilar Millán
- Department of Obstetrics, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Mercè Alsius
- Department of Biochemistry, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Sonia Diaz
- Department of Obstetrics, Hospital Universitario de Getafe, Getafe, Spain
| | - Nerea Maiz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Carreras
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Suy
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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Zhao X, Su F, Kong F, Su J, Yang X, Li L, Li A, Li Q. WD repeat domain 5 promotes the development of late-onset preeclampsia by activating nuclear factor kappa B. Acta Cir Bras 2023; 38:e386223. [PMID: 38055397 DOI: 10.1590/acb386223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/14/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE Over-activation of nuclear factor kappa B (NF-κB) was proven to be involved in the pathogenesis of preeclampsia. However, its regulation mechanism is not clear yet. This paper explored the role of WD repeat domain 5 (WDR5) in the development of late-onset preeclampsia and its relationship with NF-κB. METHODS WDR5 expression was detected in normal placentas and placentas from late-onset preeclampsia patients. CCK-8 and colony formation assays were conducted to appraise the proliferative ability of trophoblast. Migration and invasion were observed by wound healing and transwell assays. The interaction between WDR5 and NF-κB inhibitor I-kappa-B-alpha (IkBa) was verified by Co-immunoprecipitation analysis. Immunofluorescence was used to analyze the activation of NF-κB. Finally, we tested the role of WDR5 using the mice late-onset preeclampsia model. RESULTS WDR5 was highly expressed in the placentas of late-onset preeclampsia patients. WDR5 overexpression suppressed cell proliferation, migration, and invasion in trophoblast. WDR5 could interact with IkBa to activate NF-κB. Knockdown of NF-κB counteracted the anti-proliferative and anti-metastatic effects of WDR5 overexpression in trophoblast. In-vivo studies suggested that targeting WDR5 combated late-onset preeclampsia development. CONCLUSIONS Our finding provides new insights into the role of WDR5 in late-onset preeclampsia development.
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Affiliation(s)
- Xudong Zhao
- Liaocheng People's Hospital - Department of Obstetrics and Gynaecology - Liaocheng (Shandong Province) - China
- The Affiliated Taian City Central Hospital of Qingdao University - Taian City Central Hospital - Department of Obstetrics - Taian City (Shandong Province) - China
| | - Fengyun Su
- The Second Affiliated Hospital of Shandong First Medical University - Second Affiliated Hospital - Department of Pharmacy - Taian City (Shandong Province) - China
| | - Fanhua Kong
- The Affiliated Taian City Central Hospital of Qingdao University - Taian City Central Hospital - Departments of Thoracic Surgery - Taian City (Shandong Province) - China
| | - Juan Su
- The Affiliated Taian City Central Hospital of Qingdao University , Taian City Central Hospital - Department of Obstetrics and Gynecology Color Ultrasound - Taian City (Shandong Province) - China
| | - Xiaojing Yang
- The Affiliated Taian City Central Hospital of Qingdao University - Taian City Central Hospital - Department of Obstetrics - Taian City (Shandong Province) - China
| | - Lei Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University - Shandong Provincial Hospital - Department of Obstetrics - Jinan City (Shandong Province) - China
| | - Aihua Li
- Liaocheng People's Hospital - Department of Obstetrics and Gynaecology - Liaocheng (Shandong Province) - China
| | - Qinwen Li
- The Affiliated Taian City Central Hospital of Qingdao University - Taian City Central Hospital - Department of Obstetrics - Taian City (Shandong Province) - China
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Garcia‐Manau P, Bonacina E, Serrano B, Caamiña S, Ricart M, Lopez‐Quesada E, Vives À, Lopez M, Pintado E, Maroto A, Catalan S, Dalmau M, Del Barco E, Hernandez A, Miserachs M, San Jose M, Armengol‐Alsina M, Carreras E, Mendoza M. Clinical effectiveness of routine first-trimester combined screening for pre-eclampsia in Spain with the addition of placental growth factor. Acta Obstet Gynecol Scand 2023; 102:1711-1718. [PMID: 37814344 PMCID: PMC10619612 DOI: 10.1111/aogs.14687] [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: 07/02/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Pre-eclampsia affects 2%-8% of pregnancies and is one of the leading causes of maternal and perinatal morbidity and mortality. First-trimester screening using an algorithm that combines maternal characteristics, mean arterial blood pressure, uterine artery pulsatility index and biomarkers (pregnancy-associated plasma protein-A and placental growth factor) is the method that achieves a greater diagnostic accuracy. It has been shown that daily salicylic acid administration before 16 weeks in women at a high risk for pre-eclampsia can reduce the incidence of preterm pre-eclampsia. However, no previous studies have evaluated the impact of routine first-trimester combined screening for pre-eclampsia with placental growth factor after being implemented in the clinical practice. MATERIAL AND METHODS This was a multicenter cohort study conducted in eight different maternities across Spain. Participants in the reference group were prospectively recruited between October 2015 and September 2017. Participants in the study group were retrospectively recruited between March 2019 and May 2021. Pre-eclampsia risk was calculated between 11+0 and 13+6 weeks using the Gaussian algorithm combining maternal characteristics, mean arterial pressure, uterine arteries pulsatility index, pregnancy-associated plasma protein-A and placental growth factor. Patients with a risk greater than 1/170 were prescribed daily salicylic acid 150 mg until 36 weeks. Patients in the reference group did not receive salicylic acid during gestation. RESULTS A significant reduction was observed in preterm pre-eclampsia (OR 0.47; 95% CI: 0.30-0.73), early-onset (<34 weeks) pre-eclampsia (OR 0.35; 95% CI: 0.16-0.77), preterm small for gestational age newborn (OR 0.57; 95% CI: 0.40-0.82), spontaneous preterm birth (OR 0.72; 95% CI: 0.57-0.90), and admission to intensive care unit (OR 0.55; 95% CI: 0.37-0.81). A greater treatment adherence resulted in a significant reduction in adverse outcomes. CONCLUSIONS Routine first-trimester screening for pre-eclampsia with placental growth factor leads to a reduction in preterm pre-eclampsia and other pregnancy complications. Aspirin treatment compliance has a great impact on the effectiveness of this screening program.
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Affiliation(s)
- Pablo Garcia‐Manau
- Universitat Autònoma de BarcelonaBarcelonaSpain
- Department of ObstetricsVall d'Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Erika Bonacina
- Universitat Autònoma de BarcelonaBarcelonaSpain
- Department of ObstetricsVall d'Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Berta Serrano
- Universitat Autònoma de BarcelonaBarcelonaSpain
- Department of ObstetricsVall d'Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Sara Caamiña
- Department of ObstetricsHospital Universitario Nuestra Señora de CandelariaSanta Cruz de TenerifeSpain
| | - Marta Ricart
- Department of ObstetricsHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Eva Lopez‐Quesada
- Department of ObstetricsHospital Universitari Mútua TerrassaTerrassaSpain
| | - Àngels Vives
- Department of ObstetricsConsorci Sanitari de TerrassaTerrassaSpain
| | - Monica Lopez
- Department of ObstetricsHospital Universitari de Tarragona Joan XXIIITarragonaSpain
| | - Elena Pintado
- Department of ObstetricsHospital Universitario de GetafeGetafeSpain
| | - Anna Maroto
- Department of ObstetricsHospital Universitari de Girona Dr. Josep TruetaGironaSpain
| | | | | | | | | | | | | | | | | | - Manel Mendoza
- Universitat Autònoma de BarcelonaBarcelonaSpain
- Department of ObstetricsVall d'Hebron Barcelona Hospital CampusBarcelonaSpain
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10
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Tanacan A, Sakcak B, Ipek G, Agaoglu Z, Peker A, Haksever M, Kara O, Sahin D. The role of first trimester eosinophil count and eosinophil-based complete blood cell indices in the predictiction of preeclampsia: A case-control study. Placenta 2023; 143:16-21. [PMID: 37793323 DOI: 10.1016/j.placenta.2023.09.011] [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: 06/26/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION The importance of eosinophils in the pathogenesis of preeclampsia is an question of interest and there are recent studies in the literature indicating significantly lower eosinophil count values in pregnant women with preeclampsia. The present study aims to evaluate the utility of first-trimester eosinophil count and eosinophil-based complete blood cell count indices in the prediction of preeclampsia. METHODS Pregnant women diagnosed with preeclampsia (n = 281) were retrospectively compared with a control group (n = 307). The utility of first trimester eosinophil count, neutrophil to eosinophil ratio (NER) (neutrophil/eosinophil), leukocyte to eosinophil ratio (LER) (leukocyte/eosinophil), eosinophil to monocyte ratio (EMR) (eosinophil/monocyte) and, eosinophil to lymphocyte ratio (ELR) (eosinophil/lymphocyte) in the prediction of preeclampsia were evaluated. RESULTS Optimal cut-off values for eosinophil count, NER, LER, EMR and, ELR in predicting preeclampsia were 0.07 (AUC: 0.62, 58.7% sensitivity, 56.4% specificity), 90.9 (AUC: 0.65, 61.1% sensitivity, 59.4% specificity), 125.7 (AUC: 0.64, 61.4% sensitivity, 58.4% specificity), 0.15 (AUC: 0.63, 60.1% sensitivity, 59.6% specificity) and, 0.03 (AUC: 0.62, 60.9% sensitivity, 57% specificity), respectively. Mentioned values in predicting early-onset preeclampsia were 0.07 (AUC: 0.64, 60.5% sensitivity, 50.8% specificity), 102.1 (AUC: 0.64, 62.4% sensitivity, 58.8% specificity), 140.2 (AUC: 0.65, 63.5% sensitivity, 59.1% soecificity), 0.14 (AUC: 0.66, 66.3% sensitivity, 59.2% specificity), and, 0.03 (AUC: 0.63, 60.5% sensitivity, 57.4% specificity), respectively. The optimal cut-off value for EMR in the prediction of preeclampsia with severe features was 0.16 (AUC: 0.56, 56.9% sensitivity, 53.2% specificity). DISCUSSION Eosinophil-based complete blood count indices may be used to predict early-onset preeclampsia with relatively low sensitivity and specificity.
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Affiliation(s)
- Atakan Tanacan
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey; Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Bedri Sakcak
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Goksun Ipek
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Zahid Agaoglu
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ayca Peker
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Murat Haksever
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey; Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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11
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Chaemsaithong P, Gil MM, Chaiyasit N, Cuenca-Gomez D, Plasencia W, Rolle V, Poon LC. Accuracy of placental growth factor alone or in combination with soluble fms-like tyrosine kinase-1 or maternal factors in detecting preeclampsia in asymptomatic women in the second and third trimesters: a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 229:222-247. [PMID: 36990308 DOI: 10.1016/j.ajog.2023.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE This study aimed to: (1) identify all relevant studies reporting on the diagnostic accuracy of maternal circulating placental growth factor) alone or as a ratio with soluble fms-like tyrosine kinase-1), and of placental growth factor-based models (placental growth factor combined with maternal factors±other biomarkers) in the second or third trimester to predict subsequent development of preeclampsia in asymptomatic women; (2) estimate a hierarchical summary receiver-operating characteristic curve for studies reporting on the same test but different thresholds, gestational ages, and populations; and (3) select the best method to screen for preeclampsia in asymptomatic women during the second and third trimester of pregnancy by comparing the diagnostic accuracy of each method. DATA SOURCES A systematic search was performed through MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform databases from January 1, 1985 to April 15, 2021. STUDY ELIGIBILITY CRITERIA Studies including asymptomatic singleton pregnant women at >18 weeks' gestation with risk of developing preeclampsia were evaluated. We included only cohort or cross-sectional test accuracy studies reporting on preeclampsia outcome, allowing tabulation of 2×2 tables, with follow-up available for >85%, and evaluating performance of placental growth factor alone, soluble fms-like tyrosine kinase-1- placental growth factor ratio, or placental growth factor-based models. The study protocol was registered on the International Prospective Register Of Systematic Reviews (CRD 42020162460). METHODS Because of considerable intra- and interstudy heterogeneity, we computed the hierarchical summary receiver-operating characteristic plots and derived diagnostic odds ratios, β, θi, and Λ for each method to compare performances. The quality of the included studies was evaluated by the QUADAS-2 tool. RESULTS The search identified 2028 citations, from which we selected 474 studies for detailed assessment of the full texts. Finally, 100 published studies met the eligibility criteria for qualitative and 32 for quantitative syntheses. Twenty-three studies reported on performance of placental growth factor testing for the prediction of preeclampsia in the second trimester, including 16 (with 27 entries) that reported on placental growth factor test alone, 9 (with 19 entries) that reported on the soluble fms-like tyrosine kinase-1-placental growth factor ratio, and 6 (16 entries) that reported on placental growth factor-based models. Fourteen studies reported on performance of placental growth factor testing for the prediction of preeclampsia in the third trimester, including 10 (with 18 entries) that reported on placental growth factor test alone, 8 (with 12 entries) that reported on soluble fms-like tyrosine kinase-1-placental growth factor ratio, and 7 (with 12 entries) that reported on placental growth factor-based models. For the second trimester, Placental growth factor-based models achieved the highest diagnostic odds ratio for the prediction of early preeclampsia in the total population compared with placental growth factor alone and soluble fms-like tyrosine kinase-1-placental growth factor ratio (placental growth factor-based models, 63.20; 95% confidence interval, 37.62-106.16 vs soluble fms-like tyrosine kinase-1-placental growth factor ratio, 6.96; 95% confidence interval, 1.76-27.61 vs placental growth factor alone, 5.62; 95% confidence interval, 3.04-10.38); placental growth factor-based models had higher diagnostic odds ratio than placental growth factor alone for the identification of any-onset preeclampsia in the unselected population (28.45; 95% confidence interval, 13.52-59.85 vs 7.09; 95% confidence interval, 3.74-13.41). For the third trimester, Placental growth factor-based models achieved prediction for any-onset preeclampsia that was significantly better than that of placental growth factor alone but similar to that of soluble fms-like tyrosine kinase-1-placental growth factor ratio (placental growth factor-based models, 27.12; 95% confidence interval, 21.67-33.94 vs placental growth factor alone, 10.31; 95% confidence interval, 7.41-14.35 vs soluble fms-like tyrosine kinase-1-placental growth factor ratio, 14.94; 95% confidence interval, 9.42-23.70). CONCLUSION Placental growth factor with maternal factors ± other biomarkers determined in the second trimester achieved the best predictive performance for early preeclampsia in the total population. However, in the third trimester, placental growth factor-based models had predictive performance for any-onset preeclampsia that was better than that of placental growth factor alone but similar to that of soluble fms-like tyrosine kinase-1-placental growth factor ratio. Through this meta-analysis, we have identified a large number of very heterogeneous studies. Therefore, there is an urgent need to develop standardized research using the same models that combine serum placental growth factor with maternal factors ± other biomarkers to accurately predict preeclampsia. Identification of patients at risk might be beneficial for intensive monitoring and timing delivery.
