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Danielli M, Thomas RC, Gillies CL, Hu J, Khunti K, Tan BK. Blood biomarkers to predict the onset of pre-eclampsia: A systematic review and meta-analysis. Heliyon 2022; 8:e11226. [PMID: 36387521 PMCID: PMC9649987 DOI: 10.1016/j.heliyon.2022.e11226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Pre-eclampsia is one of the most common pregnancy complications, and a major cause of fetal and maternal morbidity and mortality globally. Diagnosis currently takes place in the third trimester based on clinical symptoms. This systematic review and meta-analysis sought to determine the blood biomarkers that are associated with pre-eclampsia, and in particular, the biomarkers that could predict pre-eclampsia in early pregnancy. We searched the electronic databases (Medline, Embase, Cochrane Library) from inception up to March 2022. Prospective studies with 1000 or more participants that measured blood biomarkers to predict or diagnose pre-eclampsia have been included in this systematic review. Biomarkers' measurements were considered from the first up to the third trimester, but not during labor. Data concerning pre-eclampsia, biomarker measurements and study characteristics were extracted. Meta-analysis was performed when possible. We found a total of 43 studies (assessing 62 different biomarkers in 18,170 pregnancies, have been included in this systematic review, and a total of 6 studies (assessing 2 biomarkers have been included in the meta-analysis). Statistical analysis was performed for PlGF and sFlt-1. Mean difference in PlGF levels between pre-eclampsia and healthy pregnancies, appear to increase as the pregnancy progresses. Results of sFlt-1 meta-analysis were inconclusive. No significant publication bias was identified. This is the most comprehensive and up to date systematic review and meta-analysis on this important topic on blood biomarkers for the early prediction of pre-eclampsia. Further This research highlights the urgent needed for further discovery research to identify blood biomarkers that could predict the development of pre-eclampsia.
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Affiliation(s)
- Marianna Danielli
- Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Roisin C. Thomas
- Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Clare L. Gillies
- Diabetes Research Centre, Leicester General Hospital, Leicester, LE5 4PW, United Kingdom
| | - Jiamiao Hu
- Engineering Research Centre of Fujian-Taiwan Special Marine Food Processing and Nutrition, Ministry of Education, Fuzhou, Fujian, China
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, Leicester, LE5 4PW, United Kingdom
- NIHR Applied Research Collaboration – East Midlands (ARC-EM), Leicester General Hospital, Leicester, LE5 4PW, United Kingdom
| | - Bee Kang Tan
- Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
- Diabetes Research Centre, Leicester General Hospital, Leicester, LE5 4PW, United Kingdom
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Sanches APV, de Oliveira JL, Ferreira MS, Lima BDS, Miyamoto JÉ, Simino LADP, Torsoni MA, Torsoni AS, Milanski M, Ignácio-Souza LM. Obesity phenotype induced by high-fat diet leads to maternal-fetal constraint, placental inefficiency, and fetal growth restriction in mice. J Nutr Biochem 2022; 104:108977. [PMID: 35248701 DOI: 10.1016/j.jnutbio.2022.108977] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/20/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate certain parameters regarding the maternal-fetal outcomes in a diet-induced obesity model. Obese, glucose-intolerant females who were exposed to a high-fat diet prior to pregnancy had lower placental efficiency and lower birth weight pups compared to the controls. Simple linear regression analyses showed that maternal obesity disrupts the proportionality between maternal and fetal outcomes during pregnancy. Maternal obesity is correlated with fetal outcomes, perhaps because of problems with hormonal signaling and exacerbation of inflammation in the maternal metabolic environment. The maternal obese phenotype altered the thickness of the placental layer, the transport of fatty acids, and the expression of growth factors. For example, lower expression of epidermal growth factor receptor (EGFR) mRNA in the obesity-prone group may have contributed to the rupture of the placental layers, leading to adverse fetal outcomes. Furthermore, maintenance of maternal glucose homeostasis and overexpression of placental growth factor (PGF) in the obesity-resistant group likely protected the placenta and fetuses from morphological and functional damage.
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Affiliation(s)
- Ana Paula Varela Sanches
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Josilene Lopes de Oliveira
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Maíra Schuchter Ferreira
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Bruna de Souza Lima
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Josiane Érica Miyamoto
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Laís Angélica de Paula Simino
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Márcio Alberto Torsoni
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil; Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil
| | - Adriana Souza Torsoni
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil; Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil
| | - Marciane Milanski
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil; Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil
| | - Letícia Martins Ignácio-Souza
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil; Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil.
