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Gunnesson L, Ragnarsson O, Nilsson M, Sengpiel V, Elfvin A, Elias E, Muth A. Maternal pheochromocytoma and childbirth in Sweden 1973-2015: a population-based study on short and long-term outcome. Endocrine 2024; 84:720-726. [PMID: 38421555 PMCID: PMC11076314 DOI: 10.1007/s12020-024-03749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Data guiding management of pheochromocytoma and paraganglioma (PPGL) in pregnant women is limited, and long-term effects on the child are unknown. The aim of this retrospective registry-based case-cohort study was to assess how maternal PPGL and treatment impacts maternal and fetal outcome, including long-term outcome for the child. The main outcomes were maternal and fetal mortality and morbidity at delivery and relative healthcare consumption in children born by mothers with PPGL during pregnancy. METHODS The National Birth Register identified 4,390,869 pregnancies between 1973-2015. Data was crosslinked with three Swedish national registers to identify women diagnosed with pheochromocytoma or paraganglioma within one year before or after childbirth. Hospital records were reviewed and register data was collected for five age-matched controls for each child until age 18. RESULTS 21 women and 23 children were identified (incidence 4.8/1.000.000 births/year), all women with adrenal pheochromocytomas (Pc). The majority (71%) were diagnosed post-partum. Nine women (43%) were hypertensive during pregnancy. Preterm delivery was more common in Pc patients compared to controls (30% vs 6%, p < 0.001). There was no maternal or fetal mortality. Timing of tumor removal did not affect gestational weight or APGAR scores. There was no observed difference in hospital admissions between children affected by maternal Pc and controls. CONCLUSION Pc was commonly diagnosed after delivery and raised the risk of pre-term delivery, suggesting a need for an increased awareness of this diagnosis. However, reassuringly, there was no fetal or maternal mortality or any observed long-term impact on the children.
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Affiliation(s)
- Lisa Gunnesson
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Oskar Ragnarsson
- Department of Endocrinology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Gothenburg, Sweden
| | - Maria Nilsson
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Elfvin
- The Queen Silvia Children's hospital, Department of Pediatrics, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Elias
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Muth
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abdelmageed WA, Lapointe A, Brown R, Gorgos A, Luu TM, Beltempo M, Altit G, Dayan N. Association between maternal hypertension and infant neurodevelopment in extremely preterm infants. J Perinatol 2024; 44:539-547. [PMID: 38287138 DOI: 10.1038/s41372-024-01886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To examine the association between maternal hypertension during pregnancy and neurodevelopmental impairment (NDI) at 24 months post-menstrual age in extremely preterm infants. STUDY DESIGN Using data from two tertiary neonatal units (2011-2017) for infants born at 23 + 0 to 28 + 6 weeks, we investigated outcomes of NDI related to maternal hypertension and small-for-gestational-age (SGA) status. RESULTS Of 1019 pre-term infants, 647 had complete data and were included in the analysis. Ninety-six (15%) had maternal hypertension exposure; 25 (4%) were also SGA. Infants with maternal hypertension showed a higher odds of any NDI (aOR: 2.29, 95% CI = 1.36-3.87) and significant NDI (aOR: 2.01, 95% CI = 1.02-3.95). The combination of hypertension and SGA further elevated this risk (aOR for any NDI: 4.88, 95% CI = 1.80-13.22; significant NDI: 6.91, 95% CI = 2.50-19.12). CONCLUSION Maternal hypertension during pregnancy elevates the risk of NDI in extremely preterm infants, more so when combined with SGA.
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Affiliation(s)
- Wael A Abdelmageed
- Department of Medicine, Division of Experimental Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Anie Lapointe
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - Richard Brown
- Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Andreea Gorgos
- Neonatal Follow-Up, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Thuy Mai Luu
- Neonatal Follow-Up, Department of Paediatrics, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Gabriel Altit
- Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Natalie Dayan
- Research Institute, McGill University Health Centre, Montreal, QC, Canada.
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Wei J, Huang L, Wu M, Lu X, Song Y, Wang Y, Guo Y. The relationship between human blood metabolites and preeclampsia-eclampsia: A Mendelian randomization study. Medicine (Baltimore) 2024; 103:e37505. [PMID: 38552089 PMCID: PMC10977518 DOI: 10.1097/md.0000000000037505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/14/2024] [Indexed: 04/02/2024] Open
Abstract
Preeclampsia and eclampsia are serious complications of pregnancy, leading to high rates of maternal and neonatal mortality. During pregnancy, there are changes in relevant serum metabolites in women. However, it remains unclear if these serum metabolites contribute to the development of associated disorders during pregnancy. Therefore, we conducted a Mendelian randomization study to explore the causal relationship between serum metabolites and preeclampsia and eclampsia. We utilized the inverse variance weighted model as our primary analysis approach. We complemented this with sensitivity analyses, including the heterogeneity test, horizontal pleiotropy test, and leave-one-out analysis, to ensure the robustness of our findings. Furthermore, we conducted linkage disequilibrium score regression, multivariable Mendelian randomization, and metabolic pathway analysis to further explore the genetic data. The Mendelian randomization analysis has identified γ-glutamylglutamine, inosine, and isoleucine 10 metabolites that are significantly associated with preeclampsia, and γ-glutamylglutamine and phenylacetate 8 metabolites that may potentially contribute to the development of eclampsia. Notably, γ-glutamylglutamine has been found to have a causal relationship with both preeclampsia and eclampsia. In the multivariable Mendelian randomization analysis, our research findings suggest that both isoleucine and X-14304-leucylalanine directly impact preeclampsia within the context of amino acids and peptides. Moreover, our observations reveal that carbohydrates can also have a direct effect on preeclampsia. Importantly, it should be emphasized that only 3-lactate in amino acids has been shown to have a direct influence on eclampsia. This research has the potential to enhance our understanding of the biological variances related to disease status, providing a foundation for future investigations.
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Affiliation(s)
- Jiping Wei
- School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Liyuan Huang
- School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Mingda Wu
- Precision Medical Center, Jilin Province General Hospital, Changchun, China
| | - Xiaodan Lu
- School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
- Precision Medical Center, Jilin Province General Hospital, Changchun, China
| | - Yongfu Song
- Department of Pediatrics, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Yongji Wang
- Department of Pediatrics, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Yan Guo
- School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
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Zhao Q, Liu R, Chen H, Yang X, Dong J, Bai M, Yu M, Feng Z, Zeng D. Higher Circulating Lymphocytes and the Incidence of Pre-eclampsia and Eclampsia. J Pregnancy 2024; 2024:8834312. [PMID: 38532947 PMCID: PMC10965280 DOI: 10.1155/2024/8834312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 03/28/2024] Open
Abstract
Excessive immune activation contributes to the onset of early dysfunction of the maternal-fetal interface, and it is closely linked to the development of pre-eclampsia. However, the effect of specific immune cells on the risk of pre-eclampsia and eclampsia remains controversial. We investigated the causal relationship between immune cells and pre-eclampsia and eclampsia. For exposure, we extracted genetic variants associated with immune cell-related traits, and for outcomes, we used summary genetic data of pre-eclampsia/eclampsia. A two-sample Mendelian randomization (MR) analysis was then performed to assess the causal relationship. Robustness of the MR results was then evaluated through colocalization analysis. We found that genetically proxied circulating lymphocyte absolute count was causally associated with total eclampsia (odds ratio (OR) = 1.53, 95% confidence interval (CI) (1.31-1.79), p = 1.15E - 07) and pre-eclampsia (OR = 1.50, 95% CI (1.28-1.77), p = 9.18E - 07); T cell absolute count was causally associated with total eclampsia (OR = 1.49, 95% CI (1.28-1.73), p = 2.73E - 07) and pre-eclampsia (OR = 1.47, 95% CI (1.25-1.72), p = 1.76E - 06). And CD28- CD25+ CD8+ T cell absolute count was causally associated with total eclampsia (OR = 1.83, 95% CI (1.44-2.32), p = 7.11E - 07) and pre-eclampsia (OR = 1.77, 95% CI (1.38-2.26), p = 6.55E - 06). Colocalization analysis revealed that immune cell-related traits shared the same variant with pre-eclampsia/eclampsia. Our study suggested causal effects of genetic predisposition to high lymphocyte absolute count levels, T cell absolute count, and CD28- CD25+ CD8+ T cell absolute count on eclampsia, particularly pre-eclampsia risk, providing crucial new insights into the potential prevention target for eclampsia and pre-eclampsia.
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Affiliation(s)
- Qiuping Zhao
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - Rongmei Liu
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - Hui Chen
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - Xiaomo Yang
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - Jiajia Dong
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - Minfu Bai
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - MingYang Yu
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - Zeying Feng
- Department of Gynecology and Obstetrics, Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou Key Laboratory of Gynecologic Oncology, Liuzhou Hospital, Guangzhou Women and Children's Medical Center, Liuzhou, Guangxi, China
| | - Dingyuan Zeng
- Department of Gynecology and Obstetrics, Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou Key Laboratory of Gynecologic Oncology, Liuzhou Hospital, Guangzhou Women and Children's Medical Center, Liuzhou, Guangxi, China
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Bajpai D, Popa C, Verma P, Dumanski S, Shah S. Evaluation and Management of Hypertensive Disorders of Pregnancy. KIDNEY360 2023; 4:1512-1525. [PMID: 37526641 PMCID: PMC10617800 DOI: 10.34067/kid.0000000000000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
Hypertensive disorders of pregnancy complicate up to 10% of pregnancies and remain the major cause of maternal and neonatal morbidity and mortality. Hypertensive disorders of pregnancy can be classified into four groups depending on the onset of hypertension and the presence of target organ involvement: chronic hypertension, preeclampsia, gestational hypertension, and superimposed preeclampsia on chronic hypertension. Hypertension during pregnancy is associated with a higher risk of cardiovascular disease and kidney failure. Early diagnosis and proper treatment for pregnant women with hypertension remain a priority since this leads to improved maternal and fetal outcomes. Labetalol, nifedipine, methyldopa, and hydralazine are the preferred medications to treat hypertension during pregnancy. In this comprehensive review, we discuss the diagnostic criteria, evaluation, and management of pregnant women with hypertension.
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Affiliation(s)
- Divya Bajpai
- Department of Nephrology, Seth G.S.M.C & K.E.M. Hospital, Mumbai, India
| | - Cristina Popa
- Department of Internal Medicine - Nephrology, University of Medicine and Pharmacy “Grigore T Popa”, Iasi, Romania
| | - Prasoon Verma
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sandi Dumanski
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
| | - Silvi Shah
- Division of Nephrology and Hypertension, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Lawless L, Qin Y, Xie L, Zhang K. Trophoblast Differentiation: Mechanisms and Implications for Pregnancy Complications. Nutrients 2023; 15:3564. [PMID: 37630754 PMCID: PMC10459728 DOI: 10.3390/nu15163564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Placental development is a tightly controlled event, in which cell expansion from the trophectoderm occurs in a spatiotemporal manner. Proper trophoblast differentiation is crucial to the vitality of this gestational organ. Obstructions to its development can lead to pregnancy complications, such as preeclampsia, fetal growth restriction, and preterm birth, posing severe health risks to both the mother and offspring. Currently, the only known treatment strategy for these complications is delivery, making it an important area of research. The aim of this review was to summarize the known information on the development and mechanistic regulation of trophoblast differentiation and highlight the similarities in these processes between the human and mouse placenta. Additionally, the known biomarkers for each cell type were compiled to aid in the analysis of sequencing technologies.
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Affiliation(s)
- Lauren Lawless
- Institute of Bioscience and Technology, Texas A&M University, Houston, TX 77030, USA;
- Department of Nutrition, Texas A&M University, College Station, TX 77843, USA
| | - Yushu Qin
- Department of Nutrition, Texas A&M University, College Station, TX 77843, USA
| | - Linglin Xie
- Department of Nutrition, Texas A&M University, College Station, TX 77843, USA
| | - Ke Zhang
- Institute of Bioscience and Technology, Texas A&M University, Houston, TX 77030, USA;
- Department of Nutrition, Texas A&M University, College Station, TX 77843, USA
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7
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Liu X, Liu H, Gu N, Pei J, Lin X, Zhao W. Preeclampsia promotes autism in offspring via maternal inflammation and fetal NFκB signaling. Life Sci Alliance 2023; 6:e202301957. [PMID: 37290815 PMCID: PMC10250690 DOI: 10.26508/lsa.202301957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
Preeclampsia (PE) is a risk factor for autism spectrum disorder (ASD) in offspring. However, the exact mechanisms underlying the impact of PE on progeny ASD are not fully understood, which hinders the development of effective therapeutic approaches. This study shows the offspring born to a PE mouse model treated by Nω-nitro-L-arginine methyl ester (L-NAME) exhibit ASD-like phenotypes, including neurodevelopment deficiency and behavioral abnormalities. Transcriptomic analysis of the embryonic cortex and adult offspring hippocampus suggested the expression of ASD-related genes was dramatically changed. Furthermore, the level of inflammatory cytokines TNFα in maternal serum and nuclear factor kappa B (NFκB) signaling in the fetal cortex were elevated. Importantly, TNFα neutralization during pregnancy enabled to ameliorate ASD-like phenotypes and restore the NFκB activation level in the offspring exposed to PE. Furthermore, TNFα/NFκB signaling axis, but not L-NAME, caused deficits in neuroprogenitor cell proliferation and synaptic development. These experiments demonstrate that offspring exposed to PE phenocopies ASD signatures reported in humans and indicate therapeutic targeting of TNFα decreases the likelihood of bearing children with ASD phenotypes from PE mothers.