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Affiliation(s)
- Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - María M Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain; Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Noppadol Chaiyasit
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Diana Cuenca-Gomez
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - Walter Plasencia
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - Valeria Rolle
- Biostatistics and Epidemiology Unit, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
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12
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Xue Y, Yang N, Gu X, Wang Y, Zhang H, Jia K. Risk Prediction Model of Early-Onset Preeclampsia Based on Risk Factors and Routine Laboratory Indicators. Life (Basel) 2023; 13:1648. [PMID: 37629504 PMCID: PMC10455518 DOI: 10.3390/life13081648] [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: 06/15/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Background: Globally, 10-15% of maternal deaths are statistically attributable to preeclampsia. Compared with late-onset PE, the severity of early-onset PE remains more harmful with higher morbidity and mortality. Objective: To establish an early-onset preeclampsia prediction model by clinical characteristics, risk factors and routine laboratory indicators were investigated from pregnant women at 6 to 10 gestational weeks. Methods: The clinical characteristics, risk factors, and 38 routine laboratory indicators (6-10 weeks of gestation) including blood lipids, liver and kidney function, coagulation, blood count, and other indicators of 91 early-onset preeclampsia patients and 709 normal controls without early-onset preeclampsia from January 2010 to May 2021 in Peking University Third Hospital (PUTH) were retrospectively analyzed. A logistic regression, decision tree model, and support vector machine (SVM) model were applied for establishing prediction models, respectively. ROC curves were drawn; area under curve (AUCROC), sensitivity, and specificity were calculated and compared. Results: There were statistically significant differences in the rates of diabetes, antiphospholipid syndrome (APS), kidney disease, obstructive sleep apnea (OSAHS), primipara, history of preeclampsia, and assisted reproductive technology (ART) (p < 0.05). Among the 38 routine laboratory indicators, there were no significant differences in the levels of PLT/LYM, NEU/LYM, TT, D-Dimer, FDP, TBA, ALP, TP, ALB, GLB, UREA, Cr, P, Cystatin C, HDL-C, Apo-A1, and Lp(a) between the two groups (p > 0.05). The levels of the rest indicators were all statistically different between the two groups (p < 0.05). If only 12 risk factors of PE were analyzed with the logistic regression, decision tree model, and support vector machine (SVM), and the AUCROC were 0.78, 0.74, and 0.66, respectively, while 12 risk factors of PE and 38 routine laboratory indicators were analyzed with the logistic regression, decision tree model, and support vector machine (SVM), and the AUCROC were 0.86, 0.77, and 0.93, respectively. Conclusions: The efficacy of clinical risk factors alone in predicting early-onset preeclampsia is not high while the efficacy increased significantly when PE risk factors combined with routine laboratory indicators. The SVM model was better than logistic regression model and decision tree model in early prediction of early-onset preeclampsia incidence.
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Affiliation(s)
- Yuting Xue
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing 100191, China;
| | - Nan Yang
- Department of Blood Transfusion, Peking University Third Hospital, Beijing 100191, China;
| | - Xunke Gu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China;
| | - Yongqing Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China;
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China;
| | - Keke Jia
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing 100191, China;
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13
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Mendoza M, Carreras E, Suy A. Aspirin Discontinuation in Pregnancies at High Risk of Preterm Preeclampsia-Reply. JAMA 2023; 329:1988-1989. [PMID: 37314277 DOI: 10.1001/jama.2023.7398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Manel Mendoza
- Department of Obstetrics, Gynecology and Reproductive Sciences, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Elena Carreras
- Department of Obstetrics, Gynecology and Reproductive Sciences, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Anna Suy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Vall d'Hebron University Hospital, Barcelona, Spain
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Nan MN, García-Osuna Á, Mora J, Trilla C, Antonijuan A, Orantes V, Cruz-Lemini M, Blanco-Vaca F, Llurba E. Impact of Angiogenic and Cardiovascular Biomarkers for Prediction of Placental Dysfunction in the First Trimester of Pregnancy. Biomedicines 2023; 11:biomedicines11051327. [PMID: 37238997 DOI: 10.3390/biomedicines11051327] [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: 03/27/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Algorithms for first-trimester prediction of pre-eclampsia usually include maternal risk factors, blood pressure, placental growth factor (PlGF), and uterine artery Doppler pulsatility index. However, these models lack sensitivity for the prediction of late-onset pre-eclampsia and other placental complications of pregnancy, such as small for gestational age infants or preterm birth. The aim of this study was to assess the screening performance of PlGF, soluble fms-like tyrosine kinase-1 (sFlt-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), uric acid, and high-sensitivity cardiac troponin T (hs-TnT) in the prediction of adverse obstetric outcomes related to placental insufficiency. This retrospective case-control study was based on a cohort of 1390 pregnant women, among which 210 presented pre-eclampsia, small for gestational age infants, or preterm birth. Two hundred and eight women with healthy pregnancies were selected as controls. Serum samples were collected between weeks 9 and 13 of gestation, and maternal serum concentrations of PlGF, sFlt-1, NT-proBNP, uric acid, and hs-TnT were measured. Multivariate regression analysis was used to generate predictive models combining maternal factors with the above-mentioned biomarkers. Women with placental dysfunction had lower median concentrations of PlGF (25.77 vs. 32.00 pg/mL; p < 0.001), sFlt-1 (1212.0 vs. 1363.5 pg/mL; p = 0.001), and NT-proBNP (51.22 vs. 68.71 ng/L; p < 0.001) and higher levels of uric acid (193.66 µmol/L vs. 177.40 µmol/L; p = 0.001). There was no significant difference between groups regarding the sFlt-1/PlGF ratio. Hs-TnT was not detected in 70% of the maternal serums analyzed. Altered biomarker concentrations increased the risk of the analyzed complications both in univariate and multivariate analyses. The addition of PlGF, sFlt-1, and NT-proBNP to maternal variables improved the prediction of pre-eclampsia, small for gestational age infants, and preterm birth (area under the curve: 0.710, 0.697, 0.727, and 0.697 vs. 0.668, respectively). Reclassification improvement was greater in maternal factors plus the PlGF model and maternal factors plus the NT-p roBNP model (net reclassification index, NRI: 42.2% and 53.5%, respectively). PlGF, sFlt-1, NT-proBNP, and uric acid measurements in the first trimester of pregnancy, combined with maternal factors, can improve the prediction of adverse perinatal outcomes related to placental dysfunction. In addition to PlGF, uric acid and NT-proBNP are two promising predictive biomarkers for placental dysfunction in the first trimester of pregnancy.
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Affiliation(s)
- Madalina Nicoleta Nan
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Álvaro García-Osuna
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
| | - Josefina Mora
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Network (SAMID-RICORS, RD21/0012) and Maternal and Child Health Development Network (SAMID, RD16/0022), Instituto de Salud Carlos III, 28040 Madrid, Spain
| | - Cristina Trilla
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Network (SAMID-RICORS, RD21/0012) and Maternal and Child Health Development Network (SAMID, RD16/0022), Instituto de Salud Carlos III, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Assumpta Antonijuan
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
| | - Vanesa Orantes
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
| | - Mónica Cruz-Lemini
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Network (SAMID-RICORS, RD21/0012) and Maternal and Child Health Development Network (SAMID, RD16/0022), Instituto de Salud Carlos III, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Francisco Blanco-Vaca
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Elisa Llurba
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Network (SAMID-RICORS, RD21/0012) and Maternal and Child Health Development Network (SAMID, RD16/0022), Instituto de Salud Carlos III, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Sant Quintí 77-79, 08041 Barcelona, Spain
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Wu C, Wang W, Cheng S, Zhang H, Li L, Tian C, Zhang L, Chen N, Du J, Ren L, Lang H. The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis. BMC Psychiatry 2023; 23:204. [PMID: 36978022 PMCID: PMC10053460 DOI: 10.1186/s12888-023-04698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The fear of hypoglycemia in type 2 diabetes mellitus (T2DM) patients with hypoglycemia has seriously affected their quality of life. They are always afraid of hypoglycemia and often take excessive action to avoid it. Yet, researchers have investigated the relationship between hypoglycemia worries and excessive avoiding hypoglycemia behavior using total scores on self-report measures. However, network analysis studies of hypoglycemia worries and excessive avoiding hypoglycemia behavior in T2DM patients with hypoglycemia are lacking. PURPOSE The present study investigated the network structure of hypoglycemia worries and avoiding hypoglycemia behavior in T2DM patients with hypoglycemia and aimed to identify bridge items to help them correctly treat hypoglycemia and properly deal with hypoglycemia fear. METHODS A total of 283 T2DM patients with hypoglycemia were enrolled in our study. Hypoglycemia worries and avoiding hypoglycemia behavior were evaluated with the Hypoglycemia Fear Scale. Network analyses were used for the statistical analysis. RESULTS B9 "Had to stay at home for fear of hypoglycemia" and W12 "I am worried that hypoglycemia will affect my judgment" have the highest expected influences in the present network. In the community of hypoglycemia worries, W17 "I worry about hypoglycemia during sleep" has the highest bridge expected influence. And in the community of avoiding hypoglycemia behavior, B9 "Had to stay at home for fear of hypoglycemia" has the highest bridge expected influence. CONCLUSION Complex patterns of associations existed in the relationship between hypoglycemia worries and avoiding hypoglycemia behavior in T2DM patients with hypoglycemia. From the perspective of network analysis, B9 "Had to stay at home for fear of hypoglycemia" and W12 "I am worried that hypoglycemia will affect my judgment" have the highest expected influence, indicating their highest importance in the network. W17 "I worry about hypoglycemia during sleep" aspect of hypoglycemia worries and B9 "Had to stay at home for fear of hypoglycemia" aspect of avoiding hypoglycemia behavior have the highest bridge expected influence, indicating they have the strongest connections with each community. These results have important implications for clinical practice, which provided potential targets for interventions to reduce hypoglycemia fear and improve the quality of life in T2DM patients with hypoglycemia.
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Affiliation(s)
- Chao Wu
- Nursing Department, Air Force Medical University, No.169 Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Wenwen Wang
- Department of Medical Statistics, School of Preventive Medicine, Air Force Medical University, Xi'an, China
| | - Sizhe Cheng
- Department of Military Medical Psychology, Air Force Medical University, No.169 Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Hongli Zhang
- Nursing Department, Air Force Medical University, No.169 Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Lu Li
- Department of Anesthesia Intensive Care Unit, Tangdu Hospital of Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Ci Tian
- Cardio-Thoracic Surgery, The 305th Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Linyuan Zhang
- Nursing Department, Air Force Medical University, No.169 Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Nana Chen
- Department of Otolaryngology, Army Hospital of the Seventy-seventh Group, Jiajiang, Sichuan, China
| | - Juan Du
- Nursing Department, Air Force Medical University, No.169 Changle West Road, Xi'an, Shaanxi, 710032, China.
| | - Lei Ren
- Department of Military Medical Psychology, Air Force Medical University, No.169 Changle West Road, Xi'an, Shaanxi, 710032, China.
| | - Hongjuan Lang
- Nursing Department, Air Force Medical University, No.169 Changle West Road, Xi'an, Shaanxi, 710032, China.
