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Granger M, Sevoyan M, Boghossian NS. Recurrence Risk of Pregnancy Complications in Twin and Singleton Deliveries. Am J Perinatol 2024. [PMID: 38955217 DOI: 10.1055/a-2358-9770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
OBJECTIVE This study aimed to estimate and compare the recurrence risk of preterm birth (PTB), gestational diabetes mellitus (GDM), gestational hypertension (GH), and preeclampsia and eclampsia (PE and E) in subsequent pregnancy groups (index-subsequent) of singleton-singleton (n = 49,868), twin-singleton (n = 448), and singleton-twin (n = 723) pregnancies. STUDY DESIGN Birthing individuals from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Consecutive Pregnancy Study (2002-2010) with ≥ 2 singleton or twin deliveries were examined. Adjusted relative risks (aRR) and 95% confidence intervals (CI) for recurrent PTB, GDM, GH, and PE and E were estimated using Poisson regression models with robust variance estimators. RESULTS The aRR of PTB and GDM ranged from 1.4 to 5.1 and 5.2 to 22.7, respectively, with the greatest recurrence relative risk for both conditions in singleton-singleton subsequent pregnancies (PTB: aRR = 5.1 [95% CI: 4.8-5.5], GDM: aRR = 22.7 [95% CI: 20.8-24.8]). The aRR of GH and PE and E ranged from 2.8 to 7.6 and 3.2 to 9.2, respectively, with the greatest recurrence relative risk for both conditions in twin-singleton subsequent pregnancies (GH: aRR = 7.6 [95% CI: 2.8-20.5], PE and E: aRR = 9.2 [95% CI: 2.9-28.6]). CONCLUSION Recurrence relative risk was increased for PTB, GDM, GH, and PE and E in all subsequent pregnancy groups, which varied in magnitude based on the birth number of the index and subsequent pregnancy. This information provides insight into risk management for subsequent pregnancies including multiples. KEY POINTS · Recurrence risk for all conditions is persistent in all subsequent pregnancy groups.. · The magnitude of risk varies by the presence of multiples in the index or subsequent pregnancy.. · Singleton-singleton pregnancies are at the greatest risk of PTB.. · Singleton-singleton pregnancies are at the greatest risk of GDM.. · Twin-singleton pregnancies are at the greatest risk of hypertensive disorders..
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Affiliation(s)
- Marion Granger
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Maria Sevoyan
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Nansi S Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Teixeira AL. Cardiovascular consequences of preeclampsia: Is the reactivity to stress the missing piece of the puzzle? Am J Physiol Heart Circ Physiol 2024; 327:H138-H139. [PMID: 38787384 DOI: 10.1152/ajpheart.00312.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 05/25/2024]
Affiliation(s)
- André L Teixeira
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, University of Brasilia, Brasilia, Brazil
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Wu C, Ling Z, Wang Y, Lv Y, Miao Z, Liu L, Ji X. Clinical Analysis of Risk Factors and Perinatal Outcomes in Recurrent Pre-Eclampsia with Severe Features. Reprod Sci 2024:10.1007/s43032-024-01529-4. [PMID: 38575810 DOI: 10.1007/s43032-024-01529-4] [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: 08/31/2023] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
To analyze the differences in risk factors and pregnancy outcomes between recurrent and initial pre-eclampsia(PE) with severe features. Data from recurrent (n = 128) and initial (n = 904) PE with severe features who terminated their pregnancy or gave birth at 20 weeks of gestation or later at the tertiary teaching hospital (Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital) from January 2016 to December 2022 were collected. Risk factors for recurrent PE with severe features and differences in pregnancy outcomes between the two groups were assessed using the chi-square test, student t-test, or nonparametric test. Independent risk factors for recurrent PE with severe features were further analyzed by logistic regression. (1) Logistic regression analysis identified 3 independent risk factors for recurrent PE with severe features: history of cesarean section, rural residence and chronic hypertension. In addition, assisted reproductive technology (ART) is an independent risk factor for initial PE with severe features; (2) The incidence of oligohydramnios, chorioamnionitis, preterm birth, stillbirth, fetal growth restriction (FGR) and abnormal umbilical blood flow was higher in the recurrent PE with severe features group than in the initial PE with severe features group(P < 0.05). In contrast, the incidence of premature rupture of membrane (PROM) and postpartum hemorrhage (PPH) was higher in the group of initial PE with severe features(P < 0.05); (3) In the recurrent PE with severe features group, gestational age(GA) of birth and birth weight were lower than those in the initial PE with severe features group(P < 0.05). Also, the incidence of mild asphyxia, the rate of neonatal intensive care unit (NICU) hospitalization, length of stay in NICU, and the rate of abandoning treatment in the recurrent PE with severe features group were higher than those in the initial PE with severe features group(P < 0.05). 3 independent risk factors was identified for recurrent PE with severe features: history of cesarean section, rural residence and chronic hypertension. Women with recurrent PE with severe features are more likely to have adverse perinatal outcomes than those with initial PE with severe features.
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Affiliation(s)
- Chengqian Wu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Zhonghui Ling
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Yixiao Wang
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Yan Lv
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Zhijing Miao
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Lan Liu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China.
| | - Xiaohong Ji
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China.
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Austin J, Wirtz A, Garrett M, Ferrell SC, Stephenson E, Gajjar S, Perloff S, Hartwell M. Associations of cesarean sections with comorbidities within the Pregnancy Risk Assessment Monitoring System. J Perinat Med 2023; 51:1025-1031. [PMID: 37203560 DOI: 10.1515/jpm-2023-0005] [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: 01/04/2023] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Cesarean delivery (CD) is a common obstetrical procedure aimed at reducing maternal and infant morbidity and mortality in complicated pregnancies and medical emergencies yet carries potential complications. CD rates in the USA have increased over the years - likely associated with increased comorbidities. Thus, to expand the literature, our objective was to identify the likelihood of a woman having a CD when comorbidities - diabetes, high blood pressure (HBP), or depression - are present. METHODS We conducted a cross-sectional analysis of the 2019 Pregnancy Risk Assessment Monitoring System. Binary and multivariable logistic regression were used to calculate adjusted odds ratios (AORs) to determine associations between pre-existing and gestational comorbidities and CD among pregnant women. RESULTS Compared to those without a diagnosis, women with pre-existing diabetes (AOR: 1.69; CI: 1.54-1.86), pre-existing HBP (AOR: 1.58; CI: 1.46-1.69), and pre-existing depression (AOR: 1.14; CI 1.08-1.20; Table 2) were more likely to have a CD. Additionally, participants with gestational diabetes (AOR 1.43; CI 1.34-1.52), HBP (AOR 1.86; CI 1.76-1.95) and depression (AOR 1.13; CI 1.07-1.19) were also more likely to have a CD than those without comorbidities. CONCLUSIONS Higher rates of CD were found among individuals with a pre-existing or gestational diagnosis of diabetes, HBP, or depression than those without these diagnoses. With increasing rates of these conditions, it is likely that CD rates will continue their trajectory in the USA. Thus, professional organizations can have more impact by popularizing and making effective evidence-based guidelines for management.