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Affiliation(s)
- Xueyuan Liu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Environmental and Occupational Health Science Institute, Rutgers University, Piscataway, NJ, USA
| | - Haiyan Liu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Nihao Gu
- International Peace Maternity & Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Shanghai Key Laboratory for Embryo-Feta Original Adult Disease, Shanghai Jiao Tong University, Shanghai, China
| | - Jiangnan Pei
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xianhua Lin
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Wenlong Zhao
- Environmental and Occupational Health Science Institute, Rutgers University, Piscataway, NJ, USA
- International Peace Maternity & Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Shanghai Key Laboratory for Embryo-Feta Original Adult Disease, Shanghai Jiao Tong University, Shanghai, China
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Ahmed S, Cano MÁ, Sánchez M, Hu N, Gonzalez R, Ibañez G. Effect of maternal hypertensive disorder on their children's neurocognitive functioning in mediated via low birthweight and BMI not by brain cortical thickness. APPLIED NEUROPSYCHOLOGY. CHILD 2023:1-10. [PMID: 37126727 DOI: 10.1080/21622965.2023.2206029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The aim of the study was to examine the association between prenatal exposure to maternal Hypertensive disorder during pregnancy (HDP) on brain structure and neurocognitive functioning (NCF) in singleton children aged between 9 and 10 years using the baseline wave of the Adolescent Brain and Cognitive Development (ABCD) Study. The ABCD Study® interviewed each child (and their parents), measured NCF, and performed neuroimaging. Exposure to maternal high blood pressure (HBP) and preeclampsia or eclampsia (PE/EL) were extracted from the developmental history questionnaire. Differences in cortical thickness (CTh) and five cognitive abilities (two executive functions, working and episodic memory, processing speed, and two language abilities) between exposed and unexposed children were examined using generalized linear models. The mediating effects of CTh, birthweight, and BMI on the relationship between maternal HDP on NCF were also examined. A total of 584-children exposed to HBP, 387-children exposed to PE/EL, and 5,877 unexposed children were included in the analysis. Neither CTh nor NCF differed between the exposed and unexposed children with or without adjusting for the confounders including the child's age, sex, race, education, and birth histories. The whole-brain CTh did not mediate the relationships between HDP and NCF. However, the relationship between HDP and most of the NCF was mediated by the child's birthweight and BMI. Exposure to maternal HDP can affect their offspring's later-life cognitive abilities via low birthweight and BMI during childhood. Prospective longitudinal studies, following up from infancy, are needed to further delineate the association of HDP on children's cognitive abilities.
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Affiliation(s)
- Shyfuddin Ahmed
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Miguel Ángel Cano
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mariana Sánchez
- Department of Health Promotions and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Nan Hu
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Raul Gonzalez
- Department of Psychology, College of Arts, Sciences & Education, Florida International University, Miami, Florida, USA
| | - Gladys Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
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Wang Y, Guo B, Zhao K, Yang L, Chen T. Correlation between cognitive impairment and serum phosphorylated tau181 protein in patients with preeclampsia. Front Aging Neurosci 2023; 15:1148518. [PMID: 37056688 PMCID: PMC10086317 DOI: 10.3389/fnagi.2023.1148518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
ObjectiveTo study the cognitive function status, serum phosphorylated tau181 (P-tau181) protein level, and total tau (T-tau) protein level in patients with preeclampsia (PE), pregnant healthy controls (PHCs), and non-pregnant healthy controls (NPHCs), and to research their feasibility as serum biomarkers for evaluating cognitive functional impairment in PE patients.MethodsSixty-eight patients with PE, 48 NPHCs, and 30 PHCs were included. Cognitive functional status was assessed using standardized Symbol Digit Modalities Test (SDMT) and Montreal Cognitive Assessment (MoCA) scales. Enzyme-linked immunosorbent assay (ELISA) was used to detect the level of serum P-tau181 and T-tau protein. The concentration of serum P-tau181 and T-tau protein were compared by one-way analysis of variance in the three groups of subjects. The correlation between P-tau181, T-tau, and SDMT was explore by multiple linear regression analysis. The areas under the receiver operating characteristic (ROC) curves of serum P-tau181 and SDMT were calculated to predict the cognitive level of subjects.ResultsPE patients significantly had lower scores on SDMT (47.97 ± 7.54) and MoCA (28.00 ± 2.00) than normotensive PHCs (30.00 ± 1.25, 54.73 ± 8.55, respectively). The significant difference was found in serum P-tau181 protein levels among the three groups [H(K) = 19.101, P < 0.001]. Serum P-tau181 was thicker in PE patients than PHCs or NPHCs (both P < 0.05). According to the ROC curve, T-tau had no statistical significance in predicting the ability of cognizance, while P-tau181 and SDMT had. The DeLong test showed that P-tau181 was better than T-tau in predicting the ability of cognizance (P < 0.05).ConclusionThe patients with PE have occurred the decline of cognitive function during pregnancy. The high level of serum P-tau181 can be used as a clinical laboratory indication for non-invasive assessment of cognitive functional impairment in PE patients.
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Affiliation(s)
- Yuanyuan Wang
- Department of Radiology, Binzhou Medical University, Yantai, Shandong, China
| | - Bin Guo
- Department of Radiology, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Ke Zhao
- Department of Clinical Laboratory, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Linfeng Yang
- Department of Radiology, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Tao Chen
- Department of Clinical Laboratory, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- *Correspondence: Tao Chen,
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Dabbah-Assadi F, Rashid S, Golani I, Rubinstein A, Doron R, Alon D, Palzur E, Beloosesky R, Shamir A. Long-term effects of prophylactic MgSO 4 in maternal immune activation rodent model at adolescence and adulthood. J Neurosci Res 2023; 101:316-326. [PMID: 36434794 PMCID: PMC10100175 DOI: 10.1002/jnr.25148] [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: 06/08/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Abstract
The effects of MgSO4 as an anti-inflammatory agent in pregnant women have been investigated in the last few years. Infections can cause an inflammatory reaction involving the placenta membranes and amniotic cavity. They may have short-term effects on the mother and her fetuses, like preterm birth, cerebral palsy, and developmental delay. Despite the alleged advantages of MgSO4 as a neuroprotective agent in the preterm brain, the long-term molecular and behavioral function of MgSO4 has not been fully elucidated. Here, we investigated the long-term effect of antenatal MgSO4 , during late gestation, on offspring's behavior focusing on cognitive function, motor activity, and social cognition in adolescence and adulthood, and explored its influence on brain gene expression (e.g., ErbB signaling, pro-inflammatory, and dopaminergic markers) in adulthood. A significant abnormal exploratory behavior of offspring of MgSO4 -treated dams was found compared to the control group in both adolescence and adulthood. Furthermore, we found that adult females exposed to MgSO4 under inflammation displayed working and recognition memory impairment. A reduction in IL-6 expression was detected in the prefrontal cortex, and hippocampus specimens derived from LPS-Mg-treated group. In contrast, an imbalanced expression of dopamine 1 and 2 receptors was detected only in prefrontal cortex specimens. Besides, we found that MgSO4 ameliorated the overexpression of the Nrg1 and Erbb4 receptors induced by LPS in the hippocampus. Thus, MgSO4 treatment for preventing brain injuries can adversely affect offspring cognition behavior later in life, depending on the sex and age of the offspring.
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Affiliation(s)
- Fadwa Dabbah-Assadi
- Psychobiology Research Laboratory, Mazor Mental Health Center, Akko, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Sally Rashid
- Department of Biotechnology Engineering, ORT Braude College, Karmiel, Israel
| | - Idit Golani
- Department of Biotechnology Engineering, ORT Braude College, Karmiel, Israel
| | - Alon Rubinstein
- Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel
| | - Ravid Doron
- Department of Education and Psychology, the Open University, Raanana, Israel
| | - David Alon
- Psychobiology Research Laboratory, Mazor Mental Health Center, Akko, Israel
| | - Eilam Palzur
- The Neuroscience Laboratory, Galilee Medical Center Research Institute, Nahariya, Israel
| | - Ron Beloosesky
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Alon Shamir
- Psychobiology Research Laboratory, Mazor Mental Health Center, Akko, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Escudero C, Kupka E, Ibañez B, Sandoval H, Troncoso F, Wikström AK, López-Espíndola D, Acurio J, Torres-Vergara P, Bergman L. Brain Vascular Dysfunction in Mothers and Their Children Exposed to Preeclampsia. Hypertension 2023; 80:242-256. [PMID: 35920147 DOI: 10.1161/hypertensionaha.122.19408] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Preeclampsia is a maternal syndrome characterized by the new onset of hypertension and proteinuria after 20 weeks of gestation associated with multisystemic complications, including brain alterations. Indeed, brain complications associated with preeclampsia are the leading direct causes of fetal and maternal morbidity and mortality, especially in low- and middle-income countries. In addition to the well-recognized long-term adverse cardiovascular effects of preeclampsia, women who have had preeclampsia have higher risk of stroke, dementia, intracerebral white matter lesions, epilepsy, and perhaps also cognitive decline postpartum. Furthermore, increasing evidence has also associated preeclampsia with similar cognitive and cerebral disorders in the offspring. However, the mechanistic links between these associations remain unresolved. This article summarizes the current knowledge about the cerebrovascular complications elicited by preeclampsia and the potential pathophysiological mechanisms involved, emphasizing the impaired brain vascular function in the mother and their offspring.
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Affiliation(s)
- Carlos Escudero
- Vascular Physiology Laboratory, Department of Basic Sciences, Faculty of Basic Sciences, University of Bío-Bío, Chillán, Chile (C.E., B.I., H.S., F.T., J.A.).,Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile (C.E., J.A., P.T.-V.)
| | - Ellen Kupka
- Institute of Clinical Sciences, Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Sweden (E.K.)
| | - Belen Ibañez
- Vascular Physiology Laboratory, Department of Basic Sciences, Faculty of Basic Sciences, University of Bío-Bío, Chillán, Chile (C.E., B.I., H.S., F.T., J.A.)
| | - Hermes Sandoval
- Vascular Physiology Laboratory, Department of Basic Sciences, Faculty of Basic Sciences, University of Bío-Bío, Chillán, Chile (C.E., B.I., H.S., F.T., J.A.)
| | - Felipe Troncoso
- Vascular Physiology Laboratory, Department of Basic Sciences, Faculty of Basic Sciences, University of Bío-Bío, Chillán, Chile (C.E., B.I., H.S., F.T., J.A.)
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Sweden (A.K.W., L.B.)
| | - Daniela López-Espíndola
- Escuela de Tecnología Médica, Facultad de Medicina, Universidad de Valparaíso, Chile (D.L.-E.)
| | - Jesenia Acurio
- Vascular Physiology Laboratory, Department of Basic Sciences, Faculty of Basic Sciences, University of Bío-Bío, Chillán, Chile (C.E., B.I., H.S., F.T., J.A.).,Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile (C.E., J.A., P.T.-V.)
| | - Pablo Torres-Vergara
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile (C.E., J.A., P.T.-V.).,Departamento de Farmacia, Facultad de Farmacia, Universidad de Concepción, Chile (P.T.-V.)
| | - Lina Bergman
- Department of Women's and Children's Health, Uppsala University, Sweden (A.K.W., L.B.).,Department of Obstetrics and Gynecology, Stellenbosch University, South Africa (L.B.).,Department of clinical sciences, Sahlgrenska Academy, Gothenburg University, Sweden (L.B.)
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12
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Environmental Enrichment Protects Offspring of a Rat Model of Preeclampsia from Cognitive Decline. Cell Mol Neurobiol 2023; 43:381-394. [PMID: 35119541 DOI: 10.1007/s10571-022-01192-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/07/2022] [Indexed: 01/07/2023]
Abstract
Preeclampsia affects 5-7% of all pregnancies and contributes to adverse pregnancy and birth outcomes. In addition to the short-term effects of preeclampsia, preeclampsia can exert long-term adverse effects on offspring. Numerous studies have demonstrated that offspring of preeclamptic women exhibit cognitive deficits from childhood to old age. However, effective ways to improve the cognitive abilities of these offspring remain to be investigated. The aim of this study was to explore whether environmental enrichment in early life could restore the cognitive ability of the offspring of a rat model of preeclampsia and to investigate the cellular and molecular mechanisms by which EE improves cognitive ability. L-NAME was used to establish a rat model of preeclampsia. The spatial learning and memory abilities and recognition memory of 56-day-old offspring were evaluated by the Morris water maze and Novel object recognition (NOR) task. Immunofluorescence was performed to evaluate cell proliferation and apoptosis in the DG region of the hippocampus. qRT-PCR was performed to examine the expression levels of neurogenesis-associated genes, pre- and postsynaptic proteins and inflammatory cytokines. An enzyme-linked immune absorbent assay was performed to evaluate the concentration of vascular endothelial growth factor (VEGF) and inflammatory cytokines in the hippocampus. The administration of L-NAME led to increased systolic blood pressure and urine protein levels in pregnant rats. Offspring in the L-NAME group exhibited impaired spatial learning ability and memory as well as NOR memory. Hippocampal neurogenesis and synaptic plasticity were impaired in offspring from the L-NAME group. Furthermore, cell apoptosis in the hippocampus was increased in the L-NAME group. The hippocampus was skewed to a proinflammatory profile, as shown by increased inflammatory cytokine levels. EE improved the cognitive ability of offspring in the L-NAME group and resulted in increased hippocampal neurogenesis and synaptic protein expression levels and decreased apoptosis and inflammatory cytokine levels. Environmental enrichment resolves cognitive impairment in the offspring of a rat model of preeclampsia by improving hippocampal neurogenesis and synaptic plasticity and normalizing the apoptosis level and the inflammatory balance.