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16
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Reeder HT, Haneuse S, Modest AM, Hacker MR, Sudhof LS, Papatheodorou SI. A novel approach to joint prediction of preeclampsia and delivery timing using semicompeting risks. Am J Obstet Gynecol 2023; 228:338.e1-338.e12. [PMID: 36037998 PMCID: PMC9968360 DOI: 10.1016/j.ajog.2022.08.045] [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: 07/24/2022] [Revised: 08/20/2022] [Accepted: 08/20/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preeclampsia is a pregnancy complication that contributes substantially to perinatal morbidity and mortality worldwide. Existing approaches to modeling and prediction of preeclampsia typically focus either on predicting preeclampsia risk alone, or on the timing of delivery following a diagnosis of preeclampsia. As such, they are misaligned with typical healthcare interactions during which the 2 events are generally considered simultaneously. OBJECTIVE This study aimed to describe the "semicompeting risks" framework as an innovative approach for jointly modeling the risk and timing of preeclampsia and the timing of delivery simultaneously. Through this approach, one can obtain, at any point during the pregnancy, clinically relevant summaries of an individual's predicted outcome trajectories in 4 risk categories: not developing preeclampsia and not having delivered, not developing preeclampsia but having delivered because of other causes, developing preeclampsia but not having delivered, and developing preeclampsia and having delivered. STUDY DESIGN To illustrate the semicompeting risks methodology, we presented an example analysis of a pregnancy cohort from the electronic health record of an urban, academic medical center in Boston, Massachusetts (n=9161 pregnancies). We fit an illness-death model with proportional-hazards regression specifications describing 3 hazards for timings of preeclampsia, delivery in the absence of preeclampsia, and delivery following preeclampsia diagnosis. RESULTS The results indicated nuanced relationships between a variety of risk factors and the timings of preeclampsia diagnosis and delivery, including maternal age, race/ethnicity, parity, body mass index, diabetes mellitus, chronic hypertension, cigarette use, and proteinuria at 20 weeks' gestation. Sample predictions for a diverse set of individuals highlighted differences in projected outcome trajectories with regard to preeclampsia risk and timing, and timing of delivery either before or after preeclampsia diagnosis. CONCLUSION The semicompeting risks framework enables characterization of the joint risk and timing of preeclampsia and delivery, providing enhanced, meaningful information regarding clinical decision-making throughout the pregnancy.
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Affiliation(s)
- Harrison T Reeder
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Leanna S Sudhof
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
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17
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Mendoza M, Bonacina E, Garcia-Manau P, López M, Caamiña S, Vives À, Lopez-Quesada E, Ricart M, Maroto A, de Mingo L, Pintado E, Ferrer-Costa R, Martin L, Rodríguez-Zurita A, Garcia E, Pallarols M, Vidal-Sagnier L, Teixidor M, Orizales-Lago C, Pérez-Gomez A, Ocaña V, Puerto L, Millán P, Alsius M, Diaz S, Maiz N, Carreras E, Suy A. Aspirin Discontinuation at 24 to 28 Weeks' Gestation in Pregnancies at High Risk of Preterm Preeclampsia: A Randomized Clinical Trial. JAMA 2023; 329:542-550. [PMID: 36809321 PMCID: PMC9945069 DOI: 10.1001/jama.2023.0691] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/18/2023] [Indexed: 02/23/2023]
Abstract
Importance Aspirin reduces the incidence of preterm preeclampsia by 62% in pregnant individuals at high risk of preeclampsia. However, aspirin might be associated with an increased risk of peripartum bleeding, which could be mitigated by discontinuing aspirin before term (37 weeks of gestation) and by an accurate selection of individuals at higher risk of preeclampsia in the first trimester of pregnancy. Objective To determine whether aspirin discontinuation in pregnant individuals with normal soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1:PlGF) ratio between 24 and 28 weeks of gestation was noninferior to aspirin continuation to prevent preterm preeclampsia. Design, Setting, and Participants Multicenter, open-label, randomized, phase 3, noninferiority trial conducted in 9 maternity hospitals across Spain. Pregnant individuals (n = 968) at high risk of preeclampsia during the first-trimester screening and an sFlt-1:PlGF ratio of 38 or less at 24 to 28 weeks of gestation were recruited between August 20, 2019, and September 15, 2021; of those, 936 were analyzed (intervention: n = 473; control: n = 463). Follow-up was until delivery for all participants. Interventions Enrolled patients were randomly assigned in a 1:1 ratio to aspirin discontinuation (intervention group) or aspirin continuation until 36 weeks of gestation (control group). Main Outcomes and Measures Noninferiority was met if the higher 95% CI for the difference in preterm preeclampsia incidences between groups was less than 1.9%. Results Among the 936 participants, the mean (SD) age was 32.4 (5.8) years; 3.4% were Black and 93% were White. The incidence of preterm preeclampsia was 1.48% (7/473) in the intervention group and 1.73% (8/463) in the control group (absolute difference, -0.25% [95% CI, -1.86% to 1.36%]), indicating noninferiority. Conclusions and Relevance Aspirin discontinuation at 24 to 28 weeks of gestation was noninferior to aspirin continuation for preventing preterm preeclampsia in pregnant individuals at high risk of preeclampsia and a normal sFlt-1:PlGF ratio. Trial Registration ClinicalTrials.gov Identifier: NCT03741179 and ClinicalTrialsRegister.eu Identifier: 2018-000811-26.
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Affiliation(s)
- Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Erika Bonacina
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo Garcia-Manau
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monica López
- Department of Obstetrics, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Sara Caamiña
- Department of Obstetrics, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Àngels Vives
- Department of Obstetrics, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Eva Lopez-Quesada
- Department of Obstetrics, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Marta Ricart
- Department of Obstetrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Anna Maroto
- Department of Obstetrics, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Laura de Mingo
- Department of Obstetrics, Hospital Universitario Severo Ochoa, Leganés, Spain
| | - Elena Pintado
- Department of Obstetrics, Hospital Universitario de Getafe, Getafe, Spain
| | - Roser Ferrer-Costa
- Department of Biochemistry, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lourdes Martin
- Department of Obstetrics, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Alicia Rodríguez-Zurita
- Department of Obstetrics, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Esperanza Garcia
- Department of Obstetrics, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Mar Pallarols
- Department of Obstetrics, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Laia Vidal-Sagnier
- Department of Obstetrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mireia Teixidor
- Department of Obstetrics, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | | | - Adela Pérez-Gomez
- Department of Obstetrics, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Vanesa Ocaña
- Department of Obstetrics, Hospital Universitario de Getafe, Getafe, Spain
| | - Linda Puerto
- Department of Obstetrics, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Pilar Millán
- Department of Obstetrics, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Mercè Alsius
- Department of Biochemistry, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Sonia Diaz
- Department of Obstetrics, Hospital Universitario de Getafe, Getafe, Spain
| | - Nerea Maiz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Carreras
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Suy
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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18
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Wang X, Wu Y, Sun Q, Jiang Z, Che G, Tao Y, Tian J. Ultrasound and microbubble-mediated delivery of miR-424-5p has a therapeutic effect in preeclampsia. Biol Proced Online 2023; 25:3. [PMID: 36788514 PMCID: PMC9930350 DOI: 10.1186/s12575-023-00191-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To determine the influence of ultrasound/microbubble-mediated miR-424-5p delivery on trophoblast cells and the underlying mechanism. METHODS Blood pressure and 24-h proteinuria of patients with preeclampsia (PE) were measured as well as the levels of miR-424-5p and amine oxidase copper containing 1 (AOC1) in placental tissues. HTR-8/Svneo and TEV-1 cells were subjected to cell transfection or ultrasonic microbubble transfection for determination of the expression of miR-424-5p, AOC1, β-catenin and c-Myc as well as cell proliferation, apoptosis, migration and invasiveness. The concentrations of placental growth factor (PLGF), human chorionic gonadotropin (β-hCG) and tumor necrosis factor-α (TNF-α) were measured in HTR-8/Svneo and TEV-1 cells. RNA immunoprecipitation (RIP) and dual luciferase reporter assay detected the binding of miR-424-5p to AOC1. A PE mouse model was induced by subcutaneous injection of L-NAME, where the influence of ultrasound/microbubble-mediated miR-424-5p delivery was evaluated. RESULTS miR-424-5p was downregulated while AOC1 was upregulated in the placental tissues from PE patients. Overexpression of miR-424-5p activated Wnt/β-catenin signaling pathway and promoted the proliferation of HTR-8/Svneo and TEV-1 cells as well as enhanced the migratory and invasive behaviors. AOC1 overexpression partly eliminated the effects of miR-424-5p on HTR-8/Svneo and TEV-1 cells. Ultrasound and microbubble mediated gene delivery enhanced the transfection efficiency of miR-424-5p and further promoted the effects of miR-424-5p in trophoblast cells. Ultrasound/microbubble-mediated miR-424-5p delivery alleviated experimental PE in mice. CONCLUSION Ultrasound and microbubble-mediated miR-424-5p delivery targets AOC1 and activates Wnt/β-catenin signaling pathway, thus promoting the aggressive phenotype of trophoblast cells, which indicating that miR-424-5p/AOC1 axis might be involved with PE pathogenesis.
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Affiliation(s)
- Xudong Wang
- grid.412463.60000 0004 1762 6325Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, Heilongjiang 150001 P.R. China
| | - Yan Wu
- grid.412463.60000 0004 1762 6325Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, Heilongjiang 150001 P.R. China
| | - Qinliang Sun
- grid.412463.60000 0004 1762 6325Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, Heilongjiang 150001 P.R. China
| | - Zhonghui Jiang
- grid.412463.60000 0004 1762 6325Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, Heilongjiang 150001 P.R. China
| | - Guoying Che
- grid.412463.60000 0004 1762 6325Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, Heilongjiang 150001 P.R. China
| | - Yangyang Tao
- grid.412463.60000 0004 1762 6325Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, Heilongjiang 150001 P.R. China
| | - Jiawei Tian
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, Heilongjiang, 150001, P.R. China.
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19
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Serrano B, Bonacina E, Rodo C, Garcia-Manau P, Sanchez-Duran MÁ, Pancorbo M, Forcada C, Murcia MT, Perestelo A, Armengol-Alsina M, Mendoza M, Carreras E. First-trimester screening for pre-eclampsia and small for gestational age: A comparison of the gaussian and Fetal Medicine Foundation algorithms. Int J Gynaecol Obstet 2023; 160:150-160. [PMID: 35695395 PMCID: PMC10083925 DOI: 10.1002/ijgo.14306] [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: 02/09/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Pre-eclampsia (PE) and small for gestational age (SGA) can be predicted from the first trimester. The most widely used algorithm worldwide is the Fetal Medicine Foundation (FMF) algorithm. The recently described Gaussian algorithm has reported excellent results although it is unlikely to be externally validated. Therefore, as an alternative approach, we compared the predictive accuracy for PE and SGA of the Gaussian and FMF algorithms. METHODS Secondary analysis of a prospective cohort study was conducted at Vall d'Hebron University Hospital (Barcelona) with 2641 singleton pregnancies. The areas under the curve for the predictive performance for early-onset and preterm PE and early-onset and preterm SGA were calculated with the Gaussian and FMF algorithms and subsequently compared. RESULTS The FMF and Gaussian algorithms showed a similar predictive performance for most outcomes and marker combinations. Nevertheless, significant differences for early-onset PE prediction favored the Gaussian algorithm in the following combinations: mean arterial blood pressure (MAP) with pregnancy-associated plasma protein A, MAP with placental growth factor, and MAP alone. CONCLUSIONS The first-trimester Gaussian and FMF algorithms have similar performances for PE and SGA prediction when applied with all markers within a routine care setting in a Spanish population, adding evidence to the external validity of the FMF algorithm.