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Affiliation(s)
- Jordyn Austin
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
| | - Alexis Wirtz
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, USA
| | - Morgan Garrett
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, USA
| | - Sydney C Ferrell
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, USA
| | - Elise Stephenson
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
| | - Swapnil Gajjar
- Department of Industrial Engineering & Management, Oklahoma State University, Stillwater, OK, USA
| | - Spenser Perloff
- Department of Obstetrics and Gynecology, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Phoswa WN, Khaliq OP, Eche S. A Review on Inflammasomes and Immune Checkpoints in Pre-Eclampsia Complicated with Tuberculosis and Human Immune Deficiency Virus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6627. [PMID: 37681767 PMCID: PMC10487055 DOI: 10.3390/ijerph20176627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
The current review evaluates how inflammasomes and immune checkpoints are regulated in pre-eclampsia (PE) associated with tuberculosis (TB) and Human Immune Deficiency Virus (HIV). Studies indicate that inflammasomes such as (NRLP3, NEK7, and AIM2) and immune checkpoints such as (CLT4, PD-1, TIM3, and LAG-3) are dysregulated in TB- and HIV-infected individuals, and also in pre-eclamptic pregnancies, which explains why pregnant women who are either infected with TB or HIV have an increased risk of developing PE. Evidence suggests that inhibition of inflammasomes and immune checkpoints may assist in the development of novel anti-inflammatory drugs for the prevention and management of PE in patients with or without TB and HIV infection.
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Affiliation(s)
- Wendy N. Phoswa
- Department of Life and Consumer Sciences, Science Campus, University of South Africa (UNISA), Private Bag X 6, Florida, Roodepoort 1710, South Africa
| | - Olive P. Khaliq
- Department of Paediatrics and Child Health, University of the Free State, Bloemfontein 9300, South Africa;
| | - Simeon Eche
- School of Medicine, Yale University, 333 Cedar Street, New Haven, CO 06510, USA;
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First-Trimester Screening Program for the Risk of Pre-eclampsia Using a Multiple-Marker Algorithm: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2022; 22:1-118. [PMID: 37772268 PMCID: PMC10530459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Background Pre-eclampsia is when high blood pressure develops after 20 weeks of pregnancy and either proteinuria, maternal end-organ dysfunction, or uteroplacental dysfunction causing fetal growth restriction also develops. The Fetal Medicine Foundation has created an algorithm ("the FMF algorithm") that uses maternal factors in combination with biophysical and biochemical markers to identify people at high risk for pre-eclampsia so that they can been offered acetylsalicylic acid (Aspirin) as a preventive measure. We conducted a health technology assessment to evaluate the safety, effectiveness, and cost-effectiveness of a first-trimester population-wide screening program for pre-eclampsia risk that uses the FMF algorithm ("the FMF-based screening program"). We also evaluated the accuracy of the FMF algorithm, the budget impact of publicly funding the population-wide FMF-based screening program, and patient preferences and values. Methods We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each study using the Risk of Bias in Non-randomized Studies-of Interventions tool and the Quality Assessment of Diagnostic Accuracy Studies-Comparative tool, and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search and conducted a cost-effectiveness analysis comparing the FMF-based screening program to standard care (screening for risk of pre-eclampsia using maternal factors alone) from a public payer perspective. We also analyzed the budget impact of publicly funding a population-wide FMF-based screening program in Ontario. We spoke with people who have experience with pregnancy and preeclampsia and their family members through direct interviews to gather preferences and values surrounding pre-eclampsia and the potential screening program. Results We included nine studies in the clinical evidence review. The FMF-based screening program likely reduces the risk of pre-eclampsia with delivery at less than 37 weeks' gestation compared with standard care, when initiated at 11+0 to 13+6 weeks' gestation; risk ratios ranged from 0.64 (95% confidence interval [CI] 0.46-0.93) to 0.70 (95% CI 0.58-0.84) (GRADE: Moderate). It may reduce the risks of low birth weight (risk ratio 0.89 [95% CI 0.85-0.94]) and low Apgar score (risk ratio 0.73 [95% CI 0.63-0.85]) (GRADE: Low). Evidence on the effectiveness of the FMF-based screening program in reducing the risk of stillbirth and neonatal death was highly uncertain (GRADE: Very low). In addition, the FMF algorithm can improve the detection rate of pre-eclampsia with delivery at less than 37 weeks' gestation or at less than 34 weeks' gestation compared with conventional algorithms, although there are concerns about bias and applicability across studies. The population-wide FMF-based screening program is more effective and more costly than standard care. The incremental cost-effectiveness ratio of the population-wide FMF-based screening program compared with standard care is $3,446 per prevented case of pre-eclampsia with delivery at less than 37 weeks. The annual budget impact of publicly funding the population-wide FMF-based screening program in Ontario ranges from an additional $1.23 million in year 1 to $3.56 million in year 5, for a total of $8.50 million over the next 5 years. The population-wide FMF-based screening program was seen as valuable by those who have experienced pregnancy and their family members. Strong emphasis was placed on providing education and equitable access as part of any screening program, and participants valued the potential clinical benefits that the population-wide FMF-based screening program could provide. Conclusions The FMF-based screening program is likely more effective than standard care in reducing the risk of pre-eclampsia with delivery at less than 37 weeks' gestation. Also, the FMF algorithm can improve the detection rate of pre-eclampsia with delivery at less than 37 weeks' gestation or at less than 34 weeks' gestation when compared with conventional algorithms. The population-wide FMF-based screening program is more effective and more costly than standard care. We estimate that publicly funding the population-wide FMF-based screening program in Ontario would result in additional costs of $8.50 million over the next 5 years. Pregnant people and their family members valued the potential equitable access, information, and clinical benefits that the population-wide FMF-based screening program could provide.
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Hu R, Yin H, Li X. Changing Trends of Adverse Pregnancy Outcomes With Maternal Pre-pregnancy Body Mass Index: A Join-Point Analysis. Front Med (Lausanne) 2022; 9:872490. [PMID: 35721058 PMCID: PMC9203895 DOI: 10.3389/fmed.2022.872490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAdverse pregnancy outcomes have been related to obesity and thinness; however, the changing trends of the specific outcome with pre-pregnancy BMI remain unknown. The aim of this study was to investigate the change in risk trends of specific adverse outcomes for different pre-pregnancy BMI and analyze the recommended BMI range for pre-pregnancy counseling.MethodsData were extracted from the medical records of 39 public hospitals across 14 provinces in China from 2011 to 2012. The eligibility criteria were singleton birth with delivery week ≥28 weeks. Join-point analysis was adopted to explore changing trends with pre-pregnancy BMI and calculate slopes and join points of different pregnancy complications.ResultsA total of 65,188 women were eligible for analysis. There were three categories of trend style. Continuously increasing trends were linear for intrahepatic cholestasis of pregnancy, postpartum hemorrhage, and low 1-min Apgar score, and non-linear for cesarean delivery with one join point of BMI 23, hypertension disorder in pregnancy with two join points of BMI 20 and 28, gestational diabetes mellitus with one join point of BMI 22, and macrosomia with one join point of BMI 19. The trend was continuously and linearly decreasing for anemia. The bidirectional trends were downward and upward for premature rupture of the membrane with join BMI 22, preterm premature rupture of the membrane with join BMI 22, placenta abruption with join BMI 23, preterm birth with join BMI 19, and low birth weight with join BMI 19.ConclusionsThe changes in the trends of specific outcomes differed with pre-pregnancy BMI. Our results suggested that a pre-pregnancy BMI ranging between 19 and 23 may help reduce the risk of poor maternal and neonatal outcomes.