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13
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Torres Y, Celis C, Acurio J, Escudero C. Language Impairment in Children of Mothers with Gestational Diabetes, Preeclampsia, and Preterm Delivery: Current Hypothesis and Potential Underlying Mechanisms : Language Impartment and Pregnancy Complications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1428:245-267. [PMID: 37466777 DOI: 10.1007/978-3-031-32554-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Many conditions may impair or delay language development, including socioeconomic status, parent's education, or intrauterine environment. Accordingly, increasing evidence has described that pregnancy complications, including gestational diabetes mellitus (GDM), preeclampsia, and preterm delivery, are associated with the offspring's impaired neurodevelopment. Since language is one of the high brain functions, alterations in this function are another sign of neurodevelopment impairment. How these maternal conditions may generate language impairment has yet to be entirely understood. However, since language development requires adequate structural formation and function/connectivity of the brain, these processes must be affected by alterations in maternal conditions. However, the underlying mechanisms of these structural alterations are largely unknown. This manuscript critically analyzes the literature focused on the risk of developing language impairment in children of mothers with GDM, preeclampsia, and preterm delivery. Furthermore, we highlight potential underlying molecular mechanisms associated with these alterations, such as neuroinflammatory and metabolic and cerebrovascular alterations.
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Affiliation(s)
- Yesenia Torres
- Vascular Physiology Laboratory, Department of Basic Science, Faculty of Sciences, Universidad of Bio Bio, Chillán, Chile
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Catalonia, Spain
| | - Cristian Celis
- Vascular Physiology Laboratory, Department of Basic Science, Faculty of Sciences, Universidad of Bio Bio, Chillán, Chile
- Centro terapéutico , ABCfonoaudiologia, Santiago, Chile
| | - Jesenia Acurio
- Vascular Physiology Laboratory, Department of Basic Science, Faculty of Sciences, Universidad of Bio Bio, Chillán, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile
| | - Carlos Escudero
- Vascular Physiology Laboratory, Department of Basic Science, Faculty of Sciences, Universidad of Bio Bio, Chillán, Chile.
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile.
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14
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Lara E, Rivera N, González-Bernal A, Rojas D, López-Espíndola D, Rodríguez A, Escudero C. Abnormal cerebral microvascular perfusion and reactivity in female offspring of reduced uterine perfusion pressure (RUPP) mice model. J Cereb Blood Flow Metab 2022; 42:2318-2332. [PMID: 36008921 PMCID: PMC9670000 DOI: 10.1177/0271678x221121872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 12/14/2022]
Abstract
Children born from women with preeclampsia have alterations in cerebral neurovascular development and a high risk for developing cognitive alterations. Because cerebral blood vessels are critical components in cerebrovascular development, we evaluated the brain microvascular perfusion and microvascular reactivity (exposed to external stimuli of warm and cold) in pups born to preeclampsia-like syndrome based on the reduction of uterine perfusion (RUPP). Also, we evaluate the angiogenic proteomic profile in those brains. Pregnant mice showed a reduction in uterine flow after RUPP surgery (-40 to 50%) associated with unfavorable perinatal results compared to sham mice. Furthermore, offspring of the RUPP mice exhibited reduced brain microvascular perfusion at postnatal day 5 (P5) compared with offspring from sham mice. This reduction was preferentially observed in females. Also, brain microvascular reactivity to external stimuli (warm and cold) was reduced in pups of RUPP mice. Furthermore, a differential expression of the angiogenic profile associated with inflammation, extrinsic apoptotic, cancer, and cellular senescence processes as the primary signaling impaired process was found in the brains of RUPP-offspring. Then, offspring (P5) from preeclampsia-like syndrome exhibit impaired brain perfusion and microvascular reactivity, particularly in female mice, associated with differential expression of angiogenic proteins in the brain tissue.
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Affiliation(s)
- Evelyn Lara
- Vascular Physiology Laboratory, Department of Basic Sciences,
Universidad del Bio-Bio, Chillán, Chile
| | - Nathaly Rivera
- Vascular Physiology Laboratory, Department of Basic Sciences,
Universidad del Bio-Bio, Chillán, Chile
| | - Alejandro González-Bernal
- Department of Clinical Sciences, Faculty of Veterinary Sciences,
Universidad de Concepción, Chillán, Chile
| | - Daniela Rojas
- Department of Pathology, Faculty of Veterinary Sciences,
Universidad de Concepción, Chillán, Chile
| | - Daniela López-Espíndola
- School of Medical Technology and Biomedical Research Center,
Faculty of Medicine, Universidad de Valparaíso
- Group of Research and Innovation in Vascular Health (GRIVAS
Health), Chillán, Chile
| | - Andrés Rodríguez
- Vascular Physiology Laboratory, Department of Basic Sciences,
Universidad del Bio-Bio, Chillán, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS
Health), Chillán, Chile
| | - Carlos Escudero
- Vascular Physiology Laboratory, Department of Basic Sciences,
Universidad del Bio-Bio, Chillán, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS
Health), Chillán, Chile
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15
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Li P, Wang H, Guo L, Gou X, Chen G, Lin D, Fan D, Guo X, Liu Z. Association between gut microbiota and preeclampsia-eclampsia: a two-sample Mendelian randomization study. BMC Med 2022; 20:443. [PMID: 36380372 PMCID: PMC9667679 DOI: 10.1186/s12916-022-02657-x] [Citation(s) in RCA: 172] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Several recent observational studies have reported that gut microbiota composition is associated with preeclampsia. However, the causal effect of gut microbiota on preeclampsia-eclampsia is unknown. METHODS A two-sample Mendelian randomization study was performed using the summary statistics of gut microbiota from the largest available genome-wide association study meta-analysis (n=13,266) conducted by the MiBioGen consortium. The summary statistics of preeclampsia-eclampsia were obtained from the FinnGen consortium R7 release data (5731 cases and 160,670 controls). Inverse variance weighted, maximum likelihood, MR-Egger, weighted median, weighted model, MR-PRESSO, and cML-MA were used to examine the causal association between gut microbiota and preeclampsia-eclampsia. Reverse Mendelian randomization analysis was performed on the bacteria that were found to be causally associated with preeclampsia-eclampsia in forward Mendelian randomization analysis. Cochran's Q statistics were used to quantify the heterogeneity of instrumental variables. RESULTS Inverse variance weighted estimates suggested that Bifidobacterium had a protective effect on preeclampsia-eclampsia (odds ratio = 0.76, 95% confidence interval: 0.64-0.89, P = 8.03 × 10-4). In addition, Collinsella (odds ratio = 0.77, 95% confidence interval: 0.60-0.98, P = 0.03), Enterorhabdus (odds ratio = 0.76, 95% confidence interval: 0.62-0.93, P = 8.76 × 10-3), Eubacterium (ventriosum group) (odds ratio = 0.76, 95% confidence interval: 0.63-0.91, P = 2.43 × 10-3), Lachnospiraceae (NK4A136 group) (odds ratio = 0.77, 95% confidence interval: 0.65-0.92, P = 3.77 × 10-3), and Tyzzerella 3 (odds ratio = 0.85, 95% confidence interval: 0.74-0.97, P = 0.01) presented a suggestive association with preeclampsia-eclampsia. According to the results of reverse MR analysis, no significant causal effect of preeclampsia-eclampsia was found on gut microbiota. No significant heterogeneity of instrumental variables or horizontal pleiotropy was found. CONCLUSIONS This two-sample Mendelian randomization study found that Bifidobacterium was causally associated with preeclampsia-eclampsia. Further randomized controlled trials are needed to clarify the protective effect of probiotics on preeclampsia-eclampsia and their specific protective mechanisms.
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Affiliation(s)
- Pengsheng Li
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi, Foshan, 528000, Guangdong, China
| | - Haiyan Wang
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi, Foshan, 528000, Guangdong, China.,Biobank, Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Lan Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Gou
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi, Foshan, 528000, Guangdong, China.,Biobank, Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Gengdong Chen
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi, Foshan, 528000, Guangdong, China
| | - Dongxin Lin
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi, Foshan, 528000, Guangdong, China
| | - Dazhi Fan
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi, Foshan, 528000, Guangdong, China
| | - Xiaoling Guo
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi, Foshan, 528000, Guangdong, China
| | - Zhengping Liu
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China. .,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi, Foshan, 528000, Guangdong, China.
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16
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Vakil P, Henry A, Craig ME, Gow ML. A review of infant growth and psychomotor developmental outcomes after intrauterine exposure to preeclampsia. BMC Pediatr 2022; 22:513. [PMID: 36042465 PMCID: PMC9426217 DOI: 10.1186/s12887-022-03542-5] [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] [Received: 12/24/2021] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Preeclampsia is a hypertensive disorder of pregnancy with serious health implications for mother and their offspring. The uteroplacental vascular insufficiency caused by preeclampsia is associated with epigenetic and pathological changes in the mother and fetus. However, the impact of preeclampsia in infancy (birth to 2 years), a time of rapid development influenced by pre- and postnatal factors that can predict future health outcomes, remains inconclusive. This narrative review of 23 epidemiological and basic science studies assessed the measurement and impact of preeclampsia exposure on infant growth and psychomotor developmental outcomes from birth to 2 years. Studies assessing infant growth report that preeclampsia-exposed infants have lower weight, length and BMI at 2 years than their normotensive controls, or that they instead experience accelerated weight gain to catch up in growth by 2 years, which may have long-term implications for their cardiometabolic health. In contrast, clear discrepancies remain as to whether preeclampsia exposure impairs infant motor and cognitive development, or instead has no impact. It is additionally unknown whether any impacts of preeclampsia are independent of confounders including shared genetic factors that predispose to both preeclampsia and childhood morbidity, perinatal factors including small for gestational age or preterm birth and their sequelae, and postnatal environmental factors such childhood nutrition. Further research is required to account for these variables in larger cohorts born at term, to help elucidate the independent pathophysiological impact of this clinically heterogenous and dangerous disease.
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Affiliation(s)
- Priya Vakil
- School of Women's and Children's Health, UNSW Medicine, Sydney, Australia
| | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, Sydney, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Maria E Craig
- School of Women's and Children's Health, UNSW Medicine, Sydney, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, Australia.,University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia
| | - Megan L Gow
- School of Women's and Children's Health, UNSW Medicine, Sydney, Australia. .,Department of Women's and Children's Health, St George Hospital, Sydney, Australia. .,University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia.
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17
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Cumsille P, Lara E, Verdugo-Hernández P, Acurio J, Escudero C. A robust quantitative approach for laser speckle contrast imaging perfusion analysis revealed anomalies in the brain blood flow in offspring mice of preeclampsia. Microvasc Res 2022; 144:104418. [PMID: 35931124 DOI: 10.1016/j.mvr.2022.104418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 02/01/2023]
Abstract
Microcirculation analysis of the brain cortex is challenging because surface perfusion varies rapidly in small space-time regions and is bone protected. The laser speckle contrast imaging (LSCI) technique allows analyzing in vivo brain vascular perfusion generating a large amount of data that requires sophisticated data analytics, making researchers invest much effort in processing. Our research question was whether the reduced placental perfusion model (RUPP) of preeclampsia (PE) was associated with impaired blood perfusion in the offspring's brains. We aimed to develop a robust numerical approach that mainly consisted of applying a signal-processing tool for calculating optimal segmentation and piece-wise fits of the offspring's brain perfusion signals obtained from the LSCI technique. We combined this tool with the usual statistical analysis, implementing both in Matlab software. We performed brain perfusion measurements from offspring (five days postnatal, P5) of control pregnant dams (sham, n = 13) and of RUPP dams (RUPP, n = 7) using the Pericam® PSI-HR system at a basal condition and after thermal stimuli (warm and cold). We found that pups of RUPP mice exhibited significant differences in perfusion and vascular response to thermal stimuli compared to the sham mice. These differences were associated with high data variability in the Sham group, while in the RUPP group, perfusion looks "stiffer." Data also suggest sex-dimorphism in the vascular response since female pups in the Sham group but not male pups showed statistically significant differences in response to the warm stimulus. Again, this sex-related difference was absent in pups of RUPP mice. In conclusion, we present a robust quantitative approach for LSCI measurements that revealed anomalies in the brain blood flow in offspring of the RUPP model of PE.
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Affiliation(s)
- Patricio Cumsille
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Av. Andrés Bello 720, Casilla 447, Chillán, Chile; Centre for Biotechnology and Bioengineering (CeBiB), University of Chile, Santiago, Chile.
| | - Evelyn Lara
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Av. Andrés Bello 720, Casilla 447, Chillán, Chile; Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile
| | - Paula Verdugo-Hernández
- Escuela de Pedagogía en Ciencias Naturales y Exactas, Facultad de Ciencias de la Educación, Universidad de Talca, Chile
| | - Jesenia Acurio
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Av. Andrés Bello 720, Casilla 447, Chillán, Chile; Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile
| | - Carlos Escudero
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Av. Andrés Bello 720, Casilla 447, Chillán, Chile; Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile.