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Affiliation(s)
- Berta Serrano
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Erika Bonacina
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlota Rodo
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo Garcia-Manau
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Ángeles Sanchez-Duran
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Pancorbo
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Forcada
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Teresa Murcia
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Perestelo
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mireia Armengol-Alsina
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Carreras
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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20
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Chen T, Zhang Z, Lu Q, Ma J. Screening and functional analysis of the differential peptides from the placenta of patients with healthy pregnancy and preeclampsia using placental peptidome. Front Genet 2022; 13:1014836. [DOI: 10.3389/fgene.2022.1014836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Molecular peptides play an extensive range of functions in the human body. However, no previous study has performed placental peptidome profiling. In the present study, 3,941 peptides from human placental tissues were identified using peptidomics. Compared to healthy pregnant women, there were 87 and 129 differentially expressed peptides (DEPs) in the mild and severe preeclampsia groups, respectively. In the mild PE group, 55 and 34 DEPs had high and low expressions, respectively. In comparison, in the severe PE group, 82 and 47 DEPs had high and low expressions, respectively. Functional analysis of the precursor proteins of DEPs by gene ontology suggested that they are primarily involved in focal adhesion, extracellular matrix-receptor interaction, tight junction, and extracellular matrix. Network analysis using ingenuity pathway analysis software showed that the precursor proteins of DEPs were primarily related to the transforming growth factor-β (TGF-β)/Smad signaling pathway. Further molecular docking experiments showed that the AASAKKKNKKGKTISL peptide (placenta-derived peptide, PDP) derived from the precursor protein IF4B could bind to TGF-β1. Therefore, our preliminary results suggest that the actions of PDP may be mediated through the TGF-β1/Smad signaling pathway. Our results demonstrate that the placental bioactive peptides may regulate the placental function during PE progression.
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21
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Shi F, Li L. Hsa_circ_0088196 suppresses trophoblast migration and invasion by the miR-525-5p/ABL1 axis and the PI3K/AKT signaling pathway. J Biochem Mol Toxicol 2022; 36:e23150. [PMID: 35781906 DOI: 10.1002/jbt.23150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022]
Abstract
Our study aimed to explore the role of circ_0088196 (circular TNC [circTNC]) in trophoblast invasion and migration in preeclampsia (PE) both in vitro and in vivo. CircTNC, miR-525-5p, and ABL1 expression in trophoblast HTR8/SVneo cells were evaluated by quantitative real-time polymerase chain reaction (qRT-PCR). Cell viability, migration, and invasion were detected by Cell Counting Kit-8 (CCK-8), wound healing, and Transwell assays. The binding between circTNC (or ABL1) and miR-525-5p was validated by RNA pulldown and luciferase reporter assays. The mouse model of PE was injected with sh-circTNC and the effects of circTNC knockdown on the mean artery pressure, urine protein concentration, and fetal survival number of pregnant mice were examined. The expression of MMP-2, MMP-9, and PI3K/AKT pathway molecules in placental tissues was assessed by immunohistochemistry, qRT-PCR, and western blot analysis. CircTNC overexpression inhibited cell invasion and migration, but did not influence cell proliferation. CircTNC bound with miR-525-5p, whose knockdown repressed cell invasion and migration, while it exerted no effect on cell proliferation. ABL1, a target of miR-525-5p, attenuated cell migration and invasion, without influence on cell viability. Importantly, either miR-525-5p overexpression or ABL1 depletion antagonized the repression of upregulated circTNC on trophoblast cell migration and invasion, MMP-2 and MMP-9 expression, and the PI3K/AKT pathway. CircTNC knockdown alleviated PE symptoms in pregnant mice. CircTNC knockdown promoted the trophoblast invasiveness in mice placenta by upregulating MMP-2/9 expression and suppressing the PI3K/AKT pathway. Circ_0088196 represses trophoblast invasion and migration both in vitro and in vivo via regulating the miR-525-5p/ABL1 axis and activating the PI3K/AKT pathway.
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Affiliation(s)
- Fenglian Shi
- Department of Gynaecology and Obstetrics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Li Li
- Department of Gynaecology and Obstetrics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
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22
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Diagnostic Value of IGFBP-2 in Predicting Preeclampsia before 20 Weeks of Pregnancy: A Prospective Nested Case-Control Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5075569. [PMID: 36213583 PMCID: PMC9534648 DOI: 10.1155/2022/5075569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022]
Abstract
Purpose To identify novel biomarker insulin-like growth factor binding protein-2 (IGFBP-2) associated with preeclampsia (PE) before 20 weeks of gestation and to explore the predictive value of plasma IGFBP-2 in PE. Methods A prospective nested case-control investigation involving 122 PE patients and 122 normal controls (NC) that were matched 1 : 1 in terms of age and week of pregnancy was carried out in Guangzhou Women and Children's Medical Center (Guangzhou, China, 2018030306) from April 2016 to December 2019. At 8 to 20 weeks, blood samples from the mother were taken. To calculate the correlations, univariate conditional logistic regression was employed. Results Herein, 12 clinical indices were significantly different between the PE and NC groups (uric acid (UA), cystatin C (Cys C), aspartate aminotransferase (AST), glutamyl transpeptidase (γ-GT), total bilirubin (TB), prothrombin time (PT), red blood cell (RBC), hematocrit (HCT), red cell distribution width (RDW), platelets (PLT), mean platelet volume (MPV), and thrombocytocrit (PCT)). Compared with the NC group (36.79 ± 19.91 pg/mL), the expression level of IGFBP2 in the PE group (19.76 ± 19.40 pg/mL) before 20 weeks of pregnancy was significantly decreased (P < 0.01). Two high-risk factors were found to be significantly associated with PE independently of confounders: anemia 4.35 (2.20-8.45) (P < 0.01) and cesarean section history 8.25 (2.67-26.67) (P < 0.01). As a result of the univariate logistic regression analysis, the following three variables were included in the final logistic regression model.: Y = −18.841 − 0.085 × (IGFBP‐2) + 0.630 × (RDW) + 0.165 × (AST) + 0.863 × (MPV). In comparison to IGFBP-2 alone as an independent predictor of PE (AUC = 0.897, 95% CI 0.830–0.964), the model's discriminatory power was considerably higher (AUC = 0.953, 95% CI 0.911–0.995). Conclusion Plasma IGFBP-2 before 20 weeks of pregnancy combined with high-risk factors and routine blood indexes has a high early predictive value for PE.
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Kantomaa T, Vääräsmäki M, Gissler M, Sairanen M, Nevalainen J. First trimester low maternal serum pregnancy associated plasma protein-A (PAPP-A) as a screening method for adverse pregnancy outcomes. J Perinat Med 2022; 51:500-509. [PMID: 36131518 DOI: 10.1515/jpm-2022-0241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/07/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate different cut-off values of first trimester pregnancy associated plasma protein-A (PAPP-A) in screening for adverse pregnancy outcomes in a retrospective cohort study. METHODS During the study period of 1.1.2014-31.12.2018, total of 23,482 women with singleton pregnancies participated in first trimester combined screening for chromosomal abnormalities. Maternal serum PAPP-A multiple of medians (MoM) levels were measured, and study population was divided into three study groups of PAPP-A ≤0.40 (n=1,030), ≤0.35 (n=630) and ≤0.30 (n=363) MoM. RESULTS Small for gestational age (SGA), preterm birth (PTB) and composite outcome (SGA, hypertensive disorder of pregnancy (HDP) and/or PTB) were more frequent in all three PAPP-A MoM study groups and pre-eclampsia in ≤0.40 and ≤0.35 study groups than in their control groups (p < 0.05). The odds ratio (OR) for SGA varied from 3.7 to 5.4 and sensitivity and specificity from 6.9 to 13.8% and from 95.9 to 98.6%, between study groups. Using PAPP-A ≤0.30 MoM as a screening cut-off instead of PAPP-A ≤0.40 MoM, resulted in approximately 50% reduction in screening detection of SGA and PTB. CONCLUSIONS PAPP-A ≤0.40 MoM should be considered as a primary screening cut-off for adverse pregnancy outcomes as approximately 23% will develop either SGA, HDP or PTB. It seems to be the best cut-off to screen for SGA.
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Affiliation(s)
- Tiina Kantomaa
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, Oulu, Finland
| | - Marja Vääräsmäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, Oulu, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland.,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - Jaana Nevalainen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, Oulu, Finland
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Parry S, Carper BA, Grobman WA, Wapner RJ, Chung JH, Haas DM, Mercer B, Silver RM, Simhan HN, Saade GR, Reddy UM, Parker CB. Placental protein levels in maternal serum are associated with adverse pregnancy outcomes in nulliparous patients. Am J Obstet Gynecol 2022; 227:497.e1-497.e13. [PMID: 35487327 PMCID: PMC9420814 DOI: 10.1016/j.ajog.2022.03.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND The Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be was established to investigate the underlying causes and pathophysiological pathways associated with adverse pregnancy outcomes in nulliparous gravidas. OBJECTIVE This study aimed to study placental physiology and identify novel biomarkers concerning adverse pregnancy outcomes, including preterm birth (medically indicated and spontaneous), preeclampsia, small-for-gestational-age neonates, and stillbirth. We measured levels of placental proteins in the maternal circulation in the first 2 trimesters of pregnancy. STUDY DESIGN Maternal serum samples were collected at 2 study visits (6-13 weeks and 16-21 weeks), and levels of 9 analytes were measured. The analytes we measured were vascular endothelial growth factor, placental growth factor, endoglin, soluble fms-like tyrosine kinase-1, A disintegrin and metalloproteinase domain-containing protein 12, pregnancy-associated plasma protein A, free beta-human chorionic gonadotropin, inhibin A, and alpha-fetoprotein. The primary outcome was preterm birth between 20 0/7 and 36 6/7 weeks of gestation. The secondary outcomes were spontaneous preterm births, medically indicated preterm births, preeclampsia, small-for-gestational-age neonates, and stillbirth. RESULTS A total of 10,038 eligible gravidas were enrolled in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort, from which a nested case-control study was performed comparing 800 cases with preterm birth (466 spontaneous preterm births, 330 medically indicated preterm births, and 4 unclassified preterm births), 568 with preeclampsia, 406 with small-for-gestational-age birth, and 49 with stillbirth with 911 controls who delivered at term without complications. Although levels of each analyte generally differed between cases and controls at 1 or 2 visits, the odds ratios revealed a <2-fold difference between cases and controls in all comparisons. Receiver operating characteristic curves, generated to determine the relationship between analyte levels and preterm birth and the other adverse pregnancy outcomes, resulted in areas under the receiver operating characteristic curves that were relatively low (range, 0.50-0.64) for each analyte. Logistic regression modeling demonstrated that areas under the receiver operating characteristic curves for predicting adverse pregnancy outcomes were greater using baseline clinical characteristics and combinations of analytes than baseline characteristics alone, but areas under the receiver operating characteristic curves remained relatively low for each outcome (range, 0.65-0.78). CONCLUSION We have found significant associations between maternal serum levels of analytes evaluated early in pregnancy and subsequent adverse pregnancy outcomes in nulliparous gravidas. However, the test characteristics for these analytes do not support their use as clinical biomarkers to predict adverse pregnancy outcomes, either alone or in combination with maternal clinical characteristics.
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Affiliation(s)
- Samuel Parry
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | | | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, CA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN
| | - Brian Mercer
- Department of Obstetrics and Gynecology, MetroHealth System, Cleveland, OH
| | - Robert M Silver
- Department of Obstetrics and Gynecology, The University of Utah Health Sciences Center, Salt Lake City, UT
| | - Hyagriv N Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - George R Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Uma M Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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Liu M, Yang X, Chen G, Ding Y, Shi M, Sun L, Huang Z, Liu J, Liu T, Yan R, Li R. Development of a prediction model on preeclampsia using machine learning-based method: a retrospective cohort study in China. Front Physiol 2022; 13:896969. [PMID: 36035487 PMCID: PMC9413067 DOI: 10.3389/fphys.2022.896969] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/05/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: The aim of this study was to use machine learning methods to analyze all available clinical and laboratory data obtained during prenatal screening in early pregnancy to develop predictive models in preeclampsia (PE). Material and Methods: Data were collected by retrospective medical records review. This study used 5 machine learning algorithms to predict the PE: deep neural network (DNN), logistic regression (LR), support vector machine (SVM), decision tree (DT), and random forest (RF). Our model incorporated 18 variables including maternal characteristics, medical history, prenatal laboratory results, and ultrasound results. The area under the receiver operating curve (AUROC), calibration and discrimination were evaluated by cross-validation. Results: Compared with other prediction algorithms, the RF model showed the highest accuracy rate. The AUROC of RF model was 0.86 (95% CI 0.80–0.92), the accuracy was 0.74 (95% CI 0.74–0.75), the precision was 0.82 (95% CI 0.79–0.84), the recall rate was 0.42 (95% CI 0.41–0.44), and Brier score was 0.17 (95% CI 0.17–0.17). Conclusion: The machine learning method in our study automatically identified a set of important predictive features, and produced high predictive performance on the risk of PE from the early pregnancy information.