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Zakiyah N, Tuytten R, Baker PN, Kenny LC, Postma MJ, van Asselt ADI. Early cost-effectiveness analysis of screening for preeclampsia in nulliparous women: A modelling approach in European high-income settings. PLoS One 2022; 17:e0267313. [PMID: 35446907 PMCID: PMC9022877 DOI: 10.1371/journal.pone.0267313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Preeclampsia causes substantial maternal and perinatal morbidity and mortality and significant societal economic impact. Effective screening would facilitate timely and appropriate prevention and management of preeclampsia. Objectives To develop an early cost-effectiveness analysis to assess both costs and health outcomes of a new screening test for preeclampsia from a healthcare payer perspective, in the United Kingdom (UK), Ireland, the Netherlands and Sweden. Methods A decision tree over a 9-month time horizon was developed to explore the cost-effectiveness of the new screening test for preeclampsia compared to the current screening strategy. The new test strategy is being developed so that it can stratify healthy low risk nulliparous women early in pregnancy to either a high-risk group with a risk of 1 in 6 or more of developing preeclampsia, or a low-risk group with a risk of 1 in 100 or less. The model simulated 25 plausible scenarios in a hypothetical cohort of 100,000 pregnant women, in which the sensitivity and specificity of the new test were varied to set a benchmark for the minimum test performance that is needed for the test to become cost-effective. The input parameters and costs were mainly derived from published literature. The main outcome was incremental costs per preeclampsia case averted, expressed as an incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted to assess uncertainty. Results Base case results showed that the new test strategy would be more effective and less costly compared to the current situation in the UK. In the Netherlands, the majority of scenarios would be cost-effective from a threshold of €50,000 per preeclampsia case averted, while in Ireland and Sweden, the vast majority of scenarios would be considered cost-effective only when a threshold of €100,000 was used. In the best case analyses, ICERs were more favourable in all four participating countries. Aspirin effectiveness, prevalence of preeclampsia, accuracy of the new screening test and cost of regular antenatal care were identified as driving factors for the cost-effectiveness of screening for preeclampsia. Conclusion The results indicate that the new screening test for preeclampsia has potential to be cost-effective. Further studies based on proven accuracy of the test will confirm whether the new screening test is a cost-effective additional option to the current situation.
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Affiliation(s)
- Neily Zakiyah
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- * E-mail:
| | - Robin Tuytten
- Research & Development, Metabolomic Diagnostics, Little Island, Ireland
| | - Philip N. Baker
- College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Louise C. Kenny
- Department of Women’s and Children’s Health, the Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Maarten J. Postma
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Antoinette D. I. van Asselt
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Unit of Patient Centered Health Technology Assessment, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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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: 54] [Impact Index Per Article: 27.0] [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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Ogunwole SM, Mwinnyaa G, Wang X, Hong X, Henderson J, Bennett WL. Preeclampsia Across Pregnancies and Associated Risk Factors: Findings From a High-Risk US Birth Cohort. J Am Heart Assoc 2021; 10:e019612. [PMID: 34398644 PMCID: PMC8649269 DOI: 10.1161/jaha.120.019612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Preeclampsia increases women's risks for maternal morbidity and future cardiovascular disease. The aim of this study was to identify opportunities for prevention by examining the association between cardiometabolic risk factors and preeclampsia across 2 pregnancies among women in a high‐risk US birth cohort. Methods and Results Our sample included 618 women in the Boston Birth Cohort with index and subsequent pregnancy data collected using standard protocols. We conducted log‐binomial univariate regression models to examine the association between preeclampsia in the subsequent pregnancy (defined as incident or recurrent preeclampsia) and cardiometabolic risk factors (ie, obesity, hypertension, diabetes mellitus, preterm birth, low birth weight, and gestational diabetes mellitus) diagnosed before and during the index pregnancy, and between index and subsequent pregnancies. At the subsequent pregnancy, 7% (36/540) had incident preeclampsia and 42% (33/78) had recurrent preeclampsia. Compared with women without obesity, women with obesity had greater risk of incident preeclampsia (unadjusted risk ratio [RR], 2.2 [95% CI, 1.1–4.5]) and recurrent preeclampsia (unadjusted RR, 3.1 [95% CI, 1.5–6.7]). Preindex pregnancy chronic hypertension and diabetes mellitus were associated with incident, but not recurrent, preeclampsia (hypertension unadjusted RR, 7.9 [95% CI, 4.1–15.3]; diabetes mellitus unadjusted RR, 5.2 [95% CI, 2.5–11.1]. Women with new interpregnancy hypertension versus those without had a higher risk of incident and recurrent preeclampsia (incident preeclampsia unadjusted RR, 6.1 [95% CI, 2.9–13]); recurrent preeclampsia unadjusted RR, 2.4 [95% CI, 1.5–3.9]). Conclusions In this diverse sample of high‐risk US women, we identified modifiable and treatable risk factors, including obesity and hypertension for the prevention of preeclampsia.
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Affiliation(s)
- S Michelle Ogunwole
- Department of Medicine Division of General Internal MedicineJohns Hopkins University School of Medicine Baltimore MD
| | - George Mwinnyaa
- Department of International HealthJohns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Xiaobin Wang
- Department of PediatricsJohns Hopkins University School of Medicine Baltimore MD.,Center on the Early Life Origins of Disease Department of Population, Family and Reproductive Health Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Xiumei Hong
- Center on the Early Life Origins of Disease Department of Population, Family and Reproductive Health Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | - Janice Henderson
- Department of Gynecology and Obstetrics Johns Hopkins University School of Medicine Baltimore MD
| | - Wendy L Bennett
- Department of Medicine Division of General Internal MedicineJohns Hopkins University School of Medicine Baltimore MD.,Center on the Early Life Origins of Disease Department of Population, Family and Reproductive Health Johns Hopkins University Bloomberg School of Public Health Baltimore MD
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Xu C, Li Y, Zhang W, Wang Q. Analysis of perinatal coagulation function in preeclampsia. Medicine (Baltimore) 2021; 100:e26482. [PMID: 34190173 PMCID: PMC8257867 DOI: 10.1097/md.0000000000026482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To study the dynamic changes in perinatal coagulation function in patients with preeclampsia (PE).The general data and coagulation indexes of 290 PE patients during the perinatal period (prenatal and 1 and 3 days postpartum) and 256 healthy pregnant women in the third trimester of pregnancy were investigated, and the data were analyzed.Compared with healthy pregnant women, prothrombin time (PT), fibrinogen (FIB), platelet count (PLT), mean platelet volume (MPV), thrombocytocrit (PCT), maximum amplitude (MA), and coagulation index (CI) of PE patients decreased, and activated partial thrombin time (APTT), thrombin time (TT), D-dimer (DD), platelet distribution width (PDW) and K values increased before delivery (P < .05). APTT and FIB in PE patients were lower in the day 1 postpartum group than in the prenatal and postpartum day 3 groups, and TT, DD, and fibrin degradation products (FDP) were higher (P < .05). PCT and MPV were highest in the prenatal group (P < .05).Compared with that of healthy pregnant women, the coagulation function of PE patients is in a relatively low-coagulation and high-fibrinolysis state on postpartum day 1, which increases the risk of postpartum hemorrhage and other adverse outcomes.