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18
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Zheng W, Zhang X, Feng Y, Liu B, Zhu J, Zou Y, Qin J, Li B. Association of Corpus Callosum Development With Fetal Growth Restriction and Maternal Preeclampsia or Gestational Hypertension. JAMA Netw Open 2022; 5:e2226696. [PMID: 35969398 PMCID: PMC9379741 DOI: 10.1001/jamanetworkopen.2022.26696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE It remains unknown whether neurodevelopmental impairments are directly associated with the structural development of the brain in offspring with fetal growth restriction (FGR) and mothers with preeclampsia (PE) or gestational hypertension (GH). OBJECTIVES To assess whether fetal corpus callosum (CC) development differed among pregnancies with PE or GH with FGR, pregnancies with PE or GH without FGR, and normotensive pregnancies, particularly the severity of maternal disease and FGR, and to identify the association between adverse perinatal outcomes and structural development of the CC in fetuses with FGR in pregnancies with PE or GH. DESIGN, SETTING, AND PARTICIPANTS This retrospective matched case-control study was conducted between January 1, 2014, and January 31, 2021, at Women's Hospital, Zhejiang University School of Medicine in Hangzhou, China. The participant group included cases of singleton pregnancies with PE or GH with FGR; the control groups included cases with PG or GH without FGR and cases with paired normotensive pregnancy. EXPOSURES Maternal PE or GH and FGR. MAIN OUTCOMES AND MEASURES The length, thickness, total area, subdivision areas, and apparent diffusion coefficient (ADC) values of fetal CC were measured on magnetic resonance imaging (MRI) and analyzed. The association between adverse perinatal outcomes and structural development of CC was further investigated. RESULTS A total of 56 pregnant individuals with singleton pregnancies and PE or GH and fetuses with FGR were enrolled (maternal median [IQR] age, 29.0 [26.0-34.0] years; mean [SD] gestational age at MRI, 33.6 [2.5] weeks). Significant patterns of decreased median (IQR) fetal CC length (0.4284 [0.4079-0.4470] mm vs 0.4614 [0.4461-0.4944] mm, P < .001, vs 0.4591 [0.4310-0.4927] mm, P < .001) and mean (SD) CC total area (1.0779 [0.1931] mm2 vs 1.1896 [0.1803] mm2, P = .001, vs 1.1438 [0.1935] mm2, P = .02), adjusted for the cephalic index, was observed in cases of PE or GH with FGR compared with cases without FGR and cases with normotensive pregnancy. The splenium region of fetal CC also exhibited the distinct alterations in macrostructural development (with FGR: 0.3149 [0.0697] mm2 vs without FGR: 0.3727 [0.0698] mm2, P < .001, vs normotensive pregnancies: 0.3565 [0.0763] mm2, P < .001) and microstructural development (median [IQR] ADC values: 1.47 [1.38-1.57] × 10-3 mm2/s vs 1.57 [1.53-1.63] × 10-3 mm2/s, P = .009, vs 1.63 [1.50-1.70] × 10-3 mm2/s, P < .001) in all groups. Furthermore, significant associations were found between structural abnormality of the splenium region and adverse perinatal outcomes in the PE or GH with FGR group (mean [SD] ADC value: 1.40 [0.07] × 10-3 mm2/s; P = .04). CONCLUSIONS AND RELEVANCE Results of this study suggest that, in fetuses with FGR in pregnancies with PE or GH, decreased structural development of the CC, predominantly the splenium region, may be significantly associated with a higher risk of adverse perinatal outcomes and may be regarded as an MRI-based biomarker for better prenatal counseling and early management decisions.
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Affiliation(s)
- Weizeng Zheng
- Department of Radiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaodan Zhang
- Department of Radiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Feng
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bingqing Liu
- Department of Women’s Health, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiajun Zhu
- Department of Neonatology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu Zou
- Department of Radiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiale Qin
- Department of Ultrasound, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Women’s Reproductive Health Key Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baohua Li
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Women’s Reproductive Health Key Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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19
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Middendorf L, Gellhaus A, Iannaccone A, Köninger A, Dathe AK, Bendix I, Reisch B, Felderhoff-Mueser U, Huening B. The Impact of Increased Maternal sFlt-1/PlGF Ratio on Motor Outcome of Preterm Infants. Front Endocrinol (Lausanne) 2022; 13:913514. [PMID: 35846340 PMCID: PMC9279729 DOI: 10.3389/fendo.2022.913514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio serves as a clinical biomarker to predict the hypertensive, placenta-derived pregnancy disorder pre-eclampsia which is often associated with placental dysfunction and fetal growth restriction. Additionally elevated levels also indicate an increased risk for prematurity. However, its predictive value for subsequent neonatal neurological outcome has not been studied. OBJECTIVE This study aimed to evaluate the correlation of maternal sFlt-1/PlGF ratio with early motor outcome of preterm infants. Design/Methods: 88 preterm infants (gestational age ≤ 34 + 0) born between February 2017 and August 2020 at the Department of Obstetrics and Gynecology, University Hospital Essen in Germany, were included, when the following variables were available: maternal sFlt-1/PlGF levels at parturition and general movement assessment of the infant at the corrected age of 3 to 5 months. The infants were stratified into high and low ratio groups according to maternal sFlt-1/PlGF cut-off values of 85. To investigate the early motor repertoire and quality of spontaneous movements of the infant, the Motor Optimality Score (MOS-R) based on antigravity movements and posture patterns, was applied. In the given age, special attention was paid to the presence of fidgety movements. Linear regressions were run to test differences in infants motor repertoire according to the maternal sFlt-1/PIGF ratio. RESULTS Linear regression analysis showed that the sFlt-1/PlGF ratio does not predict the MOS-R score (β=≤0.001; p=0.282). However, children with birth weight below the 10th percentile scored significantly lower (mean 20.7 vs 22.7; p=0.035). These children were 91% in the group with an increased ratio, which in turn is a known predictor of low birth weight (β= -0.315; p <0.001). In the group with a high sFlt-1/PLGF ratio above 85 the mothers of female infants had a lower average sFlt-1/PlGF ratio compared to a male infant (median: 438 in female vs. 603 in male infant, p=0.145). CONCLUSIONS In our cohort, especially low birth weight, which correlated with an elevated sFlt-1/PlGF ratio, had a negative effect on the outcome in the MOS-R. A direct correlation between an increased ratio and a worse motor outcome was not demonstrated.
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Affiliation(s)
- Lisa Middendorf
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexandra Gellhaus
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Angela Köninger
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
- Department of Obstetrics and Gynecology, University of Regensburg, Clinic St Hedwig of the Order of St. John, Regensburg, Germany
| | - Anne-Kathrin Dathe
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Ivo Bendix
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Beatrix Reisch
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Britta Huening
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- *Correspondence: Britta Huening,
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20
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Clinical outcomes of hypertensive disorders in pregnancy in the offspring during perinatal period, childhood, and adolescence. J Hum Hypertens 2021; 35:1063-1073. [PMID: 33986467 DOI: 10.1038/s41371-021-00550-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023]
Abstract
Hypertensive disorders during pregnancy (HDP) could have significant clinical impact not only on the mother's, but also on the offspring's health. The clinical impact of HDP may be evident early in the perinatal period or during childhood and adolescence. The cardiovascular system seems to be primarily affected with higher rates of congenital heart defects reported from cohort studies in the offspring of mothers with HDP. HDP are associated with alterations in cardiac and vascular structure and higher BP during childhood. HDP may also affect brain development and could result in increased prevalence of adverse cognitive outcomes and neuropsychiatric disorders in children and adolescents. The kidney, immune, endocrine, and gastrointestinal system abnormalities could also have their origin in exposure to HDP. The aim of this narrative review is to examine the clinical impact of HDP on the offspring with a focus on the perinatal period, childhood, and adolescence.
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21
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Koparkar S, Srivastava L, Randhir K, Dangat K, Pisal H, Kadam V, Malshe N, Wadhwani N, Lalwani S, Srinivasan K, Kumaran K, Fall C, Joshi S. Cognitive function and behavioral problems in children born to mothers with preeclampsia: an Indian study. Child Neuropsychol 2021; 28:337-354. [PMID: 34592908 DOI: 10.1080/09297049.2021.1978418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Studies from high-income countries report associations of preeclampsia (PE) with reduced cognitive function and adverse behavioural outcomes in children. We examined these associations in Indian children aged 5-7 years. Children of mothers with PE (n=74) and without PE (non-PE; n=234) were recruited at delivery at Bharati Hospital, Pune, India. The cognitive performance was assessed using 3 core tests from the Kaufman Assessment Battery and additional tests including Verbal fluency, Kohs block design, and Coding A (from Wechsler Intelligence Scale for Children). The parent-reported Strengths and Difficulties Questionnaire (SDQ) was used to assess children's behavioral characteristics. Scores were compared between children from PE and non-PE groups, and associations analyzed further using regression models, adjusted for potential confounders. After adjusting for age, sex, socio-economic status and maternal education, children of PE mothers had lower Kohs block design scores (adjusted odds ratio per score category 0.57, [95% CI 0.34-0.96] p=0.034; 0.62 [95%CI (0.36, 1.07), p=0.09 on further adjustment for birth weight and gestation) compared to children of mothers without PE. In the SDQ, there was a lower prevalence of abnormal 'conduct problem' scores in PE group than non-PE group (OR=0.33, 95% CI 0.13-0.83, p=0.018, in the fully adjusted model); there were no differences for other behavioral domains. This preliminary study in Indian children suggests that fetal exposure to maternal PE may have an adverse impact on visuo-spatial performance but does not adversely affect behavior. Further studies with larger sample sizes are essential to understand effects of maternal PE on cognitive/behavioral outcomes in children.
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Affiliation(s)
- Shruti Koparkar
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Leena Srivastava
- Department of Paediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth Deemed University, Pune, India
| | - Karuna Randhir
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Kamini Dangat
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Hemlata Pisal
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Vrushali Kadam
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Nandini Malshe
- Department of Paediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth Deemed University, Pune, India
| | - Nisha Wadhwani
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Sanjay Lalwani
- Department of Paediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth Deemed University, Pune, India
| | - K Srinivasan
- Department of Psychiatry, St. John's Medical College Hospital, Bangalore, India.,Division of Mental Health and Neurosciences, St. John's Research Institute, Bangalore, India
| | - K Kumaran
- Epidemiology Research Unit, CSI, Holdsworth Memorial Hospital, Mysore, India
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
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22
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Waker CA, Kaufman MR, Brown TL. Current State of Preeclampsia Mouse Models: Approaches, Relevance, and Standardization. Front Physiol 2021; 12:681632. [PMID: 34276401 PMCID: PMC8284253 DOI: 10.3389/fphys.2021.681632] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Preeclampsia (PE) is a multisystemic, pregnancy-specific disorder and a leading cause of maternal and fetal death. PE is also associated with an increased risk for chronic morbidities later in life for mother and offspring. Abnormal placentation or placental function has been well-established as central to the genesis of PE; yet much remains to be determined about the factors involved in the development of this condition. Despite decades of investigation and many clinical trials, the only definitive treatment is parturition. To better understand the condition and identify potential targets preclinically, many approaches to simulate PE in mice have been developed and include mixed mouse strain crosses, genetic overexpression and knockout, exogenous agent administration, surgical manipulation, systemic adenoviral infection, and trophoblast-specific gene transfer. These models have been useful to investigate how biological perturbations identified in human PE are involved in the generation of PE-like symptoms and have improved the understanding of the molecular mechanisms underpinning the human condition. However, these approaches were characterized by a wide variety of physiological endpoints, which can make it difficult to compare effects across models and many of these approaches have aspects that lack physiological relevance to this human disorder and may interfere with therapeutic development. This report provides a comprehensive review of mouse models that exhibit PE-like symptoms and a proposed standardization of physiological characteristics for analysis in murine models of PE.
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Affiliation(s)
- Christopher A Waker
- Department of Neuroscience, Cell Biology, and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Melissa R Kaufman
- Department of Neuroscience, Cell Biology, and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Thomas L Brown
- Department of Neuroscience, Cell Biology, and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
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23
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Gumusoglu SB, Chilukuri ASS, Hing BWQ, Scroggins SM, Kundu S, Sandgren JA, Santillan MK, Santillan DA, Grobe JL, Stevens HE. Altered offspring neurodevelopment in an arginine vasopressin preeclampsia model. Transl Psychiatry 2021; 11:79. [PMID: 33510137 PMCID: PMC7844013 DOI: 10.1038/s41398-021-01205-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/17/2020] [Accepted: 01/08/2021] [Indexed: 12/18/2022] Open
Abstract
Preeclampsia is a severe gestational hypertensive condition linked to child neuropsychiatric disorders, although underlying mechanisms are unclear. We used a recently developed, clinically relevant animal model of preeclampsia to assess offspring. C57BL/6J mouse dams were chronically infused with arginine vasopressin (AVP) or saline (24 ng/h) throughout pregnancy. Adult offspring were behaviorally tested (Y-maze, open field, rotarod, social approach, and elevated plus maze). Offspring brain was assessed histologically and by RNA sequencing. Preeclampsia-exposed adult males exhibited increased anxiety-like behavior and social approach while adult females exhibited impaired procedural learning. Adult AVP-exposed males had reduced total neocortical volume. Adult AVP-exposed females had increased caudate-putamen volume, increased caudate-putamen cell number, and decreased excitatory synapse density in hippocampal dentate gyrus (DG), CA1, and CA3. At postnatal day 7 (P7), AVP-exposed male and female offspring both had smaller neocortex. At P7, AVP-exposed males also had smaller caudate-putamen volume, while females had increased caudate-putamen volume relative to neocortical size. Similar to P7, E18 AVP-exposed offspring had smaller dorsal forebrain, mainly in reduced intermediate, subventricular, and ventricular zone volume, particularly in males. Decreased volume was not accounted for by cell size or cerebrovascular vessel diameter changes. E18 cortical RNAseq revealed 49 differentially-expressed genes in male AVP-exposed offspring, over-representing cytoplasmic translation processes. In females, 31 genes were differentially-expressed, over-representing collagen-related and epithelial regulation pathways. Gene expression changes in E18 AVP-exposed placenta indicated potential underlying mechanisms. Deficits in behavior and forebrain development in this AVP-based preeclampsia model were distinctly different in males and females, implicating different neurobiological bases.