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Affiliation(s)
- Mengyuan Liu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaofeng Yang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guolu Chen
- School of Information and Communication Engineering, Harbin Engineering University, Harbin, China
| | - Yuzhen Ding
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Meiting Shi
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lu Sun
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhengrui Huang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jia Liu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tong Liu
- School of Information and Communication Engineering, Harbin Engineering University, Harbin, China
- *Correspondence: Tong Liu, ; Ruiling Yan, ; Ruiman Li,
| | - Ruiling Yan
- The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Tong Liu, ; Ruiling Yan, ; Ruiman Li,
| | - Ruiman Li
- The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Tong Liu, ; Ruiling Yan, ; Ruiman Li,
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Trilla C, Mora J, Ginjaume N, Nan MN, Alejos O, Domínguez C, Vega C, Godínez Y, Cruz-Lemini M, Parra J, Llurba E. Reduction in Preterm Preeclampsia after Contingent First-Trimester Screening and Aspirin Prophylaxis in a Routine Care Setting. Diagnostics (Basel) 2022; 12:diagnostics12081814. [PMID: 36010165 PMCID: PMC9406877 DOI: 10.3390/diagnostics12081814] [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: 06/17/2022] [Revised: 07/17/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives: Several multivariate algorithms for preeclampsia (PE) screening in the first trimester have been developed over the past few years. These models include maternal factors, mean arterial pressure (MAP), uterine artery Doppler (UtA-PI), and biochemical markers (pregnancy-associated plasma protein-A (PAPP-A) or placental growth factor (PlGF)). Treatment with low-dose aspirin (LDA) has shown a reduction in the incidence of preterm PE in women with a high-risk assessment in the first trimester. An important barrier to the implementation of first-trimester screening is the cost of performing tests for biochemical markers in the whole population. Theoretical contingent strategies suggest that two-stage screening models could also achieve high detection rates for preterm PE with lower costs. However, no data derived from routine care settings are currently available. This study was conducted to validate and assess the performance of a first-trimester contingent screening process using PlGF for PE, with prophylactic LDA, for decreasing the incidence of preterm PE. Methods: This was a two-phase study. In phase one, a contingent screening model for PE was developed using a multivariate validated model and a historical cohort participating in a non-interventional PE screening study (n = 525). First-stage risk assessment included maternal factors, MAP, UtA-PI, and PAPP-A. Several cut-off levels were tested to determine the best screening performance, and three groups were then defined (high-, medium-, and low-risk groups). PlGF was determined in the medium-risk group to calculate the final risk. Phase two included a validation cohort of 847 singleton pregnancies prospectively undergoing first-trimester PE screening using this approach. Women at high risk of PE received prophylactic treatment with 150 mg of LDA. The clinical impact of the model was evaluated by comparing the incidence of early-onset (<34 weeks) and preterm (<37 weeks) PE between groups. Results: Cut-off levels for the contingent screening model were chosen in the first and second stages of screening to achieve a performance with sensitivities of 100% and 80% for early-onset and preterm PE detection, respectively, with a 15% false positive rate. In the development phase, 21.5% (n = 113) of the women had a medium risk of PE and required second-stage screening. In the prospective validation phase, 15.3% (n = 130) of the women required second-stage screening for PlGF, yielding an overall screen-positive rate of 14.9% (n = 126). The incidence of preterm PE was reduced by 68.4% (1.9% vs. 0.6%, p = 0.031) after one year of screening implementation. Conclusions: Implementation of contingent screening for PE using PlGF in a routine care setting led to a significant reduction (68.4%) in preterm PE, suggesting that contingent screening can achieve similar results to protocols using PlGF in the whole population. This could have financial benefits, with a similar reduction in the rate of preterm PE.
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Affiliation(s)
- Cristina Trilla
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Josefina Mora
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Nuria Ginjaume
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
| | - Madalina Nicoleta Nan
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Obdulia Alejos
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
| | - Carla Domínguez
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
| | - Carmen Vega
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
| | - Yessenia Godínez
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
| | - Monica Cruz-Lemini
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan Parra
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
| | - Elisa Llurba
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-935-337-041
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Gestational age-specific serum creatinine can predict adverse pregnancy outcomes. Sci Rep 2022; 12:11224. [PMID: 35780246 PMCID: PMC9250531 DOI: 10.1038/s41598-022-15450-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
Serum creatinine level (SCr) typically decreases during pregnancy due to physiologic glomerular hyperfiltration. Therefore, the clinical practice of estimated glomerular filtration rate (eGFR) based on SCr concentrations might be inapplicable to pregnant women with kidney disease since it does not take into account of the pregnancy-related biological changes. We integrated the Wonju Severance Christian Hospital (WSCH)-based findings and prior knowledge from big data to reveal the relationship between the abnormal but hidden SCr level and adverse pregnancy outcomes. We analyzed 4004 pregnant women who visited in WSCH. Adverse pregnancy outcomes included preterm birth, preeclampsia, fetal growth retardation, and intrauterine fetal demise. We categorized the pregnant women into four groups based on the gestational age (GA)-unadjusted raw distribution (Q1–4raw), and then GA-specific (Q1–4adj) SCr distribution. Linear regression analysis revealed that Q1-4adj groups had better predictive outcomes than the Q1–4raw groups. In logistic regression model, the Q1–4adj groups exhibited a robust non-linear U-shaped relationship with the risk of adverse pregnancy outcomes, compared to the Q1–4raw groups. The integrative analysis on SCr with respect to GA-specific distribution could be used to screen out pregnant women with a normal SCr coupled with a decreased renal function.
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Toro Wills M, Sánchez Valencia L, Rangel Ramos V, Pedraza Flechas A, Martínez Ávila M. Ácido úrico herramienta de tamización para preeclampsia. Una revisión sistemática de la literatura. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2022.100749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Serrano B, Mendoza M, Garcia-Aguilar P, Bonacina E, Garcia-Ruiz I, Garcia-Manau P, Gil J, Armengol-Alsina M, Fernandez-Hidalgo N, Sulleiro E, Lopez-Martinez RM, Ricart M, Martin L, Lopez-Quesada E, Vives A, Maroto A, Maiz N, Suy A, Carreras E. Shared risk factors for COVID-19 and preeclampsia in the first trimester: An observational study. Acta Obstet Gynecol Scand 2022; 101:803-808. [PMID: 35505629 PMCID: PMC9347999 DOI: 10.1111/aogs.14371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The association between preeclampsia and coronavirus disease 2019 (COVID-19) is under study. Previous publications have hypothesized the existence of shared risk factors for both conditions or a deficient trophoblastic invasion as possible explanations for this association. The primary aim of this study was to examine baseline risk factors measured in the first-trimester combined screening for preeclampsia in pregnant women with COVID-19 compared with the general population. A secondary aim of this study was to compare risk factors among patients with mild and severe COVID-19. MATERIAL AND METHODS This was an observational retrospective study conducted at Vall d'Hebron Hospital Campus (Catalonia, Spain). Study patients were 231 pregnant women undergoing the first-trimester screening for preeclampsia and positive for severe acute respiratory syndrome coronavirus 2 between February 2020 and September 2021. The reference cohort were 13 033 women of the general population from six centers across Catalonia from May 2019 to June 2021. Based on the need for hospitalization, patients were classified in two groups: mild and severe COVID-19. First-trimester screening for preeclampsia included maternal history, mean arterial blood pressure, mean uterine artery pulsatility index (UtAPI), placental growth factor (PlGF), and pregnancy-associated plasma protein-A (PAPP-A). RESULTS The proportion of cases at high risk for preeclampsia was significantly higher among the COVID-19 group compared with the general population (19.0% and 13.2%, respectively; p = 0.012). When analyzing risk factors for preeclampsia individually, women with COVID-19 had higher median body mass index (25.2 vs 24.5, p = 0.041), higher UtAPI multiple of the median (MoM) (1.08 vs 1.00, p < 0.001), higher incidence of chronic hypertension (2.8% vs 0.9%, p = 0.015), and there were fewer smokers (5.7% vs 11.6%, p = 0.007). The MoMs of PlGF and PAPP-A did not differ significantly between both groups (0.96 vs 0.97, p = 0.760 and 1.00 vs 1.01, p = 0.432; respectively). CONCLUSIONS In patients with COVID-19, there was a higher proportion of women at high risk for preeclampsia at the first-trimester screening than in the general population, mainly because of maternal risk factors, rather than placental signs of a deficient trophoblastic invasion.
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Affiliation(s)
- Berta Serrano
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paula Garcia-Aguilar
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Erika Bonacina
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Itziar Garcia-Ruiz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo Garcia-Manau
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Judit Gil
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mireia Armengol-Alsina
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Fernandez-Hidalgo
- Department of Infectous Diseases, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rosa Maria Lopez-Martinez
- Biochemistry Department, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Ricart
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Lourdes Martin
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari de Tarragona Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Eva Lopez-Quesada
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Angels Vives
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Consorci Sanitari de Terrassa, Universitat Internacional de Catalunya, Terrassa, Spain
| | - Anna Maroto
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari de Girona Doctor Josep Trueta, Universitat de Girona, Girona, Spain
| | - Nerea Maiz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Suy
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Carreras
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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Freimane KZ, Kerrigan L, Eastwood KA, Watson CJ. Pre-Eclampsia Biomarkers for Women With Type 1 Diabetes Mellitus: A Comprehensive Review of Recent Literature. Front Bioeng Biotechnol 2022; 10:809528. [PMID: 35721866 PMCID: PMC9198830 DOI: 10.3389/fbioe.2022.809528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/21/2022] [Indexed: 12/26/2022] Open
Abstract
Background: Pre-eclampsia is a serious consideration for women with type 1 diabetes mellitus (T1DM) planning pregnancy. Risk stratification strategies, such as biomarkers measured in the first trimester of pregnancy, could help identify high-risk women. The literature on T1DM-specific pre-eclampsia biomarkers is expanding. We aimed to provide a narrative review of recently published evidence to identify the most promising biomarker candidates that could be targeted for clinical implementation in existing PE models. Methods: A search using MeSH terms was carried out of Medline, EMBASE, Maternity and Infant Care, Web of Science, and Scopus for relevant papers published since 2015 inclusive and in English. The time limit was applied from the publication of the preceding systematic review in this field. Included studies had pre-eclampsia as a primary outcome, measured one or more serum, plasma or urine biomarkers at any time during pregnancy, and had a distinct group of women with T1DM who developed pre-eclampsia. Studies with pre-eclampsia as a composite outcome were not considered. No restrictions on study types were applied. A narrative synthesis approach was adopted for analysis. Results: A total of 510 records were screened yielding 18 eligible studies relating to 32 different biomarkers. Higher first-trimester levels of HbA1c and urinary albumin were associated with an increased risk of pre-eclampsia development in women with T1DM. Urinary neutrophil gelatinase-associated lipocalin and adipokines were novel biomarkers showing moderate predictive ability before 15 gestational weeks. Two T1DM-specific pre-eclampsia prediction models were proposed, measuring adipokines or urinary neutrophil gelatinase-associated lipocalin together with easily attainable maternal clinical characteristics. Contradicting previous literature, pre-eclampsia risk in women with T1DM was correlated with vitamin D levels and atherogenic lipid profile in the context of haptoglobin phenotype 2-2. Pregnancy-associated plasma protein-A and soluble endoglin did not predict pre-eclampsia in women with T1DM, and soluble Fms-like tyrosine kinase 1 only predicted pre-eclampsia from the third trimester. Conclusion: Maternally derived biomarkers reflecting glycemic control, insulin resistance and renal dysfunction performed better as PE predictors among women with T1DM than those derived from the placenta. These biomarkers could be trialed in current PE prediction algorithms to tailor them for women with T1DM.
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Affiliation(s)
- Katrina Z Freimane
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Lauren Kerrigan
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Kelly-Ann Eastwood
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,Department of Fetal Medicine, St. Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Chris J Watson
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
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Li S, Wang Z, Vieira LA, Zheutlin AB, Ru B, Schadt E, Wang P, Copperman AB, Stone JL, Gross SJ, Kao YH, Lau YK, Dolan SM, Schadt EE, Li L. Improving preeclampsia risk prediction by modeling pregnancy trajectories from routinely collected electronic medical record data. NPJ Digit Med 2022; 5:68. [PMID: 35668134 PMCID: PMC9170686 DOI: 10.1038/s41746-022-00612-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 05/19/2022] [Indexed: 11/15/2022] Open
Abstract
Preeclampsia is a heterogeneous and complex disease associated with rising morbidity and mortality in pregnant women and newborns in the US. Early recognition of patients at risk is a pressing clinical need to reduce the risk of adverse outcomes. We assessed whether information routinely collected in electronic medical records (EMR) could enhance the prediction of preeclampsia risk beyond what is achieved in standard of care assessments. We developed a digital phenotyping algorithm to curate 108,557 pregnancies from EMRs across the Mount Sinai Health System, accurately reconstructing pregnancy journeys and normalizing these journeys across different hospital EMR systems. We then applied machine learning approaches to a training dataset (N = 60,879) to construct predictive models of preeclampsia across three major pregnancy time periods (ante-, intra-, and postpartum). The resulting models predicted preeclampsia with high accuracy across the different pregnancy periods, with areas under the receiver operating characteristic curves (AUC) of 0.92, 0.82, and 0.89 at 37 gestational weeks, intrapartum and postpartum, respectively. We observed comparable performance in two independent patient cohorts. While our machine learning approach identified known risk factors of preeclampsia (such as blood pressure, weight, and maternal age), it also identified other potential risk factors, such as complete blood count related characteristics for the antepartum period. Our model not only has utility for earlier identification of patients at risk for preeclampsia, but given the prediction accuracy exceeds what is currently achieved in clinical practice, our model provides a path for promoting personalized precision therapeutic strategies for patients at risk.