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Affiliation(s)
- Chang Xu
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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12
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Maternal prepregnancy overweight and obesity and the risk of preeclampsia: A meta-analysis of cohort studies. Obes Res Clin Pract 2020; 14:27-33. [PMID: 32035840 DOI: 10.1016/j.orcp.2020.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/31/2019] [Accepted: 01/07/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of our meta-analysis was to explore whether overweight and obesity was associated with preeclampsia or not. DESIGN Three databases were systematically reviewed and reference lists of relevant articles were checked. Meta-analysis of published cohort studies comparing whether overweight and obesity was associated with preeclampsia and adjusting for potential confounding factors. Calculations of pooled estimates were conducted in random-effects models. Heterogeneity was tested by using Chi-square test with Cochrane and heterogeneity was explored with meta-regression. Publication bias was estimated from Egger's test (linear regression method) and Begg's test (rank correlation method). RESULTS Nineteen studies met the inclusion criteria. The meta-analysis showed that overweight and obesity was associated with an increased risk of preeclampsia. The aOR calculated for 13 studies (compared overweight to normal weight) was 1.71, 95% CI (1.52, 1.91) for random-effects models and 19 studies (compared obesity to normal weight) was 2.48, 95% CI (2.05, 2.90) for random-effects models, stratified analyses showed no differences regarding quality grade, location of study and period of anthropometric measurement. There was no indication of a publication bias either from the result of Egger's test or Begg's test. CONCLUSIONS Our results suggested that prepregnancy maternal overweight and obesity are significantly associated with an increased risk of preeclampsia.
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Maric-Bilkan C, Abrahams VM, Arteaga SS, Bourjeily G, Conrad KP, Catov JM, Costantine MM, Cox B, Garovic V, George EM, Gernand AD, Jeyabalan A, Karumanchi SA, Laposky AD, Miodovnik M, Mitchell M, Pemberton VL, Reddy UM, Santillan MK, Tsigas E, Thornburg KLR, Ward K, Myatt L, Roberts JM. Research Recommendations From the National Institutes of Health Workshop on Predicting, Preventing, and Treating Preeclampsia. Hypertension 2019; 73:757-766. [PMID: 30686084 DOI: 10.1161/hypertensionaha.118.11644] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Christine Maric-Bilkan
- From the Division of Cardiovascular Sciences (C.M.-B., S.S.A., V.L.P.), National Institutes of Health, Bethesda, MD
| | - Vikki M Abrahams
- Department of Ob/Gyn and Reproductive Sciences, Yale University School of Medicine, New Haven, CT (V.M.A.)
| | - S Sonia Arteaga
- From the Division of Cardiovascular Sciences (C.M.-B., S.S.A., V.L.P.), National Institutes of Health, Bethesda, MD
| | - Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI (G.B.)
| | - Kirk P Conrad
- Department of Physiology and Functional Genomics and Ob/Gyn, University of Florida College of Medicine, Gainesville (K.P.C.)
| | - Janet M Catov
- Department of Ob/Gyn and Reproductive Sciences, Magee-Women's Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, PA (J.M.C., A.J., J.M.R.)
| | - Maged M Costantine
- Department of Ob/Gyn, University of Texas Medical Branch, Galveston (M.M.C.)
| | - Brian Cox
- Department of Physiology and Ob/Gyn, University of Toronto, ON, Canada (B.C.)
| | - Vesna Garovic
- Department of Internal Medicine and Division of Nephrology and Hypertension, Department of Ob/Gyn, Mayo Clinic, Rochester, MN (V.G.)
| | - Eric M George
- Department of Physiology and Biophysics and Cell and Molecular Biology, University of Mississippi Medical Center, Jackson (E.M.G.)
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University (A.D.G.)
| | - Arun Jeyabalan
- Department of Ob/Gyn and Reproductive Sciences, Magee-Women's Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, PA (J.M.C., A.J., J.M.R.)
| | - S Ananth Karumanchi
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (S.A.K.)
| | - Aaron D Laposky
- Division of Lung Diseases, National Center on Sleep Disorders Research (A.D.L.), National Institutes of Health, Bethesda, MD
| | - Menachem Miodovnik
- National Heart, Lung, and Blood Institute and Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (M. Miodovnik, U.M.R.), National Institutes of Health, Bethesda, MD
| | - Megan Mitchell
- Division of Extramural Research Activities (M. Mitchell), National Institutes of Health, Bethesda, MD
| | - Victoria L Pemberton
- From the Division of Cardiovascular Sciences (C.M.-B., S.S.A., V.L.P.), National Institutes of Health, Bethesda, MD
| | - Uma M Reddy
- National Heart, Lung, and Blood Institute and Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (M. Miodovnik, U.M.R.), National Institutes of Health, Bethesda, MD
| | - Mark K Santillan
- Department of Ob/Gyn, University of Iowa Carver College of Medicine (M.K.S.)
| | | | - Kent L R Thornburg
- Bob & Charlee Moore Institute for Nutrition & Wellness, Oregon Health and Science University, Portland (K.L.R.T.)
| | | | - Leslie Myatt
- Bob & Charlee Moore Institute for Nutrition & Wellness and Department of Ob/Gyn, Oregon Health and Science University, Portland (L.M.)
| | - James M Roberts
- Department of Ob/Gyn and Reproductive Sciences, Magee-Women's Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, PA (J.M.C., A.J., J.M.R.)
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14
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Putting the "M" back in maternal-fetal medicine: A 5-year report card on a collaborative effort to address maternal morbidity and mortality in the United States. Am J Obstet Gynecol 2019; 221:311-317.e1. [PMID: 30849353 DOI: 10.1016/j.ajog.2019.02.055] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 11/21/2022]
Abstract
The Centers for Disease Control and Prevention have demonstrated continuous increased risk for maternal mortality and severe morbidity with racial disparities among non-Hispanic black women an important contributing factor. More than 50,000 women experienced severe maternal morbidity in 2014, with a mortality rate of 18.0 per 100,000, higher than in many other developed countries. In 2012, the first "Putting the 'M' back in Maternal-Fetal Medicine" session was held at the Society for Maternal-Fetal Medicine's (SMFM) Annual Meeting. With the realization that rising risk for severe maternal morbidity and mortality required action, the "M in MFM" meeting identified the following urgent needs: (i) to enhance education and training in maternal care for maternal-fetal medicine (MFM) fellows; (ii) to improve the medical care and management of pregnant women across the country; and (iii) to address critical research gaps in maternal medicine. Since that first meeting, a broad collaborative effort has made a number of major steps forward, including the proliferation of maternal mortality review committees, advances in research, increasing educational focus on maternal critical care, and development of comprehensive clinical strategies to reduce maternal risk. Five years later, the 2017 M in MFM meeting served as a "report card" looking back at progress made but also looking forward to what needs to be done over the next 5 years, given that too many mothers still experience preventable harm and adverse outcomes.