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Affiliation(s)
- Serena Banu Gumusoglu
- Interdisciplinary Neuroscience Graduate Program, University of Iowa, Iowa City, IA, USA.
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA.
| | - Akanksha Sri Satya Chilukuri
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Benjamin Wen Qing Hing
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
- Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Sabrina Marie Scroggins
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Sreelekha Kundu
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Jeremy Anton Sandgren
- Department of Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Mark Kharim Santillan
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Donna Ann Santillan
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Justin Lewis Grobe
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hanna Elizabeth Stevens
- Interdisciplinary Neuroscience Graduate Program, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
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24
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Yoneda N, Yoneda S, Tsuda S, Ito M, Shiozaki A, Niimi H, Yoshida T, Nakashima A, Saito S. Pre-eclampsia Complicated With Maternal Renal Dysfunction Is Associated With Poor Neurological Development at 3 Years Old in Children Born Before 34 Weeks of Gestation. Front Pediatr 2021; 9:624323. [PMID: 33996679 PMCID: PMC8116540 DOI: 10.3389/fped.2021.624323] [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] [Received: 10/31/2020] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to investigate perinatal factors associated with a poor neurodevelopmental outcome in preterm infants. Methods: A retrospective study was conducted by searching our clinical database between January 2006 and December 2016. A total of 165 singleton children who were born between 23 and 33 weeks of gestation were included. We defined poor neurological development outcomes as follows: cerebral palsy; intellectual disability; developmental disorder including autism and attention-deficit/hyperactivity disorder; low score (<85 points) on Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III); or low score of Kyoto Scale of Psychological Development corrected at 3 years old. We diagnosed maternal renal dysfunction according to the Clinical Practice Guideline for chronic kidney disease 2018 and the Best Practice Guide 2015 for Care and Treatment of Hypertension in Pregnancy. Results: The rate of poor neurological development was 25/165 (15.2%): cerebral palsy (n = 1), intellectual disability (n = 1), developmental disorder (n = 2), low score of Bayley-III (n = 20), and low score of Kyoto Scale of Psychological Development (n = 1). Preeclampsia complicated with maternal renal dysfunction (P = 0.045) and delivery at <30 weeks of gestation (P = 0.007) were independent risk factors for poor neurological development. Conclusions: In addition to previous risk factors such as delivery at <30 weeks of gestation, preeclampsia complicated with renal dysfunction was also associated with poor neurodevelopmental outcomes corrected at 3 years old.
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Affiliation(s)
- Noriko Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Satoshi Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Sayaka Tsuda
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Mika Ito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Arihiro Shiozaki
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Hideki Niimi
- Clinical Laboratory Center, Toyama University Hospital, Toyama, Japan
| | - Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Akitoshi Nakashima
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
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25
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Lind A, Dahlgren J, Morán A, Allvin K, Raffa L, Nilsson J, Aring E, Andersson Grönlund M. Ocular findings and growth in 5-year-old preterm children born to mothers with preeclampsia. Acta Ophthalmol 2020; 98:671-678. [PMID: 32352647 DOI: 10.1111/aos.14455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/05/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate growth, blood pressure and ophthalmological status in preschool children born preterm to mothers with preeclampsia. METHODS In a prospective cohort study, 78 children (34 girls) born preterm without retinopathy of prematurity were examined regarding length/height, weight, head circumference and insulin-like growth factor I (IGF-I) at birth and at 5 years of age. At 5 years, IGF-binding protein 3 and blood pressure were also measured. A detailed ophthalmological examination including ocular dimensions, fundus morphology, visual fields, visual evoked potentials and perceptual visual dysfunction was performed. Children born to preeclamptic mothers (n = 24) were compared to children with non-preeclamptic mothers (n = 54). RESULTS Children exposed to preeclampsia had lower weight (p = 0.0002, mean difference -1.46, 95% CI -2.09; -0.83), length (p = 0.013, -1.10, 95% CI -1.92; -0.23) and IGF-I levels (p = 0.0002, -26.0, 95% CI -36.0; -16.1) at birth compared to non-exposed children. At 5 years of age, the preeclamptic group had larger optic cup areas (p = 0.0006, 0.32, 95% CI 0.15; 0.46, in right eye, p = 0.049, 0.18, 95% CI 0.001; 0.35, in left eye). There was no significant difference between the groups regarding other ophthalmological findings or blood pressure. Children with reduced eye motility had lower neonatal IGF-I levels (p = 0.033, 15.5, 95% CI 1.1; 30.3). CONCLUSION Preeclampsia was shown to affect growth and IGF-I levels, confirming previous studies. Children exposed to preeclampsia were shown to have larger optic cup areas. Furthermore, lower neonatal IGF-I levels were seen in preterm children with reduced eye motility at 5 years of age.
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Affiliation(s)
- Alexandra Lind
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Amanda Morán
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Kerstin Allvin
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Lina Raffa
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology King Abdulaziz University Hospital Jeddah Saudi Arabia
| | - Josefin Nilsson
- Department of Clinical Neurophysiology Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Eva Aring
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Sahlgrenska University Hospital Gothenburg Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Sahlgrenska University Hospital Gothenburg Sweden
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26
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Liu L, Lin Z, Zheng B, Wang L, Zou J, Wu S, Jiang Z, Jin Q, Lai X, Lin P. Reduced Intellectual Ability in Offspring Born from Preeclamptic Mothers: A Prospective Cohort Study. Risk Manag Healthc Policy 2020; 13:2037-2046. [PMID: 33116984 PMCID: PMC7549660 DOI: 10.2147/rmhp.s277521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022] Open
Abstract
Background Severe preeclampsia may affect placental development, and high homocysteine (Hcy) levels are linked to intellectual disability. However, the correlation between perinatal Hcy levels and intellectual ability remains unknown in severe preeclampsia-affected offspring. Objective We aimed to investigate the intellectual ability in offspring born from preeclamptic mothers and examine the role of prenatal Hcy in the prediction of intellectual disability in preschool-aged offspring. Methods The IQ scores were compared between 101 children born to mothers with severe preeclampsia and 202 offsprings born to normotensive mothers. Maternal Hcy levels within 7 days prior to delivery and postnatal cord blood Hcy were measured. The associations of Hcy with IQ scores were evaluated, and the optimal cut-off values for predicting intellectual disability in the offspring were estimated. Results The children born to mothers with severe preeclampsia had a greater postnatal cord blood Hcy than those born from normotensive mothers (P < 0.001), and the mothers with severe preeclampsia presented a higher prenatal Hcy (P < 0.001). The children born to mothers with severe preeclampsia had significantly lower IQ scores than those born from normotensive mothers, and a higher Hcy was associated with a lower IQ in preeclampsia-affected offspring. The prevalence of intellectual disability was 2.86 times higher in severe preeclampsia-affected offspring than in children born from normotensive mothers, and the prevalence of low IQ was greater in children born to mothers with severe preeclampsia than in those from normotensive mothers. ROC curve analysis showed that both maternal and cord blood Hcy were predictors of intellectual disability, and the optimal cut-off for predicting intellectual disability was 17.7 and 9.75 μmol/L for maternal and cord blood Hcy. Conclusion Perinatal exposure to severe preeclampsia has an adverse effect on postnatal intellectual development, and high maternal and cord blood Hcy may contribute to this association.
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Affiliation(s)
- Linli Liu
- Department of Gynecology and Obstetrics, Fuzhou First Hospital Affiliated to Fujian Medical University, Fuzhou 350004, People's Republic of China
| | - Zhou Lin
- Department of Gynecology and Obstetrics, Fuzhou First Hospital Affiliated to Fujian Medical University, Fuzhou 350004, People's Republic of China
| | - Beihong Zheng
- Center for Assisted Reproductive Technology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350004, People's Republic of China
| | - Lanlan Wang
- Department of Gynecology and Obstetrics, Fuzhou First Hospital Affiliated to Fujian Medical University, Fuzhou 350004, People's Republic of China
| | - Jianqin Zou
- Department of Gynecology and Obstetrics, Fuzhou First Hospital Affiliated to Fujian Medical University, Fuzhou 350004, People's Republic of China
| | - Sanshan Wu
- Department of Gynecology and Obstetrics, Fuzhou First Hospital Affiliated to Fujian Medical University, Fuzhou 350004, People's Republic of China
| | - Zhongqing Jiang
- Department of Gynecology and Obstetrics, Fuzhou First Hospital Affiliated to Fujian Medical University, Fuzhou 350004, People's Republic of China
| | - Qiong Jin
- Department of Gynecology and Obstetrics, Fuzhou First Hospital Affiliated to Fujian Medical University, Fuzhou 350004, People's Republic of China
| | - Xuedan Lai
- Department of Gynecology and Obstetrics, Fuzhou First Hospital Affiliated to Fujian Medical University, Fuzhou 350004, People's Republic of China
| | - Peihong Lin
- Department of Gynecology and Obstetrics, Fuzhou First Hospital Affiliated to Fujian Medical University, Fuzhou 350004, People's Republic of China
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Kay VR, Rätsep MT, Figueiró-Filho EA, Croy BA. Preeclampsia may influence offspring neuroanatomy and cognitive function: a role for placental growth factor†. Biol Reprod 2020; 101:271-283. [PMID: 31175349 DOI: 10.1093/biolre/ioz095] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/30/2019] [Accepted: 06/06/2019] [Indexed: 01/01/2023] Open
Abstract
Preeclampsia (PE) is a common pregnancy complication affecting 3-5% of women. Preeclampsia is diagnosed clinically as new-onset hypertension with associated end organ damage after 20 weeks of gestation. Despite being diagnosed as a maternal syndrome, fetal experience of PE is a developmental insult with lifelong cognitive consequences. These cognitive alterations are associated with distorted neuroanatomy and cerebrovasculature, including a higher risk of stroke. The pathophysiology of a PE pregnancy is complex, with many factors potentially able to affect fetal development. Deficient pro-angiogenic factor expression is one aspect that may impair fetal vascularization, alter brain structure, and affect future cognition. Of the pro-angiogenic growth factors, placental growth factor (PGF) is strongly linked to PE. Concentrations of PGF are inappropriately low in maternal blood both before and during a PE gestation. Fetal concentrations of PGF appear to mirror maternal circulating concentrations. Using Pgf-/- mice that may model effects of PE on offspring, we demonstrated altered central nervous system vascularization, neuroanatomy, and behavior. Overall, we propose that development of the fetal brain is impaired in PE, making the offspring of preeclamptic pregnancies a unique cohort with greater risk of altered cognition and cerebrovasculature. These individuals may benefit from early interventions, either pharmacological or environmental. The early neonatal period may be a promising window for intervention while the developing brain retains plasticity.
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Affiliation(s)
- Vanessa R Kay
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Matthew T Rätsep
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - B Anne Croy
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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28
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Marcelle ET, Oliva MT, Hinshaw SP. Gestational Smoking and Hypertension as Predictors of Working Memory Functioning in Childhood Attention-Deficit/Hyperactivity Disorder. Front Psychol 2020; 11:1950. [PMID: 33041878 PMCID: PMC7518085 DOI: 10.3389/fpsyg.2020.01950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/14/2020] [Indexed: 01/03/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition affecting between 5 and 8% of all children and adolescents, characterized by impairing levels of inattention, hyperactivity, and impulsivity. Existing cognitive models of ADHD have placed working memory (WM) deficits at the core of ADHD and suggest that primary WM deficits may also underlie the additional deficits associated with the condition. Although not all children with ADHD show WM deficits, those with such deficits have been found to have worse functional outcomes when compared to their diagnosed peers with typical WM functioning. Even so, contributors to the variability of impaired WM functioning seen within this population remain unknown. In the present study, we examined the association between two known prenatal and perinatal risk factors for impaired cognitive functioning - gestational smoking and hypertension - in three independent samples of children and adolescents with ADHD (samples varied with respect to sample size and WM measurement procedures). Contrary to hypotheses and existing literature, presence of high blood pressure during pregnancy was unexpectedly found to be a positive predictor of offspring WM capacity in one of three samples (a sample of all girls with ADHD). Implications and considerations for future research are discussed.
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Affiliation(s)
- Enitan T. Marcelle
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Mercedes T. Oliva
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
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29
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Bardanzellu F, Puddu M, Fanos V. The Human Breast Milk Metabolome in Preeclampsia, Gestational Diabetes, and Intrauterine Growth Restriction: Implications for Child Growth and Development. J Pediatr 2020; 221S:S20-S28. [PMID: 32482230 DOI: 10.1016/j.jpeds.2020.01.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU University of Cagliari, Italy.
| | - Melania Puddu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU University of Cagliari, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU University of Cagliari, Italy
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30
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Turbeville HR, Sasser JM. Preeclampsia beyond pregnancy: long-term consequences for mother and child. Am J Physiol Renal Physiol 2020; 318:F1315-F1326. [PMID: 32249616 PMCID: PMC7311709 DOI: 10.1152/ajprenal.00071.2020] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 01/26/2023] Open
Abstract
Preeclampsia is defined as new-onset hypertension after the 20th wk of gestation along with evidence of maternal organ failure. Rates of preeclampsia have steadily increased over the past 30 yr, affecting ∼4% of pregnancies in the United States and causing a high economic burden (22, 69). The pathogenesis is multifactorial, with acknowledged contributions by placental, vascular, renal, and immunological dysfunction. Treatment is limited, commonly using symptomatic management and/or early delivery of the fetus (6). Along with significant peripartum morbidity and mortality, current research continues to demonstrate that the consequences of preeclampsia extend far beyond preterm delivery. It has lasting effects for both mother and child, resulting in increased susceptibility to hypertension and chronic kidney disease (45, 54, 115, 116), yielding lifelong risk to both individuals. This review discusses recent guideline updates and recommendations along with current research on these long-term consequences of preeclampsia.