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Administration of recombinant human placental growth factor decreases blood pressure in obese hypertensive pregnant rats. J Hypertens 2021; 38:2295-2304. [PMID: 32618892 DOI: 10.1097/hjh.0000000000002528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Although epidemiological studies have shown that obesity is associated with increased incidence of hypertension during pregnancy, the mechanisms linking these two comorbidities are not as well studied. Previous investigations detected lower levels of the anti-hypertensive and pregnancy-related factor, placental growth factor (PlGF), in obese hypertensive pregnancies. Therefore, we examined whether obese hypertensive pregnant rats have reduced PlGF and whether increasing its levels by administering recombinant human (rh)PlGF reduces their blood pressure. METHODS We utilized a genetic model of obesity characterized to be heavier, hypertensive and fertile, namely rats having heterozygous deficiency of the melanocortin-4 receptor (MC4R-def). RESULTS MC4R-def obese rats had lower circulating levels of PlGF than wild-type lean controls at gestational day 19. Also, assessment of the PlGF receptor, Flt-1, in the vasculature showed that its levels were reduced in aorta and kidney glomeruli but increased in small mesenteric arteries. Chronic intraperitoneal administration of rhPlGF from gestational day 13-19 significantly increased circulating PlGF levels in both obese and lean rats, but reduced blood pressure only in the obese pregnant group. The rhPlGF treatment did not alter maternal body and fat masses or circulating levels of the adipokines, leptin and adiponectin. In addition, this treatment did not impact average foetal weights but increased placental weights regardless of obese or lean pregnancy. CONCLUSION PlGF is reduced in MC4R-def obese hypertensive pregnant rats, which is similar to findings in obese hypertensive pregnant women, while increasing its levels with exogenous rhPlGF reduces their blood pressure.
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Spradley FT. High-fat diet from parental generation exaggerates body and adipose tissue weights in pregnant offspring. PLoS One 2020; 15:e0237708. [PMID: 32817646 PMCID: PMC7446828 DOI: 10.1371/journal.pone.0237708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/25/2020] [Indexed: 11/18/2022] Open
Abstract
Parental high-fat diet (HFD) programs for obesity and hypertension in female offspring in rats, but it is unknown how the pregnancies of these offspring are impacted. Therefore, the hypothesis was tested that parental HFD exaggerates obesity and hypertension during pregnancy of the offspring. Wistar Hannover rat dams (the parental, P generation) were maintained on normal-fat diet (NFD) or HFD from weaning and were kept on respective diets through pregnancy and lactation. Their offspring (the first filial, F1 generation) were weaned onto the same diet as the P generation, or they were changed to the other diet to determine if combined HFD in the P and F1 generations exaggerates body weight and blood pressure levels during pregnancy in these offspring. This diet paradigm resulted in the following groups of pregnant F1 offspring: P-NFD/F1-NFD, P-HFD/F1-NFD, P-NFD/F1-HFD, and P-HFD/F1-HFD. Maternal body and adipose tissue weights were greatest in the P-HFD/F1-HFD group compared to the other 3 groups by the end of pregnancy. Plasma leptin and conscious mean arterial blood pressure were not significantly different between any group, although there was a main effect for increased blood pressure in the F1-HFD groups. Circulating levels of the antihypertensive pregnancy factor, placental growth factor (PlGF), were assessed. Although average PlGF levels were similar among all groups, correlative studies revealed that lower levels of PlGF were associated with higher blood pressure only in the P-HFD/F1-HFD group. In summary, HFD feeding from the P generation exaggerated HFD-induced body and adipose tissue weights in the pregnant offspring.
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Affiliation(s)
- Frank T. Spradley
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS, United States of America
- * E-mail:
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Lin D, Yong J, Ni S, Ou W, Tan X. Negative association between serum adropin and hypertensive disorders complicating pregnancy. Hypertens Pregnancy 2019; 38:237-244. [PMID: 31438729 DOI: 10.1080/10641955.2019.1657887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/15/2019] [Indexed: 02/05/2023]
Abstract
Objective: Study the association of adropin and hypertensive disorders complicating pregnancy (HDCP). Methods: Patients with HDCP were matched with normotensive women (47 pairs). Adropin concentrations were detected by enzyme-linked immunosorbent assay. Results: Compared with the controls, the serum adropin levels were lower in the HDCP group (P < 0.001) and in HDCP subgroups (gestational hypertension, mild preeclampisa, and severe preeclampsia, term, preterm, early onset, and late onset) (all P < 0.05). After adjustment for confounders, adropin remained negatively associated with HDCP (P = 0.027). Conclusion: Lower adropin concentration is significantly associated with HDCP, suggesting that higher or normal adropin levels may be protective against HDCP.