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15
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Chronic kidney disease in preeclamptic patients: not found unless searched for—Is a nephrology evaluation useful after an episode of preeclampsia? J Nephrol 2019; 32:977-987. [DOI: 10.1007/s40620-019-00629-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022]
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Thiele K, Ahrendt LS, Hecher K, Arck PC. The mnemonic code of pregnancy: Comparative analyses of pregnancy success and complication risk in first and second human pregnancies. J Reprod Immunol 2019; 134-135:11-20. [PMID: 31374263 DOI: 10.1016/j.jri.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 11/16/2022]
Abstract
Obstetrical complications such as spontaneous abortion/miscarriage, fetal growth restriction, preeclampsia or preterm birth occur in approx. 15% of human pregnancies. Clinical experts often state that a previous uncomplicated pregnancy reduces the risk for complications in subsequent pregnancies. Vice versa, a prior pregnancy affected by obstetrical complications increases the risk for reoccurrence. However, published evidence directly underpinning these clinical statements is sparse. Considering that the maternal immune adaptation may be causally involved in determining the outcome of subsequent pregnancies, a comprehensive analysis of clinical data was long overdue. We here present a systematic analysis of clinical data using a PubMed-based approach to identify human studies with relevant information on birth weight and incidences of pregnancy complications in first and second pregnancies. From initially 18,592 publications, 37 studies were included in the quantitative data analysis. Women with a previous pregnancy affected by complications where a derailed immune response can be inferred have a 2.2-3.2-fold increased risk to be affected again in a subsequent pregnancy. Conversely, a normally progressing primary pregnancy reduced the risk for complications in a subsequent pregnancy by 35-65%. Moreover, an uncomplicated primary pregnancy was associated with a 4.2% increased birth weight in a following pregnancy without a difference in gestational age at delivery. In conclusion, the increased birth weight after previously uncomplicated pregnancies suggests that an immune memory is mounted during primary pregnancies. This immune memory may promote the successful outcome of subsequent pregnancies or - if missing or compromised - account for a risk perpetuation of pregnancy complications.
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Affiliation(s)
- Kristin Thiele
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Lisa Sophie Ahrendt
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Clara Arck
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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17
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Tannis C, Fletcher-Slater R, Lopez I, Gichingiri A, Cassara M, Lachapelle S, Garland E. Risk Factors for Preeclampsia in a High-Risk Cohort of Women Served by a Nursing-based Home Visiting Program. INTERNATIONAL PUBLIC HEALTH JOURNAL 2018; 10:411-419. [PMID: 31762934 PMCID: PMC6873224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This descriptive study aimed to identify the impact of psychosocial risk factors on pregnancy outcomes for high risk women in an urban setting. Women in this category tend to experience adverse pregnancy outcomes, like preeclampsia, at greater rates than low or medium risk women. A retrospective paper chart review of East Harlem women served by LSA Family Health Service (LSA) Maternal Outreach Program (MOP) was conducted. All women who enrolled in the MOP with a singleton pregnancy from January 2015 to December 2017, were eligible for inclusion in our analyses. Data were analyzed using SPSS (version 23). Of 379 total participants, 68.6% (n=203) were Hispanic/Latina women, 44.8% (n=163) were English only speakers, 67.4% (n=226) were identified as overweight/obese, 90.6% (n=328) were mothers over the age of 20 among those for whom data were available. Sixty-two percent (n=235) initiated prenatal care in their first trimester, and 71.5% (n=271) were referred to the MOP by a hospital or other healthcare provider. The percentage of preeclampsia among mothers was 26.9% (n=102). After adjustment for type of LSA services received, and race/ethnicity, there were no associations between psychosocial risk factors and preeclampsia diagnosis in this population. Further research is needed on the relationship between psychosocial risk factors and preeclampsia to identify potential areas of intervention and reduce the burden of disease.
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Affiliation(s)
- Candace Tannis
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Rachel Fletcher-Slater
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Inessa Lopez
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Alexandrah Gichingiri
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Mario Cassara
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | | | - Elizabeth Garland
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
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18
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Hao N, Graham J, Hitchcock A, O'Brien TJ, Vajda FJE. The role of ethnicity on pregnancy outcomes in women with epilepsy: The need for specific research. Epilepsia 2018; 59:1124-1131. [PMID: 29727483 DOI: 10.1111/epi.14086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 02/05/2023]
Abstract
The role of ethnicity on pregnancy outcomes of women with epilepsy (WWE) has received little research attention but is important to guide management. The aim of this review is to identify and describe current knowledge of ethnicity for WWE giving birth. Literature searches were performed with the following terms: ethnic/race combined with epilepsy/seizure, antiepileptic drugs (AED), and/or pregnancy, and combined them with congenital malformation, birth outcome, or pregnancy complication, with English language restriction in PubMed, EMBASE, and Web of Science. Both primary studies and review articles were included. Ethnicity disparities exist in specific congenital malformations, pregnancy complications, and birth outcomes among the general population. There is also ethnicity-related diversity of AED disposition. Information on ethnicity is rarely considered in studies about pregnant WWE. The association between ethnicity and pregnancy outcomes of WWE remains to be elucidated. The lack of data relating to ethnicity in pregnancy studies among WWE needs addressing. Knowledge of potential effects of ethnicity on pregnancy outcomes in WWE will help inform better clinical care around the world.
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Affiliation(s)
- Nanya Hao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.,Department of Medicine and Neurology, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic., Australia
| | - Janet Graham
- Department of Medicine and Neurology, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic., Australia
| | - Alison Hitchcock
- Department of Medicine and Neurology, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic., Australia
| | - Terence J O'Brien
- Department of Medicine and Neurology, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic., Australia.,Departments of Neurosciences and Neurology, The Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Vic., Australia
| | - Frank J E Vajda
- Department of Medicine and Neurology, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic., Australia
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19
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Liang C, Wang J, Xia X, Wang Q, Li Z, Tao R, Tao Y, Xiang H, Tong S, Tao F. Serum cobalt status during pregnancy and the risks of pregnancy-induced hypertension syndrome: A prospective birth cohort study. J Trace Elem Med Biol 2018; 46:39-45. [PMID: 29413109 DOI: 10.1016/j.jtemb.2017.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/23/2017] [Accepted: 11/15/2017] [Indexed: 12/30/2022]
Abstract
Cobalt (Co) is an essential trace element and has been suggested to be involved in blood pressure regulation, but few studies have focused on serum Co status during pregnancy and the risks of pregnancy-induced hypertension syndrome (PIH). The aim of this study was to prospectively assess the association between serum Co levels during pregnancy and the risks of PIH, and to explore how the maternal Co status contributes to the incidence of PIH. 3260 non-hypertensive women before pregnancy with singleton births in Ma'anShan birth cohort study (MABC) were recruited with the assessment of maternal Co concentrations, additionally, the levels of 7 inflammatory factors and 3 stress factors in placentas were also determined. Relative risks (RRs) [95% confidence intervals (CIs)] for the risks of PIH were assessed and the relationships between 10 factors and maternal Co status during pregnancy were evaluated as well. A total of 194 (5.95%) women were diagnosed with PIH. The concentrations of Co varied from the first trimester to the second trimester, and maternal serum Co concentrations during pregnancy were negatively associated with the incidence of PIH in a linear fashion. There was a clear trend in RRs according to decreasing exposure to Co levels in the second trimester (RRa=1.80, 95% CI (1.26, 2.56); RRb=1.73, 95% CI (1.21, 2.46) and RRc=1.43, 95% CI (1.02, 2.04) when low Co levels comparing with high Co levels before and after adjustment for confounders; and RRa=1.29, 95% CI (0.88, 1.88); RRb=1.28, 95% CI (0.87, 1.87) and RRc=1.25, 95% CI (0.86, 1.82) when medium Co levels comparing with high Co levels before and after adjustment for confounders). In addition, the trend for the first trimester was nearly identifical to those for the second trimester (RRa=1.35, 95% CI (0.94, 1.93); RRb=1.33, 95% CI (0.93, 1.91); RRc=1.22, 95%CI (0.86, 1.73) when low Co levels comparing with high Co levels before and after adjustment for confounders; and RRa=1.10, 95% CI (0.76, 1.60); RRb=1.13, 95% CI (0.77, 1.64) and RRc=1.12, 95% CI (0.77, 1.63) before and after adjustment for confounders). Interestingly, Co concentrations in the second trimester were also inversely associated with the levels of some inflammatory factors and all three stress factors in placentas. This prospective study suggested that lower maternal serum Co concentration in the second trimester may associate with the incidence of PIH in Chinese population. Additionally, the maternal Co concentrations in the second trimester could reduce inflammatory and oxidative damage to the placenta. Further evidence is needed to support the findings and assess the mechanisms underlying the association.