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Affiliation(s)
- Hannah R Turbeville
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jennifer M Sasser
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
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31
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Gumusoglu SB, Chilukuri ASS, Santillan DA, Santillan MK, Stevens HE. Neurodevelopmental Outcomes of Prenatal Preeclampsia Exposure. Trends Neurosci 2020; 43:253-268. [PMID: 32209456 DOI: 10.1016/j.tins.2020.02.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/21/2020] [Accepted: 02/05/2020] [Indexed: 01/06/2023]
Abstract
Preeclampsia is a dangerous hypertensive disorder of pregnancy with known links to negative child health outcomes. Here, we review epidemiological and basic neuroscience work from the past several decades linking prenatal preeclampsia to altered neurodevelopment. This work demonstrates increased rates of neuropsychiatric disorders [e.g., increased autism spectrum disorder, attention deficit hyperactivity disorder (ADHD)] in children of preeclamptic pregnancies, as well as increased rates of cognitive impairments [e.g., decreased intelligence quotient (IQ), academic performance] and neurological disease (e.g., stroke and epilepsy). We also review findings from multiple animal models of preeclampsia. Manipulation of key clinical preeclampsia processes in these models (e.g., placental hypoxia, immune dysfunction, angiogenesis, oxidative stress) causes various disruptions in offspring, including ones in white matter/glia, glucocorticoid receptors, neuroimmune outcomes, cerebrovascular structure, and cognition/behavior. This animal work implicates potentially high-yield targets that may be leveraged in the future for clinical application.
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Affiliation(s)
- Serena B Gumusoglu
- Department of Psychiatry, University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA
| | - Akanksha S S Chilukuri
- Department of Psychiatry, University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA
| | - Donna A Santillan
- University of Iowa Carver College of Medicine, Department of Obstetrics and Gynecology, Iowa City, IA, USA
| | - Mark K Santillan
- University of Iowa Carver College of Medicine, Department of Obstetrics and Gynecology, Iowa City, IA, USA
| | - Hanna E Stevens
- Department of Psychiatry, University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA.
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32
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Zwertbroek EF, Zwertbroek J, Broekhuijsen K, Franssen MTM, Ganzevoort W, Langenveld J, Mol BWJ, van Pampus M, Scherjon S, van Baar AL, Groen H. Neonatal developmental and behavioral outcomes of immediate delivery versus expectant monitoring in mild hypertensive disorders of pregnancy: 5-year outcomes of the HYPITAT II trial. Eur J Obstet Gynecol Reprod Biol 2019; 244:172-179. [PMID: 31810023 DOI: 10.1016/j.ejogrb.2019.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare effects of immediate delivery vs expectant monitoring on neurodevelopmental and behavioral outcomes at 5 years of age in offspring of women with mild late preterm hypertensive disorders. STUDY DESIGN We studied children born during the HYPITAT-II trial, in which 704 women with a hypertensive disorder between 34 and 37 weeks of gestation were randomized to immediate delivery or expectant monitoring. Participating women were asked to complete the Ages and Stages Questionnaire (ASQ) for developmental outcome and the Child Behavior Checklist (CBCL) for behavioral problems when their child was 5 years old. Outcomes were dichotomized and analyzed by logistic regression analysis. We also assessed factors influencing development and behavior at both 2 and 5 years after a hypertensive pregnancy. RESULTS Five years after the original study 322(46%) women were contacted for follow-up, of whom 148 (46%) responded. In the delivery group 22%(n = 14/65) of the children had an abnormal ASQ score compared to 21% (n = 13/62) in the expectant monitoring group (p = 0.9). Abnormal CBCL-scores were found in 19% (n = 14/72) of the children in the delivery group versus in 27% (n = 20/75) in the expectant monitoring group (p = 0.3). The main predictor of development and behavior at 2 and 5 years was fetal growth restriction (for abnormal development OR 2.1, CI 1.0-4.4; for behavior problems OR 2.2, CI 1.1-5.5). Higher maternal education decreased abnormal behavior outcomes (OR 0.5, CI 0.2-0.9) and a similar tendency was observed for developmental problems (OR 0.6, CI 0.3 - 1.1). CONCLUSION We did not find different developmental and behavior outcomes at 5 years of age between a management policy of immediate delivery and expectant management in preterm hypertensive disorders. The increased risk of developmental delay at 2 years of age after immediate delivery, we found in the 2 year follow up study, did not persist at 5 years of age.
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Affiliation(s)
- Eva F Zwertbroek
- Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands.
| | - Julia Zwertbroek
- Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kim Broekhuijsen
- Obstetrics and Gynaecology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Maureen T M Franssen
- Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Wessel Ganzevoort
- Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Josje Langenveld
- Obstetrics and Gynaecology, Zuyderland Medical Center Heerlen, Heerlen, The Netherlands
| | - Ben W J Mol
- Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | | | - Sicco Scherjon
- Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Henk Groen
- Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
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33
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Giambrone AB, Logue OC, Shao Q, Bidwell GL, Warrington JP. Perinatal Micro-Bleeds and Neuroinflammation in E19 Rat Fetuses Exposed to Utero-Placental Ischemia. Int J Mol Sci 2019; 20:ijms20164051. [PMID: 31434191 PMCID: PMC6720786 DOI: 10.3390/ijms20164051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 12/24/2022] Open
Abstract
Offspring of preeclampsia patients have an increased risk of developing neurological deficits and cognitive impairment. While low placental perfusion, common in preeclampsia and growth restriction, has been linked to neurological deficits, a causative link is not fully established. The goal of this study was to test the hypothesis that placental ischemia induces neuroinflammation and micro-hemorrhages in utero. Timed-pregnant Sprague Dawley rats were weight-matched for sham surgery (abdominal incision only) or induced placental ischemia (surgical reduction of utero-placental perfusion (RUPP)); n = 5/group on gestational day 14. Fetal brains (n = 1–2/dam/endpoint) were collected at embryonic day (E19). Placental ischemia resulted in fewer live fetuses, increased fetal demise, increased hematocrit, and no difference in brain water content in exposed fetuses. Additionally, increased cerebral micro-bleeds (identified with H&E staining), pro-inflammatory cytokines: IL-1β, IL-6, and IL-18, eotaxin (CCL11), LIX (CXCL5), and MIP-2 (CXCL2) were observed in RUPP-exposed fetuses. Microglial density in the sub-ventricular zone decreased in RUPP-exposed fetuses, with no change in cortical thickness. Our findings support the hypothesis that exposure to placental ischemia contributes to microvascular dysfunction (increased micro-bleeds), fetal brain inflammation, and reduced microglial density in proliferative brain areas. Future studies will determine whether in utero abnormalities contribute to long-term behavioral deficits in preeclampsia offspring through impaired neurogenesis regulation.
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Affiliation(s)
- Ashtin B Giambrone
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Omar C Logue
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Qingmei Shao
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Gene L Bidwell
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Junie P Warrington
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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34
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Zwertbroek EF, Franssen MT, Broekhuijsen K, Langenveld J, Bremer H, Ganzevoort W, van Loon AJ, van Pampus MG, Rijnders RJ, Sikkema MJ, Scherjon SA, Woiski MD, Mol BW, van Baar AL, Groen H. Neonatal developmental and behavioral outcomes of immediate delivery versus expectant monitoring in mild hypertensive disorders of pregnancy: 2-year outcomes of the HYPITAT-II trial. Am J Obstet Gynecol 2019; 221:154.e1-154.e11. [PMID: 30940558 DOI: 10.1016/j.ajog.2019.03.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/01/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Management of preterm hypertensive disorders remains a clinical dilemma. The maternal benefits of delivery need to be weighed against the adverse neonatal consequences of preterm birth. Long-term consequences of obstetric management in offspring of women with hypertensive disorders in preterm pregnancy are largely unknown. We report child neurodevelopmental and behavioral outcomes at 2 years after the Hypertension and Preeclampsia Intervention Trial at near Term (HYPITAT-II) trial, which compared immediate delivery versus expectant monitoring in mild late preterm hypertensive disorders of pregnancy. OBJECTIVE To compare effects of immediate delivery vs expectant monitoring on neurodevelopmental and behavioral outcomes at 2 years of age in offspring of women with mild late preterm hypertensive disorders. MATERIALS AND METHODS We studied children born in the HYPITAT-II trial, a study in which women (n = 704) with hypertensive disorders of pregnancy who were between 34 and 37 weeks' gestation were randomized to immediate delivery or expectant monitoring. Participating women were asked to complete the Ages and Stages Questionnaire for developmental outcome and the Child Behavior Checklist for behavioral problems when their toddlers were 2 years old. RESULTS We approached 545 of 704 randomized women (77%); 330 of 545 (61%) returned the questionnaires. In the immediate delivery group, 45 of 162 infants (28%) had an abnormal Ages and Stages Questionnaire score compared to 27 of 148 (18%) in the expectant monitoring group (risk difference, 9.6%; 95% CI, 0.3-18.0%); P = .045. In the pregnancies (n = 94) that delivered before reaching 36 weeks, 27% (n = 25) had an abnormal Ages and Stages Questionnaire score compared to 22% (n = 47) when delivered after 36 weeks (odds ratio, 0.77; confidence interval, 0.44-1.34). An abnormal Child Behavior Checklist outcome was found in 31 of 175 (18%) in the delivery group vs 24 of 166 (15%) in the expectant monitoring group (risk difference, 3.2%; 95% CI, -4.6% to 11.0%). After correction for maternal education, management strategy remained an independent predictor of abnormal Ages and Stages Questionnaire score (odds ratio, 0.48; confidence interval, 0.24 to -0.96, P = .03). In multivariable analyses, low birth weight, low maternal education, and immediate delivery policy were all significantly associated with an abnormal Ages and Stages Questionnaire score. CONCLUSION In this study, we found that early delivery in women with late preterm hypertensive disorders is associated with poorer neurodevelopmental outcomes in their children at 2 years of age. These findings indicate an increased risk of developmental delay after early delivery compared to expectant monitoring. This follow-up study underlines the conclusion of the original HYPITAT-II study that, until the clinical situation deteriorates, expectant monitoring remains the most appropriate management strategy in the light of short- and long-term neonatal outcomes in women with preterm hypertensive disorders.
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35
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Lu HQ, Hu R. Lasting Effects of Intrauterine Exposure to Preeclampsia on Offspring and the Underlying Mechanism. AJP Rep 2019; 9:e275-e291. [PMID: 31511798 PMCID: PMC6736667 DOI: 10.1055/s-0039-1695004] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/12/2019] [Indexed: 12/18/2022] Open
Abstract
Preeclampsia is a common pregnancy complication which can have adverse impact on both mother and baby. In addition to the short term effects, a large body of epidemiological evidence has found preeclampsia can exert long-lasting effects on mother and offspring. Studies suggest that offspring exposed to preeclampsia are at a higher risk of developing cardiovascular, metabolic, and neurological diseases, as well as other diseases. However, studies investigating the underlying mechanism are limited, the exact mechanism still remains unclear. In this study, we will review the epidemiological evidence and studies exploring the mechanism underlying long-term effects of preeclampsia on offspring. Further studies should be targeted at this field so as to implement effective clinical management to prevent the exposed offspring from potential diseases.
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Affiliation(s)
- Hui Qing Lu
- Department of Obstetrics, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Rong Hu
- Department of Obstetrics, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
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36
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Adult Pgf -/- mice behaviour and neuroanatomy are altered by neonatal treatment with recombinant placental growth factor. Sci Rep 2019; 9:9285. [PMID: 31243296 PMCID: PMC6594955 DOI: 10.1038/s41598-019-45824-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/12/2019] [Indexed: 12/20/2022] Open
Abstract
Offspring of preeclamptic pregnancies have cognitive alterations. Placental growth factor (PGF), is low in preeclampsia; reduced levels may affect brain development. PGF-null mice differ from normal congenic controls in cerebrovasculature, neuroanatomy and behavior. Using brain imaging and behavioral testing, we asked whether developmentally asynchronous (i.e. neonatal) PGF supplementation alters the vascular, neuroanatomic and/or behavioral status of Pgf−/− mice at adulthood. C57BL/6-Pgf−/− pups were treated intraperitoneally on postnatal days 1–10 with vehicle or PGF at 10 pg/g, 70 pg/g or 700 pg/g. These mice underwent behavioral testing and perfusion for MRI and analysis of retinal vasculature. A second cohort of vehicle- or PGF-treated mice was perfused for micro-CT imaging. 10 pg/g PGF-treated mice exhibited less locomotor activity and greater anxiety-like behavior relative to vehicle-treated mice. Depressive-like behavior showed a sex-specific, dose-dependent decrease and was lowest in 700 pg/g PGF-treated females relative to vehicle-treated females. Spatial learning did not differ. MRI revealed smaller volume of three structures in the 10 pg/g group, larger volume of seven structures in the 70 pg/g group and smaller volume of one structure in the 700 pg/g group. No cerebral or retinal vascular differences were detected. Overall, neonatal PGF replacement altered behavior and neuroanatomy of adult Pgf−/− mice.