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Affiliation(s)
| | | | - Luciana A Vieira
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Pei Wang
- Department of Genetics and Genomic Sciences, The Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan B Copperman
- Sema4, Stamford, CT, USA.,Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, NY, USA
| | - Joanne L Stone
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan J Gross
- Sema4, Stamford, CT, USA.,Department of Genetics and Genomic Sciences, The Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Siobhan M Dolan
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Genetics and Genomic Sciences, The Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric E Schadt
- Sema4, Stamford, CT, USA. .,Department of Genetics and Genomic Sciences, The Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Li Li
- Sema4, Stamford, CT, USA. .,Department of Genetics and Genomic Sciences, The Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Li W, Lin X, Chen Y, Liu K, Yang W, Zeng S, Zhang J. Predictive value of the second-trimester fibronectin concentration for severe preeclampsia: A prospective nested case-control study in China. J Obstet Gynaecol Res 2022; 48:1721-1731. [PMID: 35385197 DOI: 10.1111/jog.15259] [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: 12/27/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the value of the second-trimester fibronectin concentration, alone and in combination with other markers (e.g., mean arterial pressure, inhibin A), in the identification of women who subsequently develop severe preeclampsia. METHODS For this prospective nested case-control study, serum from pregnant women (gestational age 15-22 weeks) who underwent routine Down syndrome screening was analyzed. The women were tracked to delivery and assigned to the severe preeclampsia or control group, according to whether they developed severe preeclampsia. Each woman who later developed severe preeclampsia was paired with five healthy women with pregnancies of similar gestational age (± 1 week). Fibronectin, inhibin A, human chorionic gonadotropin, placental growth factor, cysteine, and homocysteine concentrations were measured in 44 cases in the severe preeclampsia group and 220 cases in the control group. The body mass index and mean arterial pressure were calculated. All results were compared between the two groups. Logistic regression analysis and receiver operating characteristic curve construction were conducted for markers differing significantly between two groups. RESULTS The second-trimester fibronectin value was positively correlated with severe preeclampsia and predicted 67.7% of severe preeclampsia cases. The combination of fibronectin, inhibin A, and mean arterial pressure predicted 76.7% of severe preeclampsia cases; predictive values for combinations of fibronectin with mean arterial pressure or inhibin A were 75.4% and 74.6%, respectively. Combination with these other markers increased the predictive value of fibronectin. In addition, fibronectin was more powerful for the late severe preeclampsia and severe preeclampsia without fetal growth restriction subgroups. CONCLUSIONS The second-trimester fibronectin concentration can be used to predict severe preeclampsia.
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Affiliation(s)
- Wei Li
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Xiaowen Lin
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Yuchen Chen
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Kun Liu
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Weibin Yang
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Sifan Zeng
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Jing Zhang
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
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Liu Z, Chen B, Chang J, Feng L, Zhao X. Melatonin regulates trophoblast pyroptosis, invasion and migration in preeclampsia by inhibiting HtrA1 transcription through the microRNA-520c-3p/SETD7 axis. Am J Reprod Immunol 2022; 87:e13523. [PMID: 35137483 DOI: 10.1111/aji.13523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/16/2022] [Accepted: 01/31/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Melatonin has an inhibitory effect on preeclampsia (PE). This study was launched to explore the way that melatonin regulated trophoblast migration, invasion, and pyroptosis in PE and to provide new ideas for the diagnosis and treatment of PE. METHODS Expression levels of melatonin receptors (MT1 and MT2), microRNA (miR)-520c-3p, SETD7, and HtrA1 in placental tissues and HTR8/SVneo cells were measured by RT-qPCR and Western blot. Scratch, Transwell, and Western blot assays were performed to detect migration, invasion, and pyroptosis of hypoxia/reoxygenation (H/R)-treated HTR8/SVneo cells. Dual-luciferase reporter assay was utilized to verify the targeting relationship between miR-520c-3p and SETD7. ChIP experiment was conducted to detect the enrichment of H3K4me3 and SETD7 in HtrA1 promoter. RESULTS Low expression of MT1, MT2, and miR-520c-3p and high expression of SETD7 and HtrA1 were observed in the placental tissues of PE patients and H/R-treated HTR8/Svneo cells. A high concentration of melatonin promoted migration and invasion and inhibited pyroptosis of PE cell models. Knockdown of miR-520c-3p, overexpression of SETD7, or overexpression of HtrA1 impaired migration and invasion and accelerated pyroptosis of H/R-treated HTR8/SVneo cells, but these outcomes could be reversed by treatment with 1000 μM melatonin. miR-520c-3p targeted SETD7 which promoted histone methylation in the promoter region of HtrA1. CONCLUSION Melatonin may inhibit HtrA1 transcription through the miR-520c-3p/SETD7 axis to promote trophoblast invasion and migration and reduce trophoblast pyroptosis in PE.
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Affiliation(s)
- Zhaochun Liu
- Department of Obstetrics, the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang, P.R. China
| | - Bin Chen
- Department of Obstetrics, the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang, P.R. China
| | - Jing Chang
- Department of Obstetrics, the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang, P.R. China
| | - Lulu Feng
- Department of Obstetrics, the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang, P.R. China
| | - Xia Zhao
- Department of Obstetrics, the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang, P.R. China
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Differences and similarities in endothelial and angiogenic profiles of preeclampsia and COVID-19 in pregnancy. Am J Obstet Gynecol 2022; 227:277.e1-277.e16. [PMID: 35351411 PMCID: PMC8957356 DOI: 10.1016/j.ajog.2022.03.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Background COVID-19 presents a spectrum of signs and symptoms in pregnant women that might resemble preeclampsia. Differentiation between severe COVID-19 and preeclampsia is difficult in some cases. Objective To study biomarkers of endothelial damage, coagulation, innate immune response, and angiogenesis in preeclampsia and COVID-19 in pregnancy in addition to in vitro alterations in endothelial cells exposed to sera from pregnant women with preeclampsia and COVID-19. Study Design Plasma and sera samples were obtained from pregnant women with COVID-19 infection classified into mild (n=10) or severe (n=9) and from women with normotensive pregnancies as controls (n=10) and patients with preeclampsia (n=13). A panel of plasmatic biomarkers was assessed, including vascular cell adhesion molecule-1, soluble tumor necrosis factor-receptor I, heparan sulfate, von Willebrand factor antigen (activity and multimeric pattern), α2-antiplasmin, C5b9, neutrophil extracellular traps, placental growth factor, soluble fms-like tyrosine kinase-1, and angiopoietin 2. In addition, microvascular endothelial cells were exposed to patients’ sera, and changes in the cell expression of intercellular adhesion molecule 1 on cell membranes and von Willebrand factor release to the extracellular matrix were evaluated through immunofluorescence. Changes in inflammation cell signaling pathways were also assessed by of p38 mitogen-activated protein kinase phosphorylation. Statistical analysis included univariate and multivariate methods. Results Biomarker profiles of patients with mild COVID-19 were similar to those of controls. Both preeclampsia and severe COVID-19 showed significant alterations in most circulating biomarkers with distinctive profiles. Whereas severe COVID-19 exhibited higher concentrations of vascular cell adhesion molecule-1, soluble tumor necrosis factor-α receptor I, heparan sulfate, von Willebrand factor antigen, and neutrophil extracellular traps, with a significant reduction of placental growth factor compared with controls, preeclampsia presented a marked increase in vascular cell adhesion molecule-1 and soluble tumor necrosis factor-α receptor I (significantly increased compared with controls and patients with severe COVID-19), with a striking reduction in von Willebrand factor antigen, von Willebrand factor activity, and α2-antiplasmin. As expected, reduced placental growth factor, increased soluble fms-like tyrosine kinase-1 and angiopoietin 2, and a very high soluble fms-like tyrosine kinase-1 to placental growth factor ratio were also observed in preeclampsia. In addition, a significant increase in C5b9 and neutrophil extracellular traps was also detected in preeclampsia compared with controls. Principal component analysis demonstrated a clear separation between patients with preeclampsia and the other groups (first and second components explained 42.2% and 13.5% of the variance), mainly differentiated by variables related to von Willebrand factor, soluble tumor necrosis factor-receptor I, heparan sulfate, and soluble fms-like tyrosine kinase-1. Von Willebrand factor multimeric analysis revealed the absence of von Willebrand factor high-molecular-weight multimers in preeclampsia (similar profile to von Willebrand disease type 2A), whereas in healthy pregnancies and COVID-19 patients, von Willebrand factor multimeric pattern was normal. Sera from both preeclampsia and severe COVID-19 patients induced an overexpression of intercellular adhesion molecule 1 and von Willebrand factor in endothelial cells in culture compared with controls. However, the effect of preeclampsia was less pronounced than the that of severe COVID-19. Immunoblots of lysates from endothelial cells exposed to mild and severe COVID-19 and preeclampsia sera showed an increase in p38 mitogen-activated protein kinase phosphorylation. Patients with severe COVID-19 and preeclampsia were statistically different from controls, suggesting that both severe COVID-19 and preeclampsia sera can activate inflammatory signaling pathways. Conclusion Although similar in in vitro endothelial dysfunction, preeclampsia and severe COVID-19 exhibit distinctive profiles of circulating biomarkers related to endothelial damage, coagulopathy, and angiogenic imbalance that could aid in the differential diagnosis of these entities.
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Chen L, Xiu Y, Wu Q, Wang Y, Zhang Y, Xue J, Wang Q, Yuan Z. Maternal serum Lamin A is a potential biomarker that can predict adverse pregnancy outcomes. EBioMedicine 2022; 77:103932. [PMID: 35286896 PMCID: PMC8924630 DOI: 10.1016/j.ebiom.2022.103932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Maternal serum Lamin A (LMNA) was reported to have potential diagnostic value in the prenatal diagnosis of congenital heart disease (CHD). In this study, we aimed to further assess the prognostic value of maternal serum LMNA in predicting adverse pregnancy outcomes. Methods A prospective screening study was performed on singleton pregnancies at 15–18 weeks of gestation. After a routine test for alpha fetoprotein (AFP), chorionic gonadotropin (hCG), and unconjugated estriol (uE3), serum LMNA levels were measured. Serum LMNA levels were then converted into multiples of the median (MoM). The median MoM values for adverse pregnancy outcomes were compared with those in normal pregnancies. For diseases with differential LMNA expression in the prospective study, another case-control cohort was recruited. The diagnostic value of LMNA in these diseases was further evaluated. Findings Between January 1, 2017 and June 30, 2018, a total of 2906 singleton pregnancies were recruited. Of the 2,906 cases, 2711 had data available for analysis. Congenital structural abnormalities, chromosomal abnormalities, and obstetric complications were observed in 152 (5·6%), 15 (0·6%), and 278 (10·3%) patients, respectively. LMNA was downregulated in pregnancies with fetal CHD, fetal neural tube defects (NTD), and preeclampsia (PE). The case-control study cohort included 256 CHD, 60 NTD, 67 PE, and 400 normal pregnancies. The areas under the curve for the prenatal diagnoses of CHD, NTD, and PE were 0·875, 0·871, and 0·816, respectively. Interpretation Maternal serum LMNA was found to be a potential biomarker for the prenatal diagnosis of fetal CHD, NTD, and PE. Funding National Key Research and Development Program, National Natural Science Foundation of China, LiaoNing Revitalization Talents Program, National Natural Science Foundation of Liaoning, and 345 Talent Project of Shengjing Hospital.
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Tsujimoto Y, Kataoka Y, Banno M, Taito S, Kokubo M, Masuzawa Y, Yamamoto Y. Association of low birthweight and premature birth with hypertensive disorders in pregnancy: a systematic review and meta-analysis. J Hypertens 2022; 40:205-212. [PMID: 34992195 DOI: 10.1097/hjh.0000000000003020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Growing evidence suggests that women born preterm or small have an increased risk of experiencing hypertensive disorders during pregnancy; however, a quantitative summary of the evidence on this issue is unavailable. OBJECTIVE We aimed to systematically review the literature to describe the association between being born preterm, low birthweight (LBW), or small for gestational age (SGA), and future gestational hypertension, preeclampsia, or eclampsia. METHODS We searched the MEDLINE, Embase, CINAHL, ClinicalTrials.gov, and ICTRP databases. We included all cohort and case-control studies examining the association between LBW, preterm birth, or SGA and hypertensive disorders in pregnancy. We pooled the odds ratios and 95% confidence intervals using the DerSimonian and Laird random-effects model. We assessed the certainty of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluation criteria. RESULTS Eleven studies were identified, totalling 752 316 participants. Being born preterm, LBW, or SGA was associated with gestational hypertension [pooled odds ratio (OR), 1.31; 95% confidence interval (CI) 1.15-1.50; moderate certainty of evidence] and preeclampsia (pooled OR, 1.35; 95% CI 1.23-1.48; moderate certainty of evidence). No study measured eclampsia as an outcome. CONCLUSION Women born preterm, LBW, or SGA have an increased risk of gestational hypertension and preeclampsia. The course of the mother's own birth might be used to identify women at risk of gestational hypertension and preeclampsia.