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Affiliation(s)
- Chunmei Liang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Jianqing Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Xun Xia
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Qunan Wang
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Zhijuan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Ruiwen Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Yiran Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Haiyun Xiang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Shilu Tong
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China; Shanghai Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China; School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China.
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Defective decidualization during and after severe preeclampsia reveals a possible maternal contribution to the etiology. Proc Natl Acad Sci U S A 2017; 114:E8468-E8477. [PMID: 28923940 DOI: 10.1073/pnas.1706546114] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In preeclampsia (PE), cytotrophoblast (CTB) invasion of the uterus and spiral arteries is often shallow. Thus, the placenta's role has been a focus. In this study, we tested the hypothesis that decidual defects are an important determinant of the placental phenotype. We isolated human endometrial stromal cells from nonpregnant donors with a previous pregnancy that was complicated by severe PE (sPE). Compared with control cells, they failed to decidualize in vitro as demonstrated by morphological criteria and the analysis of stage-specific antigens (i.e., IGFBP1, PRL). These results were bolstered by global transcriptional profiling data that showed they were transcriptionally inert. Additionally, we used laser microdissection to isolate the decidua from tissue sections of the maternal-fetal interface in sPE. Global transcriptional profiling revealed defects in gene expression. Also, decidual cells from patients with sPE, which dedifferentiated in vitro, failed to redecidualize in culture. Conditioned medium from these cells failed to support CTB invasion. To mimic aspects of the uterine environment in normal pregnancy, we added PRL and IGFBP1, which enhanced invasion. These data suggested that failed decidualization is an important contributor to down-regulated CTB invasion in sPE. Future studies will be aimed at determining whether this discovery has translational potential with regard to assessing a woman's risk of developing this pregnancy complication.
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Tolcher MC, Chu DM, Hollier LM, Mastrobattista JM, Racusin DA, Ramin SM, Sangi-Haghpeykar H, Aagaard KM. Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia. Am J Obstet Gynecol 2017; 217:365.e1-365.e8. [PMID: 28455079 DOI: 10.1016/j.ajog.2017.04.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/17/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND The US Preventive Services Task Force recommends low-dose aspirin for the prevention of preeclampsia among women at high risk for primary occurrence or recurrence of disease. Recommendations for the use of aspirin for preeclampsia prevention were issued by the US Preventive Services Task Force in September 2014. OBJECTIVES The objective of the study was to evaluate the incidence of recurrent preeclampsia in our cohort before and after the US Preventive Services Task Force recommendation for aspirin for preeclampsia prevention. STUDY DESIGN This was a retrospective cohort study designed to evaluate the rates of recurrent preeclampsia among women with a history of preeclampsia. We utilized a 2-hospital, single academic institution database from August 2011 through June 2016. We excluded multiple gestations and included only the first delivery for women with multiple deliveries during the study period. The cohort of women with a history of preeclampsia were divided into 2 groups, before and after the release of the US Preventive Services Task Force 2014 recommendations. Potential confounders were accounted for in multivariate analyses, and relative risk and adjusted relative risk were calculated. RESULTS A total of 17,256 deliveries occurred during the study period. A total of 417 women had a documented history of prior preeclampsia: 284 women before and 133 women after the US Preventive Services Task Force recommendation. Comparing the before and after groups, the proportion of Hispanic women in the after group was lower and the method of payment differed between the groups (P <.0001). The prevalence of type 1 diabetes was increased in the after period, but overall rates of pregestational diabetes were similar (6.3% before vs 5.3% after [P > .05]). Risk factors for recurrent preeclampsia included maternal age >35 years (relative risk, 1.83; 95% confidence interval, 1.34-2.48), Medicaid insurance (relative risk, 2.08; 95% confidence interval, 1.15-3.78), type 2 diabetes (relative risk, 2.13; 95% confidence interval, 1.37-3.33), and chronic hypertension (relative risk, 1.96; 95% confidence interval, 1.44-2.66). The risk of recurrent preeclampsia was decreased by 30% in the after group (adjusted relative risk, 0.70; 95% confidence interval, 0.52-0.95). CONCLUSION Rates of recurrent preeclampsia among women with a history of preeclampsia decreased by 30% after release of the US Preventive Services Task Force recommendation for aspirin for preeclampsia prevention. Future prospective studies should include direct measures of aspirin compliance, gestational age at initiation, and explore the influence of race and ethnicity on the efficacy of this primary prevention.
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Myers JE. What are the metabolic precursors which increase the risk of pre-eclampsia and how could these be investigated further. Placenta 2017; 60:110-114. [PMID: 28855067 PMCID: PMC5730540 DOI: 10.1016/j.placenta.2017.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/28/2017] [Accepted: 08/22/2017] [Indexed: 12/11/2022]
Abstract
Several maternal and pregnancy characteristics have been associated with an increased risk of preeclampsia in epidemiological studies. This review discusses metabolic risk factors in particular and their interaction with other maternal and/or pregnancy characteristics. Examples of research studies that have used data from women with specific characteristics or explored the interaction between risk factors are discussed. Suggestions for future research using large data sets and incorporating knowledge of cardiovascular disease and other metabolic diseases are also highlighted. Obesity and nulliparity account for the largest population risk of preeclampsia. Low PlGF in early pregnancy is more strongly associated with preeclampsia in obese women. There are interactions between obesity and other characteristics which amplify the risk of preeclampsia e.g. ART, ethnicity.