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37
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Lara E, Acurio J, Leon J, Penny J, Torres-Vergara P, Escudero C. Are the Cognitive Alterations Present in Children Born From Preeclamptic Pregnancies the Result of Impaired Angiogenesis? Focus on the Potential Role of the VEGF Family. Front Physiol 2018; 9:1591. [PMID: 30487752 PMCID: PMC6246680 DOI: 10.3389/fphys.2018.01591] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/23/2018] [Indexed: 12/12/2022] Open
Abstract
Evidence from clinical studies has proposed that children born from preeclamptic women have a higher risk of suffering neurological, psychological, or behavioral alterations. However, to date, the mechanisms behind these outcomes are poorly understood. Here, we speculate that the neurodevelopmental alterations in the children of preeclamptic pregnancies result from impaired angiogenesis. The pro-angiogenic factors vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) are key regulators of both vascular and neurological development, and it has been widely demonstrated that umbilical blood of preeclamptic pregnancies contains high levels of soluble VEGF receptor type 1 (sFlt-1), a decoy receptor of VEGF. As a consequence, this anti-angiogenic state could lead to long-lasting neurological outcomes. In this non-systematic review, we propose that alterations in the circulating concentrations of VEGF, PlGF, and sFlt-1 in preeclamptic pregnancies will affect both fetal cerebrovascular function and neurodevelopment, which in turn may cause cognitive alterations in post-natal life.
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Affiliation(s)
- Evelyn Lara
- Vascular Physiology Laboratory, Group of Investigation in Tumor Angiogenesis (LFV-GIANT), Department of Basic Sciences, Faculty of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile.,Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile
| | - Jesenia Acurio
- Vascular Physiology Laboratory, Group of Investigation in Tumor Angiogenesis (LFV-GIANT), Department of Basic Sciences, Faculty of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile.,Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile
| | - José Leon
- Vascular Physiology Laboratory, Group of Investigation in Tumor Angiogenesis (LFV-GIANT), Department of Basic Sciences, Faculty of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile.,Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile
| | - Jeffrey Penny
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Pablo Torres-Vergara
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile.,Department of Pharmacy, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - Carlos Escudero
- Vascular Physiology Laboratory, Group of Investigation in Tumor Angiogenesis (LFV-GIANT), Department of Basic Sciences, Faculty of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile.,Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile.,Red Iberoamericana de alteraciones Vasculares Asociadas a TRastornos del EMbarazo (RIVA-TREM), Chillán, Chile
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38
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Maher GM, McCarthy FP, McCarthy CM, Kenny LC, Kearney PM, Khashan AS, O'Keeffe GW. A perspective on pre-eclampsia and neurodevelopmental outcomes in the offspring: Does maternal inflammation play a role? Int J Dev Neurosci 2018; 77:69-76. [PMID: 30391740 DOI: 10.1016/j.ijdevneu.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 10/28/2022] Open
Abstract
Pre-eclampsia is a leading cause of maternal death and maternal and perinatal morbidity. Whilst the clinical manifestations of pre-eclampsia often occur in late pregnancy, the molecular events leading into the onset of this disease are thought to originate in early pregnancy and result in insufficient placentation. Although the causative molecular basis of pre-eclampsia remains poorly understood, maternal inflammation is recognised as a core clinical feature. While the adverse effects of pre-eclampsia on maternal and fetal health in pregnancy is well-recognised, the long-term impact of pre-eclampsia exposure on the risk of autism spectrum disorder (ASD) in exposed offspring is a topic of on-going debate. In particular, a recent systematic review has reported an association between exposure to pre-eclampsia and increased risk of ASD, however the molecular basis of this association is unknown. Here we review recent evidence for; 1) maternal inflammation in pre-eclampsia; 2) epidemiological evidence for alterations in neurodevelopmental outcomes in offspring exposed to pre-eclampsia; 3) long-term changes in the brains of offspring exposed to pre-eclampsia; and 4) how maternal inflammation may lead to altered neurodevelopmental outcomes in pre-eclampsia exposed offspring. Finally, we discuss the implications of this for the development of future studies in this field.
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Affiliation(s)
- Gillian M Maher
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Ireland
| | - Cathal M McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland.,Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland
| | - Louise C Kenny
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Patricia M Kearney
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland
| | - Gerard W O'Keeffe
- Department of Anatomy and Neuroscience and Cork Neuroscience Centre, Western Gateway Building, University College Cork, Cork, Ireland
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39
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Kay VR, Rätsep MT, Cahill LS, Hickman AF, Zavan B, Newport ME, Ellegood J, Laliberte CL, Reynolds JN, Carmeliet P, Tayade C, Sled JG, Croy BA. Effects of placental growth factor deficiency on behavior, neuroanatomy, and cerebrovasculature of mice. Physiol Genomics 2018; 50:862-875. [PMID: 30118404 DOI: 10.1152/physiolgenomics.00076.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Preeclampsia, a hypertensive syndrome occurring in 3-5% of human pregnancies, has lifelong health consequences for fetuses. Cognitive ability throughout life is altered, and adult stroke risk is increased. One potential etiological factor for altered brain development is low concentrations of proangiogenic placental growth factor (PGF). Impaired PGF production may promote an antiangiogenic fetal environment during neural and cerebrovascular development. We previously reported delayed vascularization of the hindbrain, altered retinal vascular organization, and less connectivity in the circle of Willis in Pgf-/- mice. We hypothesized Pgf-/- mice would have impaired cognition and altered brain neuroanatomy in addition to compromised cerebrovasculature. Cognitive behavior was assessed in adult Pgf-/- and Pgf+/+ mice by four paradigms followed by postmortem high-resolution MRI of neuroanatomy. X-ray microcomputed tomography imaging investigated the three-dimensional cerebrovascular geometry in another cohort. Pgf-/- mice exhibited poorer spatial memory, less depressive-like behavior, and superior recognition of novel objects. Significantly smaller volumes of 10 structures were detected in the Pgf-/- compared with Pgf+/+ brain. Pgf-/- brain had more total blood vessel segments in the small-diameter range. Lack of PGF altered cognitive functions, brain neuroanatomy, and cerebrovasculature in mice. Pgf-/- mice may be a preclinical model for the offspring effects of low-PGF preeclampsia gestation.
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Affiliation(s)
- Vanessa R Kay
- Department of Biomedical and Molecular Sciences, Queen's University , Kingston, Ontario , Canada
| | - Matthew T Rätsep
- Department of Biomedical and Molecular Sciences, Queen's University , Kingston, Ontario , Canada
| | - Lindsay S Cahill
- Mouse Imaging Centre, Hospital for Sick Children , Toronto, Ontario , Canada
| | - Andrew F Hickman
- Department of Biomedical and Molecular Sciences, Queen's University , Kingston, Ontario , Canada
| | - Bruno Zavan
- Department of Biomedical and Molecular Sciences, Queen's University , Kingston, Ontario , Canada.,Federal University of Alfenas (UNIFAL), Alfenas, Minas Gerais , Brazil
| | - Margaret E Newport
- Department of Biomedical and Molecular Sciences, Queen's University , Kingston, Ontario , Canada
| | - Jacob Ellegood
- Mouse Imaging Centre, Hospital for Sick Children , Toronto, Ontario , Canada
| | | | - James N Reynolds
- Centre for Neuroscience Studies, Queen's University , Kingston, Ontario , Canada
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, VIB - Vesalius Research Center, University of Leuven, Department of Oncology , Leuven , Belgium
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen's University , Kingston, Ontario , Canada
| | - John G Sled
- Mouse Imaging Centre, Hospital for Sick Children , Toronto, Ontario , Canada.,Department of Medical Biophysics, University of Toronto , Ontario , Canada
| | - B Anne Croy
- Department of Biomedical and Molecular Sciences, Queen's University , Kingston, Ontario , Canada
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Resting-state functional connectivity in children born from gestations complicated by preeclampsia: A pilot study cohort. Pregnancy Hypertens 2018; 12:23-28. [PMID: 29674194 DOI: 10.1016/j.preghy.2018.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/02/2017] [Accepted: 02/06/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Individuals (PE-F1s) born from preeclampsia (PE)-complicated pregnancies have elevated risks for cognitive impairment. Intervals of disturbed maternal plasma angiokines precede clinical signs of PE. We hypothesized pan-blastocyst dysregulation of angiokines underlies altered PE-F1 brain vascular and neurological development. This could alter brain functional connectivity (FC) patterns at rest. MATERIALS AND METHODS Resting-state functional MRI datasets of ten, matched child pairs (5 boys and 5 girls aged 7-10 years of age) from PE or control pregnancies were available for study. Seed-based analysis and independent component analysis (ICA) methodologies were used to assess whether differences in resting-state functional connectivity (rs-FC) were present between PE-F1s and controls. Bilateral amygdala, bilateral hippocampus, and medial prefrontal cortex (MPFC) were selected as regions of interest (ROI) for the seed-based analysis based on previous imaging differences that we reported in this set of children. RESULTS Compared to controls, PE-F1 children had increased rs-FC between the right amygdala and left frontal pole, the left amygdala and bilateral frontal pole, and the MPFC and precuneus. PE-F1 children additionally had decreased rs-FC between the MPFC and the left occipital fusiform gyrus compared to controls. CONCLUSION These are the first reported rs-FC data for PE-F1s of any age. Theysuggest that PE alters FC during human fetal brain development. Altered FC may contribute to the behavioural and neurological alterations reported in PE-F1s. Longitudinal MRI studies with larger sample sizes are required to confirm these novel findings.
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Korzeniewski SJ, Allred EN, Joseph RM, Heeren T, Kuban KC, O’Shea TM, Leviton A. Neurodevelopment at Age 10 Years of Children Born <28 Weeks With Fetal Growth Restriction. Pediatrics 2017; 140:peds.2017-0697. [PMID: 29030525 PMCID: PMC5654396 DOI: 10.1542/peds.2017-0697] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to evaluate the relationships between fetal growth restriction (FGR) (both severe and less severe) and assessments of cognitive, academic, and adaptive behavior brain function at age 10 years. METHODS At age 10 years, the Extremely Low Gestational Age Newborns Cohort Study assessed the cognitive function, academic achievement, social-communicative function, psychiatric symptoms, and overall quality of life of 889 children born before 28 weeks' gestation. A pediatric epileptologist also interviewed parents as part of a seizure evaluation. The 52 children whose birth weight z scores were <-2 were classified as having severe FGR, and the 113 whose birth weight z scores were between -2 and -1 were considered to have less severe FGR. RESULTS The more severe the growth restriction in utero, the lower the level of function on multiple cognitive and academic achievement assessments performed at age 10 years. Growth-restricted children were also more likely than their extremely preterm peers to have social awareness impairments, autistic mannerisms, autism spectrum diagnoses, difficulty with semantics and speech coherence, and diminished social and psychosocial functioning. They also more frequently had phobias, obsessions, and compulsions (according to teacher, but not parent, report). CONCLUSIONS Among children born extremely preterm, those with severe FGR appear to be at increased risk of multiple cognitive and behavioral dysfunctions at age 10 years, raising the possibility that whatever adversely affected their intrauterine growth also adversely affected multiple domains of cognitive and neurobehavioral development.
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Affiliation(s)
- Steven J. Korzeniewski
- Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, Michigan;,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Elizabeth N. Allred
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Tim Heeren
- Department of Biostatistics, School of Public Health
| | - Karl C.K. Kuban
- Boston University, Boston, Massachusetts;,Departments of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
| | - T. Michael O’Shea
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Alan Leviton
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts
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Giachini FR, Galaviz-Hernandez C, Damiano AE, Viana M, Cadavid A, Asturizaga P, Teran E, Clapes S, Alcala M, Bueno J, Calderón-Domínguez M, Ramos MP, Lima VV, Sosa-Macias M, Martinez N, Roberts JM, Escudero C. Vascular Dysfunction in Mother and Offspring During Preeclampsia: Contributions from Latin-American Countries. Curr Hypertens Rep 2017; 19:83. [PMID: 28986756 DOI: 10.1007/s11906-017-0781-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pregnancy is a physiologically stressful condition that generates a series of functional adaptations by the cardiovascular system. The impact of pregnancy on this system persists from conception beyond birth. Recent evidence suggests that vascular changes associated with pregnancy complications, such as preeclampsia, affect the function of the maternal and offspring vascular systems, after delivery and into adult life. Since the vascular system contributes to systemic homeostasis, defective development or function of blood vessels predisposes both mother and infant to future risk for chronic disease. These alterations in later life range from fertility problems to alterations in the central nervous system or immune system, among others. It is important to note that rates of morbi-mortality due to pregnancy complications including preeclampsia, as well as cardiovascular diseases, have a higher incidence in Latin-American countries than in more developed countries. Nonetheless, there is a lack both in the amount and impact of research conducted in Latin America. An impact, although smaller, can be seen when research in vascular disorders related to problems during pregnancy is analyzed. Therefore, in this review, information about preeclampsia and endothelial dysfunction generated from research groups based in Latin-American countries will be highlighted. We relate the need, as present in many other countries in the world, for increased effective regional and international collaboration to generate new data specific to our region on this topic.