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Affiliation(s)
- Yasushi Tsujimoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe cho, Sakyo-ku, Kyoto
- Department of Nephrology and Dialysis, Kyoritsu Hospital, Chuo-cho 16-5, Kawanishi, Hyogo
- Systematic Review Peer Support Group, Koraibashi, Chuo-ku, Osaka
- Cochrane Japan, Akashi Cho 10-1, Chuo-ku, Tokyo
| | - Yuki Kataoka
- Systematic Review Peer Support Group, Koraibashi, Chuo-ku, Osaka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Tanaka Asukai-cho 89, Sakyo-ku, Kyoto
| | - Masahiro Banno
- Systematic Review Peer Support Group, Koraibashi, Chuo-ku, Osaka
- Department of Psychiatry, Seichiryo Hospital, Tsurumai 4-16-27, Showa-ku, Nagoya, Aichi
| | - Shunsuke Taito
- Systematic Review Peer Support Group, Koraibashi, Chuo-ku, Osaka
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima
| | - Masayo Kokubo
- Department of Neonatology, Nagano Children's Hospital, Toyoshina, Azumino, Nagano
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto
| | - Yuko Masuzawa
- Cochrane Japan, Akashi Cho 10-1, Chuo-ku, Tokyo
- Division of Nursing, Chiba Faculty of Nursing, Tokyo Healthcare University, Kaijinchonishi 1-1042-2, Funabashi, Chiba
| | - Yoshiko Yamamoto
- Cochrane Japan, Akashi Cho 10-1, Chuo-ku, Tokyo
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
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Chaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening and prediction. Am J Obstet Gynecol 2022; 226:S1071-S1097.e2. [PMID: 32682859 DOI: 10.1016/j.ajog.2020.07.020] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022]
Abstract
Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Early-onset disease requiring preterm delivery is associated with a higher risk of complications in both mothers and babies. Evidence suggests that the administration of low-dose aspirin initiated before 16 weeks' gestation significantly reduces the rate of preterm preeclampsia. Therefore, it is important to identify pregnant women at risk of developing preeclampsia during the first trimester of pregnancy, thus allowing timely therapeutic intervention. Several professional organizations such as the American College of Obstetricians and Gynecologists (ACOG) and National Institute for Health and Care Excellence (NICE) have proposed screening for preeclampsia based on maternal risk factors. The approach recommended by ACOG and NICE essentially treats each risk factor as a separate screening test with additive detection rate and screen-positive rate. Evidence has shown that preeclampsia screening based on the NICE and ACOG approach has suboptimal performance, as the NICE recommendation only achieves detection rates of 41% and 34%, with a 10% false-positive rate, for preterm and term preeclampsia, respectively. Screening based on the 2013 ACOG recommendation can only achieve detection rates of 5% and 2% for preterm and term preeclampsia, respectively, with a 0.2% false-positive rate. Various first trimester prediction models have been developed. Most of them have not undergone or failed external validation. However, it is worthy of note that the Fetal Medicine Foundation (FMF) first trimester prediction model (namely the triple test), which consists of a combination of maternal factors and measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor, has undergone successful internal and external validation. The FMF triple test has detection rates of 90% and 75% for the prediction of early and preterm preeclampsia, respectively, with a 10% false-positive rate. Such performance of screening is superior to that of the traditional method by maternal risk factors alone. The use of the FMF prediction model, followed by the administration of low-dose aspirin, has been shown to reduce the rate of preterm preeclampsia by 62%. The number needed to screen to prevent 1 case of preterm preeclampsia by the FMF triple test is 250. The key to maintaining optimal screening performance is to establish standardized protocols for biomarker measurements and regular biomarker quality assessment, as inaccurate measurement can affect screening performance. Tools frequently used to assess quality control include the cumulative sum and target plot. Cumulative sum is a sensitive method to detect small shifts over time, and point of shift can be easily identified. Target plot is a tool to evaluate deviation from the expected multiple of median and the expected median of standard deviation. Target plot is easy to interpret and visualize. However, it is insensitive to detecting small deviations. Adherence to well-defined protocols for the measurements of mean arterial pressure, uterine artery pulsatility index, and placental growth factor is required. This article summarizes the existing literature on the different methods, recommendations by professional organizations, quality assessment of different components of risk assessment, and clinical implementation of the first trimester screening for preeclampsia.
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Garrido-Gómez T, Castillo-Marco N, Cordero T, Simón C. Decidualization resistance in the origin of preeclampsia. Am J Obstet Gynecol 2022; 226:S886-S894. [PMID: 33007270 DOI: 10.1016/j.ajog.2020.09.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022]
Abstract
Preeclampsia is a major obstetrical complication with short- and long-term life-threatening consequences for both mother and child. Shallow cytotrophoblast invasion through the uterine decidua into the spiral arteries is implicated in the pathogenesis of preeclampsia, although the cause of deficient arterial invasion remains unknown. Research that is focused on the "soil"-the maternal decidua-highlights the importance of this poorly understood but influential uterine layer. Decidualization of endometrial cells regulates embryo invasion, which is essential for spiral artery remodeling and establishing the maternal-fetal interface. Exploration of the association between impaired decidualization and preeclampsia revealed suboptimal endometrial maturation and uterine natural killer cells present in the decidua before preeclampsia development. Furthermore, decidualization defects in the endometrium of women with severe preeclampsia, characterized by impaired cytotrophoblast invasion, were detected at the time of delivery and persisted 5 years after the affected pregnancy. Recently, a maternal deficiency of annexin A2 expression was found to influence aberrant decidualization and shallow cytotrophoblast invasion, suggesting that decidualization resistance, which is a defective endometrial cell differentiation during the menstrual cycle, could underlie shallow trophoblast invasion and the poor establishment of the maternal-fetal interface. Based on these findings, the transcriptional signature in the endometrium that promotes decidualization deficiency could be detected before (or after) conception. This would serve to identify women at risk of developing severe preeclampsia and aid the development of therapies focused on improving decidualization, perhaps also preventing severe preeclampsia. Here, we discuss decidualization deficiency as a contributor to the pathogenesis of pregnancy disorders with particular attention to severe preeclampsia. We also review current diagnostic strategies and discuss future directions in diagnostic methods based on decidualization.
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Fabre M, Calvo P, Ruiz-Martinez S, Peran M, Oros D, Medel-Martinez A, Strunk M, Benito Ruesca R, Schoorlemmer J, Paules C. Frequent Placental SARS-CoV-2 in Patients with COVID-19-Associated Hypertensive Disorders of Pregnancy. Fetal Diagn Ther 2021; 48:801-811. [PMID: 34794139 PMCID: PMC8678236 DOI: 10.1159/000520179] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
Introduction Studies described an increased frequency of hypertensive disorders of pregnancy (HDP) after a COVID-19 episode. There is limited evidence about SARS-CoV-2 viral load in placenta. This study aimed to investigate the relationship between SARS-CoV-2 viral load in the placenta and clinical development of HDP after COVID-19 throughout different periods of gestation. Methods This is a case-control study in women with and without gestational hypertensive disorders after SARS-CoV-2 infection diagnosed by RT-PCR during pregnancy. Patients were matched by gestational age at the moment of COVID-19 diagnosis. We performed an analysis of SARS-CoV-2 RNA levels in placenta. Results A total of 28 women were enrolled. Sixteen patients were diagnosed with COVID-19 during the third trimester and the remaining 12 patients in the other trimesters. Ten placentas (35.7%) were positive for SARS-CoV-2, 9 of them (9/14, 64.3%) belonged to the HDP group versus 1 (1/14, 7.2%) in the control group (p = 0.009). Those cases with the highest loads of viral RNA developed severe preeclampsia (PE). Conclusion Among women diagnosed with COVID-19 during pregnancy, the presence of SARS-CoV-2 in the placenta was more frequent among women suffering from PE or gestational hypertension. Furthermore, the most severe cases of HDP were associated with high placental viral load, not necessarily associated with a positive nasopharyngeal RT-PCR at delivery. Our data suggest that SARS-CoV-2 infection during pregnancy could trigger gestational hypertensive disorders through persistent placental infection and resulting placental damage.
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Affiliation(s)
- Marta Fabre
- Instituto de Investigación Sanitario de Aragón (IIS Aragon) Biochemistry Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain, .,Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain,
| | - Pilar Calvo
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain.,Instituto de Investigación Sanitario de Aragón (IIS Aragon), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Sara Ruiz-Martinez
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain.,Instituto de Investigación Sanitario de Aragón (IIS Aragon), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain.,Red de Salud Materno Infantil y Del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de La Investigación y Fondo Europeo de Desarrollo Regional (FEDER) Ref: RD16/0022/0013, Zaragoza, Spain
| | - Maria Peran
- Instituto de Investigación Sanitario de Aragón (IIS Aragon) Biochemistry Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain.,Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain
| | - Daniel Oros
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain.,Instituto de Investigación Sanitario de Aragón (IIS Aragon), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain.,Red de Salud Materno Infantil y Del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de La Investigación y Fondo Europeo de Desarrollo Regional (FEDER) Ref: RD16/0022/0013, Zaragoza, Spain
| | - Ana Medel-Martinez
- Laboratorio Satélite, Instituto Aragonés de Ciencias de La Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain
| | - Mark Strunk
- Laboratorio Satélite, Instituto Aragonés de Ciencias de La Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain.,Sequencing and Functional Genomics, Instituto Aragonés de Ciencias de La Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain
| | - Rafael Benito Ruesca
- Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain, Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain
| | - Jon Schoorlemmer
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain.,Instituto Aragonés de Ciencias de La Salud (IACS), Zaragoza, Spain.,ARAID Foundation, Zaragoza, Spain
| | - Cristina Paules
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain.,Instituto de Investigación Sanitario de Aragón (IIS Aragon), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain.,Red de Salud Materno Infantil y Del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de La Investigación y Fondo Europeo de Desarrollo Regional (FEDER) Ref: RD16/0022/0013, Zaragoza, Spain
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Sadek A, Baban R, Al-Habib M, Khazaali E. Serum vitamin D3 levels in pregnant women with preeclampsia at third trimester of pregnancy. BAGHDAD JOURNAL OF BIOCHEMISTRY AND APPLIED BIOLOGICAL SCIENCES 2021. [DOI: 10.47419/bjbabs.v2i03.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Preeclampsia (PE) is a pregnancy-specific condition, characterized by high blood pressure and proteinuria after 20 weeks of gestation. One of the hypotheses concerning the etiology of PE is vitamin D3 deficiency during pregnancy. Vitamin D3 is especially important during pregnancy as low maternal vitamin D3 stores may contribute to problems like low birth weight as well as an increased risk of maternal comorbidities.
Objectives: To evaluate serum vitamin D3 levels and how they can be affected by the severity of PE at the third trimester of pregnancy.
Methods: This case-control study included a total of 71 pregnant women at the third trimester of pregnancy (41 with PE and 30 without PE as controls). Vitamin D3 serum level was measured by enzyme-linked immune-sorbent assay (ELISA).
Results: The study’s findings showed no significant difference in serum vitamin D3 level (p>0.05) between controls (14.41±1.41ng/ml) and PE patients (14.32±1.00). As well, subgroup analysis revealed non-considerable changes between mild PE cases (15.92±1.73 ng/ml) and severe ones (13.07±1.09 ng/ml).
Conclusions: PE and its severity may have no significant effect on serum vitamin D3 levels of pregnant women at the third trimester of pregnancy.
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Abbas RA, Ghulmiyyah L, Hobeika E, Usta IM, Mirza F, Nassar AH. Preeclampsia: A Review of Early Predictors. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Stefańska K, Zieliński M, Jankowiak M, Zamkowska D, Sakowska J, Adamski P, Jassem-Bobowicz J, Piekarska K, Leszczyńska K, Świątkowska-Stodulska R, Kwiatkowski S, Preis K, Trzonkowski P, Marek-Trzonkowska N. Cytokine Imprint in Preeclampsia. Front Immunol 2021; 12:667841. [PMID: 34248946 PMCID: PMC8261231 DOI: 10.3389/fimmu.2021.667841] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
The hallmark of preeclampsia (PE) is a shift toward persistent inflammatory response, accompanied by endothelial dysfunction. The driving forces in PE are proinflammatory cytokine and growth factors, in parallel with reduced functionality of anti-inflammatory effectors, like regulatory T cells are observed. Unfortunately, no conclusive mechanism underlying preeclampsia has been identified. For this reason, research on preeclampsia is needed to provide a state of the art understanding of the pathophysiology, identification of new diagnostics tools and the development of targeted therapies. The 68 patients were divided into three groups: gestational hypertension (GH) group (n = 19) and PE group (n = 28) and a control group (n = 21). We have tested a set of 53 cytokines, chemokines and growth factors in preeclampsia and gestational hypertension, and then compared them with normal pregnancies. Using a diagnostic test assessment characteristic parameters (IL-22, MDC/CCL22, IL-2/IL-4 ratio) have been identified and cut-off values have been proposed to diagnose preeclampsia. All parameters had high negative or positive predictive values, above 80%. In conclusion, we have proposed a potential set of immune parameters to diagnose preeclampsia.