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Affiliation(s)
- Jenny E Myers
- Maternal & Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; St Mary's Hospital, Central Manchester Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
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23
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Mendola P, Ghassabian A, Mills JL, Zhang C, Tsai MY, Liu A, Yeung EH. Retinol-Binding Protein 4 and Lipids Prospectively Measured During Early to Mid-Pregnancy in Relation to Preeclampsia and Preterm Birth Risk. Am J Hypertens 2017; 30:569-576. [PMID: 28338737 DOI: 10.1093/ajh/hpx020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/25/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Maternal retinol-binding protein 4 (RBP4) and lipids may relate to preeclampsia and preterm birth risk but longitudinal data are lacking. This study examines these biomarkers longitudinally during pregnancy in relation to preeclampsia and preterm birth risk. METHODS Maternal serum samples from the Calcium for Preeclampsia Prevention (CPEP) trial were analyzed at baseline: average 15 gestational weeks; mid-pregnancy: average 27 weeks; and at >34 weeks. We measured RBP4, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides and lipoprotein (a) (Lp(a)). Cross-sectional logistic regression analyses estimated the odds ratio (OR) and 95% confidence intervals (CI) for preterm preeclampsia (n = 63), term preeclampsia (n = 104), and preterm delivery (n = 160) associated with RBP4 and lipids at baseline and mid-pregnancy compared with controls (n = 136). Longitudinal trajectories across pregnancy were assessed using mixed linear models with fixed effects. Adjusted models included clinical and demographic factors. RESULTS RBP4 concentrations at baseline and mid-pregnancy were associated with a 4- to 8-fold increase in preterm preeclampsia risk but were not associated with term preeclampsia. RBP4 measured mid-pregnancy was also associated with preterm birth (OR = 6.67, 95% CI: 1.65, 26.84). Higher triglyceride concentrations in mid-pregnancy were associated with a 2- to 4-fold increased risk for both preeclampsia and preterm birth. Longitudinal models demonstrate that both preterm preeclampsia and preterm birth cases had elevated RBP4 throughout gestation. CONCLUSIONS Elevated RBP4 is detectable early in pregnancy and its strong relation with preterm preeclampsia merits further investigation and confirmation to evaluate its potential use as a predictor, particularly among high-risk women.
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Affiliation(s)
- Pauline Mendola
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Akhgar Ghassabian
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - James L. Mills
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Michael Y. Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aiyi Liu
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Edwina H. Yeung
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Shen M, Smith GN, Rodger M, White RR, Walker MC, Wen SW. Comparison of risk factors and outcomes of gestational hypertension and pre-eclampsia. PLoS One 2017; 12:e0175914. [PMID: 28437461 PMCID: PMC5402970 DOI: 10.1371/journal.pone.0175914] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 04/02/2017] [Indexed: 12/03/2022] Open
Abstract
Background It remains an enigma whether gestational hypertension (GH) and pre-eclampsia (PE) are distinct entities or different spectrum of the same disease. We aimed to compare the risk factors and outcomes between GH and PE. Method A total of 7,633 pregnant women recruited between 12 and 20 weeks of gestation in the Ottawa and Kingston Birth Cohort from 2002 to 2009 were included in the analysis. Cox proportional hazards model was used to identify and compare the risk factors for GH and PE by treating gestational age at delivery as the survival time. Logistic regression model was used to compare outcome. Subgroup analysis was performed for early- and late-onset PE. Results GH and PE shared most risk factors including overweight and obesity, nulliparity, PE history, type 1 and 2 diabetes, and twin birth. Effect size of PE history (RR = 14.1 for GH vs. RR = 6.4 for PE) and twin birth (RR = 4.8 for GH vs. RR = 10.3 for PE) showed substantial difference. Risk factors modified gestational age at delivery in patients with GH and PE in similar pattern. Subgroup analysis showed that early- and late-onset PE shared some risk factors with different effect sizes, whereas folic acid supplementation showed protective effect for early-onset PE only. PE was strongly associated with several adverse outcomes including cesarean section, placental abruption, small for gestational age, preterm birth, and 5 min Apgar score < 7, whereas GH was associated with increased risk of preterm birth only. Conclusions GH and PE shared common risk factors. Differences in effect sizes of risk factors and outcomes indicate that the conditions may have different pathophysiology and mechanism.
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Affiliation(s)
- Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Graeme N. Smith
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Marc Rodger
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ruth Rennicks White
- OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Mark C. Walker
- OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Thomas G, Kenny LC, Baker PN, Tuytten R. A novel method for interrogating receiver operating characteristic curves for assessing prognostic tests. Diagn Progn Res 2017; 1:17. [PMID: 31093546 PMCID: PMC6460848 DOI: 10.1186/s41512-017-0017-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/30/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Disease prevalence is rarely explicitly considered in the early stages of the development of novel prognostic tests. Rather, researchers use the area under the receiver operating characteristic (AUROC) as the key metric to gauge and report predictive performance ability. Because this statistic does not account for disease prevalence, proposed tests may not appropriately address clinical requirements. This ultimately impedes the translation of prognostic tests into clinical practice. METHODS A method to express positive- and/or negative predictive value criteria (PPV, NPV) within the ROC space is presented. Equations are derived for so-called equi-PPV (and equi-NPV) lines. Herewith it is possible, for any given prevalence, to plot a series of sensitivity-specificity pairs which meet a specified PPV (or NPV) criterion onto the ROC space.This concept is introduced by firstly reviewing the well-established "mechanics", strengths and limitations of the ROC analysis in the context of developing prognostic models. Then, the use of PPV (and/or) NPV criteria to augment the ROC analysis is elaborated.Additionally, an interactive web tool was also created to enable people to explore the dynamics of lines of equi-predictive value in function of prevalence. The web tool also allows to gauge what ROC curve shapes best meet specific positive and/or negative predictive value criteria (http://d4ta.link/ppvnpv/). RESULTS To illustrate the merits and implications of this concept, an example on the prediction of pre-eclampsia risk in low-risk nulliparous pregnancies is elaborated. CONCLUSIONS In risk stratification, the clinical usefulness of a prognostic test can be expressed in positive- and negative predictive value criteria; the development of novel prognostic tests will be facilitated by the possibility to co-visualise such criteria together with ROC curves. To achieve clinically meaningful risk stratification, the development of separate tests to meet either a pre-specified positive value (rule-in) or a negative predictive value (rule-out) criteria should be considered: the characteristics of successful rule-in and rule-out tests may markedly differ.
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Affiliation(s)
| | - Louise C. Kenny
- 0000000123318773grid.7872.aDepartment of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), 5th Floor, Cork University Maternity Hospital, Cork, Ireland
| | - Philip N. Baker
- 0000 0004 1936 8411grid.9918.9College of Medicine, Biological Sciences and Psychology, University of Leicester, University Road, Leicester, LE1 7RH UK
| | - Robin Tuytten
- Metabolomic Diagnostics, Hoffmann Park, Little Island, Cork, Ireland
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Zamora-Kapoor A, Nelson LA, Buchwald DS, Walker LR, Mueller BA. Pre-eclampsia in American Indians/Alaska Natives and Whites: The Significance of Body Mass Index. Matern Child Health J 2016; 20:2233-2238. [PMID: 27461024 PMCID: PMC5106312 DOI: 10.1007/s10995-016-2126-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction The prevalence of pre-eclampsia, a major cause of maternal morbidity, varies by race, being greater in African Americans, and lower in Asians and Hispanics than in White women. Little is known about its prevalence in American Indians/Alaska Natives (AI/ANs). We estimated pre-eclampsia risk in AI/ANs compared to Whites, with consideration of the potential effect of obesity, a major risk factor for pre-eclampsia, and a condition disproportionately affecting AI/AN women. Methods This retrospective cohort study of linked birth-hospital discharge data from Washington State (2003-2013) included all AI/AN women and a sample of White first-time mothers with singleton deliveries. Logistic regression was used to estimate odds ratio (OR) and 95 % confidence intervals (CI) for pre-eclampsia risk in AI/ANs compared to Whites, first controlling for several important risk factors, and subsequently with additional adjustment for pre-pregnancy body mass index (BMI). Results AI/ANs had an increased risk of pre-eclampsia compared to Whites after controlling for all covariates except BMI (OR 1.17, 95 % CI 1.06-1.29). After further adjustment for BMI, the racial disparity in pre-eclampsia risk was greatly attenuated (OR 1.05, 95 % CI 0.95-1.16). Discussion This population-based study suggests that any increased risk in AI/ANs relative to Whites may be at least partly due to differences in BMI.