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Affiliation(s)
- Fernanda Regina Giachini
- Laboratory of Vascular Biology, Institute of Health Sciences and Health, Universidade Federal de Mato Grosso, Barra do Garcas, MT, Brazil
| | | | - Alicia E Damiano
- Laboratorio de Biología de la Reproducción, IFIBIO Houssay-UBA-CONICET, Buenos Aires, Argentina.,Departamento de Ciencias Biológicas, Facultad de Farmacia y Bioquimica, UBA, Buenos Aires, Argentina
| | - Marta Viana
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Angela Cadavid
- Grupo Reproducción, Departamento de Fisiologia, Facultad de Medicina Universidad de Antioquia, Medellin, Colombia
| | | | - Enrique Teran
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Sonia Clapes
- Universidad de Ciencias Médicas de La Habana, Havana, Cuba
| | - Martin Alcala
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Julio Bueno
- Grupo Reproducción, Departamento de Fisiologia, Facultad de Medicina Universidad de Antioquia, Medellin, Colombia
| | - María Calderón-Domínguez
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - María P Ramos
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Victor Vitorino Lima
- Laboratory of Vascular Biology, Institute of Health Sciences and Health, Universidade Federal de Mato Grosso, Barra do Garcas, MT, Brazil
| | - Martha Sosa-Macias
- Pharmacogenomics Academia, Instituto Politécnico Nacional-CIIDIR Durango, Durango, Mexico
| | - Nora Martinez
- Laboratorio de Biología de la Reproducción, IFIBIO Houssay-UBA-CONICET, Buenos Aires, Argentina
| | - James M Roberts
- Magee-Womens Research Institute, Departments of Obstetrics, Gynecology and Reproductive Sciences, Epidemiology, and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carlos Escudero
- Vascular Physiology Laboratory Group of Investigation in Tumor Angiogenesis (GIANT) Group of Research and Innovation in Vascular Health (GRIVAS Health) Basic Sciences Department Faculty of Sciences, Universidad del Bio-Bio, Chillan, Chile.
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Maher GM, O'Keeffe GW, Kenny LC, Kearney PM, Dinan TG, Khashan AS. Hypertensive disorders of pregnancy and risk of neurodevelopmental disorders in the offspring: a systematic review and meta-analysis protocol. BMJ Open 2017; 7:e018313. [PMID: 28982838 PMCID: PMC5640119 DOI: 10.1136/bmjopen-2017-018313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDPs), that is chronic hypertension, gestational hypertension, pre-eclampsia (de novo or superimposed on chronic hypertension) and white coat hypertension, affect approximately 5%-15% of pregnancies. HDP exposure has been linked to an increased risk of autism spectrum disorder, attention deficit/hyperactivity disorder and other neurodevelopmental disorders in children. However, findings are inconsistent, and a clear consensus on the impact of HDPs on the risk of neurodevelopmental disorders is needed. Therefore, we aim to synthesise the published literature on the relationship between HDPs and the risk of neurodevelopmental disorders in the form of a systematic review and meta-analysis. METHODS AND ANALYSIS We will include cohort, case-control and cross-sectional studies in which diagnosis of an HDP was reported, and neurodevelopmental disorders were the outcome of interest based on a preprepared protocol. A systematic search of PubMed, CINAHL, Embase, PsycINFO and Web of Science will be conducted in accordance with a detailed search strategy. Two authors will independently review the titles and abstracts of all studies, perform data extraction using a standardised data collection form and assess study quality using a bias classification tool. Meta-analyses will be performed to calculate overall pooled estimates using the generic inverse variance method. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. ETHICS AND DISSEMINATION This proposed systematic review and meta-analysis is based on published data, therefore, does not require ethics approval. Findings will be presented at scientific conferences and disseminated through publication in a peer-reviewed journal. REGISTRATION CRD42017068258.
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Affiliation(s)
- Gillian M Maher
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Gerard W O'Keeffe
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, Western Gateway Building, University College Cork, Cork, Ireland
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Ted G Dinan
- Department of Psychiatry, Cork University Hospital and University College Cork, Cork, Ireland
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Ali S Khashan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital and University College Cork, Cork, Ireland
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Ireland
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Neurological function in children born to preeclamptic and hypertensive mothers - A systematic review. Pregnancy Hypertens 2017; 10:1-6. [PMID: 29153658 DOI: 10.1016/j.preghy.2017.07.144] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Offspring whose mothers developed preeclampsia (PE-F1s) show developmental effects that are now being identified, such as cognitive, behavioural, and mood differences compared to offspring from non-complicated pregnancies. We hypothesize that the progressive angiokine dysregulation associated with development of preeclampsia (PE) reflects gene dysregulation in pre-implantation conceptuses, and manifests in all developing fetal tissues rather than exclusively to the placenta. This hypothesis predicts that fetal cerebrovascular and brain development are deviated by fetal-intrinsic, brain-based mechanisms during what is currently considered a placentally-induced maternal disease. Due to our initial results from brain-imaging and cognitive screening in a child pilot PE-F1 cohort, we developed this systematic review to answer the question of whether any consistent neurological measurements have been found to discriminate between brain functions in offspring of mothers who experienced a hypertensive pregnancy vs. offspring of mothers that did not. METHODS Relevant studies were searched systematically up to June 2017 in MEDLINE, PsycINFO, EMBASE and the grey literature. RESULTS Following predetermined inclusion and exclusion criteria, our search identified 27 out of 464 studies reporting on neurological function in offspring born to preeclamptic and hypertensive mothers. CONCLUSION The current literature strongly supports the conclusion of the behavioural and cognitive deviations in PE-F1s. However, only three studies associated their findings with brain measurements via magnetic resonance imaging (MRI) in both healthy and at-risk pediatric populations. PE-F1s should be identified as an at-risk pediatric population during brain development and studied further as a defined group, perhaps stratified by maternal plasma angiokine levels.
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Kay VR, Tayade C, Carmeliet P, Croy BA. Influences of placental growth factor on mouse retinal vascular development. Dev Dyn 2017. [PMID: 28646507 DOI: 10.1002/dvdy.24540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Placental growth factor (PGF) is important for wound-healing and vascular collaterogenesis. PGF deficiency is associated with preeclampsia, a hypertensive disease of human pregnancy. Offspring born to preeclamptic mothers display cognitive impairments and brain vascular and neurostructural deviations. Low PGF production during development may contribute to alterations in offspring cerebrovascular beds. Retina is a readily accessible part of the central nervous system with a well-described pattern of vascular development in mice. Impacts of PGF deficiency were addressed during mouse retinal vascularization. RESULTS Retinal vessels were compared between Pgf-/- and congenic C57BL/6 (B6) mice. PGF deficiency altered neonatal retinal vascularization patterns. Some anatomic alterations persisted into adulthood, particularly in males. Greater arterial wall collagen IV expression was found in adult Pgf-/- females. Pregnancy (studied in adult females at gestational days 11.5 or 18.5) induced subtle changes upon the mother's retinal vasculature but these pregnancy-induced changes did not differ between genotypes. Significant sex-related differences occurred between adult male and female B6 although sexually dimorphic retinal vascular differences were absent in B6 neonates. CONCLUSIONS Overall, PGF has a role in retinal vascular angiogenesis and vessel organization during development but does not affect retinal vessel adaptations in adult females during pregnancy. Developmental Dynamics 246:700-712, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Vanessa R Kay
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, VIB - Vesalius Research Center, University of Leuven, Department of Oncology, Leuven, Belgium
| | - B Anne Croy
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Figueiró-Filho EA, Croy BA, Reynolds JN, Dang F, Piro D, Rätsep MT, Forkert ND, Paolozza A, Smith GN, Stroman PW. Diffusion Tensor Imaging of White Matter in Children Born from Preeclamptic Gestations. AJNR Am J Neuroradiol 2017; 38:801-806. [PMID: 28126749 DOI: 10.3174/ajnr.a5064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/06/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Individuals born from pregnancies complicated by preeclampsia have an elevated risk for cognitive impairment. Deviations in maternal plasma angiokines occur for prolonged intervals before clinical signs of preeclampsia. We hypothesized that fetal brain vascular and nervous tissue development become deviated during maternal progression toward preeclampsia and that such deviations would be detectable by MR imaging. MATERIALS AND METHODS In this pilot study, 10 matched (gestational and current ages) pairs (5 boys/5 girls, 7-10 years of age) from preeclampsia or control pregnancies were examined by using diffusion tensor MR imaging. An unbiased voxel-based analysis was conducted on fractional anisotropy and mean diffusivity parametric maps. Six brain ROIs were identified for subsequent analysis by tractography (middle occipital gyrus, caudate nucleus and precuneus, cerebellum, superior longitudinal fasciculus, and cingulate gyrus). RESULTS Statistical differences were present between groups for fractional anisotropy in the caudate nucleus (offspring from preeclamptic gestation > controls), volume of the tract for the superior longitudinal fasciculus (offspring from preeclamptic gestation > controls) and the caudate nucleus (offspring from preeclamptic gestation > controls), and for parallel diffusivity of the cingulate gyrus (offspring from preeclamptic gestation > controls). CONCLUSIONS These novel preliminary results along with previous results from the same children that identified altered cerebral vessel calibers and increased regional brain volumes justify fully powered MR imaging studies to address the impact of preeclampsia on human fetal brain development.
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Affiliation(s)
- E A Figueiró-Filho
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.) .,Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada.,Faculty of Medicine (E.A.F.-F.), Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - B A Croy
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - J N Reynolds
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada
| | - F Dang
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - D Piro
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - M T Rätsep
- Obstetrics and Gynecology (M.T.R., G.N.S.)
| | - N D Forkert
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Department of Radiology and Hotchkiss Brain Institute (N.D.F.), University of Calgary, Calgary, Alberta, Canada
| | - A Paolozza
- Laboratory for Infant Studies (A.P.), University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - G N Smith
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Obstetrics and Gynecology (M.T.R., G.N.S.)
| | - P W Stroman
- Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada
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Warshafsky C, Pudwell J, Walker M, Wen SW, Smith GN. Prospective assessment of neurodevelopment in children following a pregnancy complicated by severe pre-eclampsia. BMJ Open 2016; 6:e010884. [PMID: 27388354 PMCID: PMC4947739 DOI: 10.1136/bmjopen-2015-010884] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To prospectively examine whether children of women with a pregnancy affected by severe pre-eclampsia (PE), compared to children of women without a PE-affected pregnancy, have differences in neurodevelopmental performance up to 5 years of age. DESIGN Prospective cohort study. SETTING Tertiary care centre. PARTICIPANTS Women were recruited following a PE-affected pregnancy. After each PE participant was recruited, the next normotensive woman without a prior history of PE and matched by parity, maternal age and race was invited to participate. Women with a history of chronic hypertension, diabetes or renal disease were excluded. Total enrolment included 129 PE-affected and 140 normotensive mothers. OUTCOME MEASURES The primary outcome measure was failure of the Ages and Stages Questionnaire (ASQ). The ASQ was completed yearly, until age 5. RESULTS A significant difference was found in the proportion of ASQ categories failed in year 3 (p<0.05), and this approached significance in years 1 and 4 (p<0.10 and p<0.15, respectively). At year 1, the number of ASQ categories failed was significantly greater among children born to PE mothers. A subgroup analysis revealed that a significant proportion of PE children born preterm (<37 weeks) failed the ASQ in years 3 and 4 (p<0.05), and when failed, those who were preterm failed significantly more categories (p<0.05). A trend towards increased failure in the gross motor category was found. There was a significant positive correlation between maternal lifetime CVD risk score and number of ASQ categories failed at years 1 and 3 (p<0.05). CONCLUSIONS Severe PE is associated with other adverse pregnancy outcomes, including intrauterine growth restriction and preterm birth, all of which are associated with increased neurodevelopment delays. Thus, PE indicates a need for early screening and intervention at the neurodevelopmental level to improve children's long-term health, with larger studies required to tease out contributing factors.
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Affiliation(s)
- Chelsie Warshafsky
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Jessica Pudwell
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Mark Walker
- Department of Obstetrics and Gynecology, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Shi-Wu Wen
- Department of Obstetrics and Gynecology, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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Rätsep MT, Hickman AF, Croy BA. The Elsevier trophoblast research award lecture: Impacts of placental growth factor and preeclampsia on brain development, behaviour, and cognition. Placenta 2016; 48 Suppl 1:S40-S46. [PMID: 26880207 DOI: 10.1016/j.placenta.2016.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/19/2016] [Accepted: 02/03/2016] [Indexed: 12/17/2022]
Abstract
Preeclampsia (PE) is a significant gestational disorder affecting 3-5% of all human pregnancies. In many PE pregnancies, maternal plasma is deficient in placental growth factor (PGF), a placentally-produced angiokine. Beyond immediate fetal risks associated with acute termination of the pregnancy, offspring of PE pregnancies (PE-F1) have higher long-term risks for hypertension, stroke, and cognitive impairment compared to F1s from uncomplicated pregnancies. At present, mechanisms that explain PE-F1 gains in postpartum risks are poorly understood. Our laboratory found that mice genetically-deleted for Pgf have altered fetal and adult brain vascular development. This is accompanied by sexually dimorphic alterations in anatomic structure in the adult Pgf-/- brain and impaired cognitive functions. We hypothesize that cerebrovascular and neurological aberrations occur in fetuses exposed to the progressive development of PE and that these brain changes impair cognitive functioning, enhance risk for stroke, elevate severity of stroke, and lead to worse stroke outcomes. These brain and placental outcomes may be linked to down-regulated PGF gene expression in early pre-implantation embryos, prior to gastrulation. This review explores our hypothesis that there are mechanistic links between low PGF detection in maternal plasma prodromal to PE, PE, and altered brain vascular, structural, and functional development amongst PE-F1s. We also include a summary of preliminary outcomes from a pilot study of 7-10 year old children that is the first to report magnetic resonance imaging, magnetic resonance angiography, and functional brain region assessment by eye movement control studies in PE-F1s.
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Affiliation(s)
- Matthew T Rätsep
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Andrew F Hickman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - B Anne Croy
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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