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Affiliation(s)
| | - Maciej Zieliński
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland
| | - Martyna Jankowiak
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland
| | - Dorota Zamkowska
- Department of Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Justyna Sakowska
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | - Karolina Piekarska
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Krzysztof Preis
- Department of Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Trzonkowski
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland
| | - Natalia Marek-Trzonkowska
- International Centre for Cancer Vaccine Science Cancer Immunology Group, University of Gdansk, Gdańsk, Poland
- Laboratory of Immunoregulation and Cellular Therapies, Department of Family Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Mendoza M, Serrano B, Bonacina E, Capote S, Garcia-Manau P, Regincós L, Murcia MT, Barberan L, Míguez M, Carreras E. Diagnostic accuracy of the Gaussian first-trimester combined screening for pre-eclampsia to predict small-for-gestational-age neonates. Int J Gynaecol Obstet 2021; 156:322-330. [PMID: 33724448 DOI: 10.1002/ijgo.13673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Pre-eclampsia and delivery of small-for-gestational-age (SGA) neonates can be predicted from the first trimester. A Gaussian model for prediction of PE has recently been described, although its capacity to predict SGA is still unknown. METHODS This was a secondary analysis of a prospective cohort study conducted at Vall d'Hebron University Hospital (Barcelona) in 2483 single pregnancies from October 2015 to September 2017. Mean arterial blood pressure and mean uterine artery pulsatility index were recorded at the first-trimester scan. Serum concentrations of placental growth factor and pregnancy-associated plasma protein-A were assessed between 8+0 and 13+6 weeks. The predictive capacities of early (<32 weeks) and preterm (<37 weeks) SGA were tested. RESULTS For SGA without pre-eclampsia, detection rates of 25.0% (95% confidence interval [CI] 0-75.0) for early SGA and 14.3% (95% CI 3.6-28.6) for preterm SGA were achieved. For SGA with pre-eclampsia, the algorithm showed detection rates of 100.0% (95% CI 25.0-100.0) for early SGA and 56.3% (95% CI 31.3-81.3) for preterm SGA. CONCLUSION This algorithm identifies 62.5% of early SGA and 27.3% of preterm SGA. Combined screening for predicting both pre-eclampsia and SGA by using the Gaussian algorithm is feasible and would simplify clinical practice.
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Affiliation(s)
- Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Serrano
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Erika Bonacina
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sira Capote
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo Garcia-Manau
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Regincós
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Teresa Murcia
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lidia Barberan
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Míguez
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Carreras
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Serra B. Reply. Am J Obstet Gynecol 2021; 224:247. [PMID: 33127428 DOI: 10.1016/j.ajog.2020.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
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Cuckle H. Screening for early-onset preeclampsia. Am J Obstet Gynecol 2021; 224:246. [PMID: 33203529 DOI: 10.1016/j.ajog.2020.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
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Mendoza M, Garcia‐Manau P, Arévalo S, Avilés M, Serrano B, Sánchez‐Durán MÁ, Garcia‐Ruiz I, Bonacina E, Carreras E. Diagnostic accuracy of first-trimester combined screening for early-onset and preterm pre-eclampsia at 8-10 compared with 11-13 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:84-90. [PMID: 32388877 PMCID: PMC7839448 DOI: 10.1002/uog.22071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/07/2020] [Accepted: 04/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To compare the ability of first-trimester combined screening for pre-eclampsia (PE) to predict early-onset and preterm PE when pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) were assessed before vs after 11 weeks' gestation. METHODS This was a secondary analysis of a prospective cohort study of singleton pregnancies undergoing routine first-trimester screening conducted at Vall d'Hebron University Hospital, Barcelona, Spain, between October 2015 and September 2017. Demographic characteristics, obstetric history, maternal history and biophysical markers (mean uterine artery pulsatility index and mean arterial blood pressure (MAP)) were recorded at the first-trimester scan (at 11 + 0 to 13 + 6 weeks' gestation). Maternal serum concentrations of PAPP-A and PlGF were assessed from the routine first-trimester blood test (at 8 + 0 to 13 + 6 weeks). Women were classified into two groups depending on whether serum biomarkers were assessed at 8 + 0 to 10 + 6 weeks or at 11 + 0 to 13 + 6 weeks. Probability scores for early-onset and preterm PE were calculated by using two different algorithms: the multivariate Gaussian-distribution model and The Fetal Medicine Foundation (FMF) competing-risks model. Receiver-operating-characteristics (ROC) curves were produced and detection rates at fixed 5% and 10% false-positive rates were computed to compare the performance of these algorithms when PAPP-A and PlGF were assessed before vs after 11 weeks. RESULTS Of the 2641 women included, serum biomarkers were assessed before 11 weeks in 1675 (63.4%) and at or after 11 weeks in 966 (36.6%). Of these, 90 (3.4%) women developed PE, including 11 (0.4%) cases of early-onset PE and 30 (1.1%) of preterm PE. Five (45.5%) cases of early-onset and 16 (53.3%) of preterm PE were identified in the group in which serum biomarkers were assessed at 8 + 0 to 10 + 6 weeks and six (54.5%) cases of early-onset and 14 (46.7%) of preterm PE in the group in which serum biomarkers were assessed at 11 + 0 to 13 + 6 weeks. In the prediction of early-onset and preterm PE using the Gaussian algorithm, no differences were observed between the areas under the ROC curves (AUCs) when PAPP-A and PlGF were measured before or after 11 weeks. In the prediction of early-onset and preterm PE using the FMF algorithm, no differences were observed between AUCs for any of the combinations used for risk calculation when the serum biomarkers were obtained before vs after 11 weeks, except for the combination of PAPP-A and MAP, which showed a greater AUC for the prediction of early-onset PE when PAPP-A was measured at or after 11 weeks. CONCLUSIONS The prediction of early-onset and preterm PE is similar when serum biomarkers are measured before or after 11 weeks. This allows the use of a two-step approach for PE risk assessment that permits immediate risk calculation at the time of the first-trimester scan. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M. Mendoza
- Maternal Fetal Medicine Unit, Department of ObstetricsHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - P. Garcia‐Manau
- Maternal Fetal Medicine Unit, Department of ObstetricsHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - S. Arévalo
- Maternal Fetal Medicine Unit, Department of ObstetricsHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - M. Avilés
- Maternal Fetal Medicine Unit, Department of ObstetricsHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - B. Serrano
- Maternal Fetal Medicine Unit, Department of ObstetricsHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - M. á. Sánchez‐Durán
- Maternal Fetal Medicine Unit, Department of ObstetricsHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - I. Garcia‐Ruiz
- Maternal Fetal Medicine Unit, Department of ObstetricsHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - E. Bonacina
- Maternal Fetal Medicine Unit, Department of ObstetricsHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - E. Carreras
- Maternal Fetal Medicine Unit, Department of ObstetricsHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
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Golinska-Grzybala K, Wiechec M, Golinski B, Rostoff P, Szlósarczyk B, Gackowski A, Nessler J, Konduracka E. Subclinical cardiac performance in obese and overweight women as a potential risk factor of preeclampsia. Pregnancy Hypertens 2020; 23:131-135. [PMID: 33348313 DOI: 10.1016/j.preghy.2020.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Failure to increase cardiac output owing to suboptimal cardiac performance in obese women may contribute to placental hypoperfusion, and therefore subsequently to the abnormal placental development. The aim of this study was to evaluate the relationship between left ventricle (LV) function in overweight and obese pregnant women and parameters of blood flow in uterine arteries. STUDY DESIGN AND MAIN OUTCOME MEASURES We conducted a prospective cohort study, which included consecutive 87 women with singleton pregnancy - 56 women with normal weight and 31 overweight and obese women. During pregnancy blood pressure, echocardiography and the assessment of blood flow in uterine arteries - pulsatility index (PI) and resistance index (RI) were assessed on two visits (V): V1 between 10 and 14 weeks and V2 between 25 and 30 weeks of gestation. A stepwise logistic regression analysis was performed to determine the independent predictors of upper quartile of RI and PI during V2 in the study population. RESULTS The multivariate logistic regression analysis showed that LVCI and LV mass measured on V1 were the only independent predictors of upper quartile of RI during V2, whereas LVCI was the only independent predictor of upper quartile of PI during V2. CONCLUSIONS Subclinical left ventricle dysfunction in obese and overweight women, present from the first trimester, may contribute to placental hypoperfusion and higher resistance in uterine arteries later during pregnancy. This may lead in some women to preeclampsia.
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Affiliation(s)
- Karolina Golinska-Grzybala
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Prądnicka 80 Street, 31-202, Kraków, Poland; Multimed Medical Center, Outpatient Clinic, W. Jagielly Street 15, 32-800, Brzesko, Poland
| | - Marcin Wiechec
- Department of Gynaecology and Obstetrics, University Hospital, M. Kopernika Street, 31-501, Krakow, Poland
| | - Bogdan Golinski
- Multimed Medical Center, Outpatient Clinic, W. Jagielly Street 15, 32-800, Brzesko, Poland
| | - Pawel Rostoff
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka 80 Street, 31-202, Krakow, Poland
| | - Barbara Szlósarczyk
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Prądnicka 80 Street, 31-202, Kraków, Poland; Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka 80 Street, 31-202, Krakow, Poland
| | - Andrzej Gackowski
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Prądnicka 80 Street, 31-202, Kraków, Poland; Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka 80 Street, 31-202, Krakow, Poland
| | - Jadwiga Nessler
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka 80 Street, 31-202, Krakow, Poland
| | - Ewa Konduracka
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka 80 Street, 31-202, Krakow, Poland
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Early-Onset-Präeklampsie: neues Screeningmodell für Niedrigrisikokollektive. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/a-1189-8329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mendoza M, Tur H, Garcia-Manau P, Hurtado I, Serrano B, Lopez-Martinez RM, Castellote L, Martinez L, Bonacina E, Carreras E. Cut-off values for Gaussian first-trimester screening for early-onset preeclampsia with maternal history, biochemical markers and uterine artery Doppler. J Gynecol Obstet Hum Reprod 2020; 50:101827. [PMID: 32512213 DOI: 10.1016/j.jogoh.2020.101827] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/19/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Several algorithms for first-trimester screening for preeclampsia are available; however, the Gaussian model algorithm is more likely to match the characteristics of different populations. It is recommended to validate a screening strategy before being implemented in clinical practice; unfortunately, the validation process might not be feasible in all settings. Thus, the aim of this study was to provide cut-off values for the Gaussian model for its use in clinical practice. MATERIAL AND METHODS This prospective cohort study was conducted at Vall d'Hebron University Hospital (Barcelona) from October 2015 to September 2017. A total of 2641 women with singleton pregnancies were recruited. Recorded at the first-trimester scan were demographic characteristics, maternal obstetric history, maternal history, uterine artery Doppler and arterial blood pressure. Serum concentrations of pregnancy-associated plasma protein-A and placental growth factor were assessed from the first-trimester blood test. Detection rates and cut-off values for fixed 5%, 10 %, 15 %, 20 %, 25 % and 30 % false-positive rates were calculated for all combinations of markers. RESULTS Ninety (3.41 %) of the 2641 women developed preeclampsia, which was early-onset in 11 (0.42 %). The cut-off values and their respective detection rates, for the screening of early-onset PE by all possible combinations of markers involved in this model, are provided. DISCUSSION When external validation of first-trimester screening for preeclampsia before its clinical implementation is not feasible, the cut-off values from the Gaussian model algorithm provided in this study could be used and median values corrected prospectively if necessary.
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Affiliation(s)
- Manel Mendoza
- Department of Obstetrics, Maternal-Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Helena Tur
- Department of Obstetrics, Maternal-Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Pablo Garcia-Manau
- Department of Obstetrics, Maternal-Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Ivan Hurtado
- Department of Obstetrics, Maternal-Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Berta Serrano
- Department of Obstetrics, Maternal-Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Rosa Maria Lopez-Martinez
- Biochemistry Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Laura Castellote
- Biochemistry Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Luisa Martinez
- Biochemistry Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Erika Bonacina
- Department of Obstetrics, Maternal-Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Elena Carreras
- Department of Obstetrics, Maternal-Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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