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Affiliation(s)
- Anna Zamora-Kapoor
- Initiative for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA.
- Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Lonnie A Nelson
- Initiative for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA
| | - Dedra S Buchwald
- Initiative for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA
- College of Medicine, Washington State University, Spokane, WA, USA
| | - Leslie R Walker
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Beth A Mueller
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Weiner E, Mizrachi Y, Grinstein E, Feldstein O, Rymer-Haskel N, Juravel E, Schreiber L, Bar J, Kovo M. The role of placental histopathological lesions in predicting recurrence of preeclampsia. Prenat Diagn 2016; 36:953-960. [PMID: 27568920 DOI: 10.1002/pd.4918] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/10/2016] [Accepted: 08/24/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We aimed to study the role of placental pathology in the prediction of preeclampsia (PE) recurrence. METHODS The medical records and pathological placental reports of all women diagnosed with PE, during 2008-2015, were reviewed. The study population was divided according to the outcome of their subsequent pregnancy: those who did (recurrence group) or did not (no-recurrence group) develop recurrent PE. Data regarding maternal characteristics and placental maternal/fetal vascular malperfusion lesions, of the initial pregnancies, were compared. Two prediction models were generated for PE recurrence. RESULTS Compared to the no-recurrence group (n = 130), the recurrence group (n = 96) was characterized by lower gestational age (p < 0.001), longer inter-pregnancy interval (p = 0.012), and higher rate of severe features (p < 0.001). By logistic regression analysis composite maternal (aOR = 3.05, 95%CI 1.39-6.71, p = 0.005), fetal (aOR = 9.31, 95%CI 3.9-22.1, p < 0.001), and concurrent maternal + fetal (aOR = 13.94, 95%CI 5.08-38.21, p < 0.001), vascular malperfusion lesions were found to be independently associated with recurrence. A clinical prediction model accounted for 20.8% of PE recurrence (R2 = 0.208, AUC = 0.732), while a clinical-pathological model accounted for 34.2% of recurrence (R2 = 0.342, AUC = 0.80). CONCLUSION Placental maternal and fetal vascular malperfusion lesions are independently associated with increased risk for PE recurrence. A clinical-pathological prediction model for recurrence of PE is superior to a prediction model based merely on clinical factors. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Eran Weiner
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yossi Mizrachi
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grinstein
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Feldstein
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Rymer-Haskel
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Juravel
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bartsch E, Medcalf KE, Park AL, Ray JG. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ 2016; 353:i1753. [PMID: 27094586 PMCID: PMC4837230 DOI: 10.1136/bmj.i1753] [Citation(s) in RCA: 520] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤ 16 weeks' gestation to estimate a woman's risk of pre-eclampsia. DESIGN Systematic review and meta-analysis of cohort studies. DATA SOURCES PubMed and Embase databases, 2000-15. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Cohort studies with ≥ 1000 participants that evaluated the risk of pre-eclampsia in relation to a common and generally accepted clinical risk factor assessed at ≤ 16 weeks' gestation. DATA EXTRACTION Two independent reviewers extracted data from included studies. A pooled event rate and pooled relative risk for pre-eclampsia were calculated for each of 14 risk factors. RESULTS There were 25,356,688 pregnancies among 92 studies. The pooled relative risk for each risk factor significantly exceeded 1.0, except for prior intrauterine growth restriction. Women with antiphospholipid antibody syndrome had the highest pooled rate of pre-eclampsia (17.3%, 95% confidence interval 6.8% to 31.4%). Those with prior pre-eclampsia had the greatest pooled relative risk (8.4, 7.1 to 9.9). Chronic hypertension ranked second, both in terms of its pooled rate (16.0%, 12.6% to 19.7%) and pooled relative risk (5.1, 4.0 to 6.5) of pre-eclampsia. Pregestational diabetes (pooled rate 11.0%, 8.4% to 13.8%; pooled relative risk 3.7, 3.1 to 4.3), prepregnancy body mass index (BMI) >30 (7.1%, 6.1% to 8.2%; 2.8, 2.6 to 3.1), and use of assisted reproductive technology (6.2%, 4.7% to 7.9%; 1.8, 1.6 to 2.1) were other prominent risk factors. CONCLUSIONS There are several practical clinical risk factors that, either alone or in combination, might identify women in early pregnancy who are at "high risk" of pre-eclampsia. These data can inform the generation of a clinical prediction model for pre-eclampsia and the use of aspirin prophylaxis in pregnancy.
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Affiliation(s)
| | | | - Alison L Park
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Joel G Ray
- Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynecology, St Michael's Hospital, University of Toronto, Toronto, Canada
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Poorolajal J, Jenabi E. The association between body mass index and preeclampsia: a meta-analysis. J Matern Fetal Neonatal Med 2016; 29:3670-6. [PMID: 26762770 DOI: 10.3109/14767058.2016.1140738] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several observational studies have reported a positive association between elevated body mass index (BMI) and preeclampsia, but no meta-analysis has been conducted yet. This meta-analysis was conducted to estimate the overall association between overweight or obesity and preeclampsia. METHODS Major electronic databases, including PubMed, Web of Science, and Scopus were searched until August 2015. The reference lists of included studies were screened as well. Epidemiological studies addressing the association between BMI and preeclampsia were enrolled. The heterogeneity across studies was explored by Q-test and I(2) statistic. The possibility of publication bias was assessed using Begg's and Egger's tests. The results were reported using odds ratio (OR) estimate with its 95% confidence intervals (CI) using a random-effects model. RESULTS We identified a total of 1298 references and included 23 studies with 1 387 599 participants. Preeclampsia was associated with overweight (OR = 1.73; 95% CI: 1.59, 1.87; 21 studies; I(2 )=( )62.3%) and obesity (OR = 3.15; 95% CI: 2.96, 3.35; 22 studies; I(2 )=( )36.0%). There was no evidence of publication bias. CONCLUSIONS There is sufficient evidence that excess body mass index is significantly associated with an increased risk of preeclampsia. Therefore, overweight and obesity can be considered as a predictor of preeclampsia.
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Affiliation(s)
- Jalal Poorolajal
- a Department of Epidemiology , Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences , Hamadan , Iran and.,b Department of Midwifery , Toyserkan Branch, Islamic Azad University , Toyserkan , Iran
| | - Ensiyeh Jenabi
- a Department of Epidemiology , Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences , Hamadan , Iran and.,b Department of Midwifery , Toyserkan Branch, Islamic Azad University , Toyserkan , Iran
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