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Affiliation(s)
- Dong Lin
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College , Shantou , China
| | - Jian Yong
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College , Shantou , China
| | - Shuhua Ni
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College , Shantou , China
| | - Weichao Ou
- Department of Cardiology, Shantou University Medical College , Shantou , China
| | - Xuerui Tan
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College , Shantou , China
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Kreepala C, Kitporntheranunt M, Sangwipasnapaporn W, Rungsrithananon W, Wattanavaekin K. Assessment of preeclampsia risk by use of serum ionized magnesium-based equation. Ren Fail 2018; 40:99-106. [PMID: 29318926 PMCID: PMC6014514 DOI: 10.1080/0886022x.2017.1422518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Preeclampsia is a common medical complication in pregnancy. It has been reported to be associated with decreased serum magnesium levels. However, there has not been evidence demonstrating utilization of change in magnesium for prediction of preeclampsia. The purpose of this study was to develop magnesium fraction-based equations which took other significant clinical risk factors into consideration for prediction of preeclampsia. Methods: We collected serum total and ionized magnesium ionized magnesium levels from 84 pregnant women diagnosed with preeclampsia after week 20 of pregnancy. The ionized magnesium fraction was then calculated by the percentage ratio of ionized and total magnesium level. Results: Sixty-four (76.19%) women had normal pregnancy and 20 (23.81%) developed preeclampsia. The ionized magnesium fraction was significantly lower in preeclampsia group (23.95 ± 4.7% vs. 26.28 ± 2.3%, p = .04). Additionally, lower ionized magnesium fraction (24.67%), teenage and elderly primigravida were significantly associated with preeclampsia (OR = 4.41, 95% CI: 1.46–13.40, OR = 5.47, 95% CI: 1.85–35.42 and OR = 11.11, 95% CI: 1.09–113.78, respectively). Consequently, we attempted to develop ionized magnesium fraction-based equations calculate risk scores for preeclampsia. The area of ROC for predictive accuracy of the model was 0.77 (p < .001) and ROC suggested that the score of 0.27 would be a threshold for screening preeclampsia with 70% sensitivity and 81% specificity. Conclusions: Ionized magnesium fraction may have been appropriate for screening of preeclampsia. We suggested blood testing on total and ionized magnesium concentrations as well as calculation of ionized magnesium fraction in addition to routine antenatal care for better screening of the disease.
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Affiliation(s)
- Chatchai Kreepala
- a Department of Internal Medicine, Faculty of Medicine , Srinakharinwirot University , Ongkharak , Thailand
| | - Maethaphan Kitporntheranunt
- b Department of Obstetrics and Gynecology, Faculty of Medicine , Srinakharinwirot University , Ongkharak , Thailand
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Canto-Cetina T, Coral-Vázquez RM, Rojano-Mejía D, Pérez Godoy S, Coronel A, Canto P. Higher prepregnancy body mass index is a risk factor for developing preeclampsia in Maya-Mestizo women: a cohort study. ETHNICITY & HEALTH 2018; 23:682-690. [PMID: 28385076 DOI: 10.1080/13557858.2017.1315367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM Preeclampsia and obesity are two closely related syndromes. The high maternal prepregnancy body mass index (BMI) is a risk factor for present preeclampsia, independently of the ethnic background of the studied population. The aim of this study was to analyse in a prospective cohort study the relation between prepregnancy BMI and development of preeclampsia in Maya-Mestizo women. DESIGN This is a prospective cohort study of 642 pregnant women that were included in the first trimester of the pregnancy (gestational age ≤12 weeks at the first antenatal visit) and all of them were of Maya-Mestizo ethnic origin from the state of Yucatán, México. We assessed the potential risk factors for preeclampsia and documented the prepregnancy BMI (kg/m2) that was based on measured height and maternal self-report of prepregnancy weight at the initial visit. Besides, in the antenatal visit we documented if the pregnant women developed preeclampsia. RESULTS Of the 642 pregnant Maya-Mestizo women, 49 developed preeclampsia, with an incidence of 7.6% (44.9% had severe and 55% mild). The prepregnancy BMI was higher in women with developed preeclampsia than in those with normal pregnancies. Women with overweight or obesity in comparison with normal weight presented a RR = 2.82 (95% CI: 1.32-6.03; P = 0.008) and RR= 4.22 (95% CI: 2.07-8.61; P = 0.001), respectively. CONCLUSIONS Our findings expand the previous studies to show that the higher prepregnancy BMI is a strong, independent risk factor for preeclampsia.
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Affiliation(s)
- Thelma Canto-Cetina
- a Laboratorio de Biología de la Reproducción , Centro de Investigaciones Regionales "Dr. Hideyo NoguchiUniversidad Autónoma de Yucatán" , Mérida , México
| | - Ramón Mauricio Coral-Vázquez
- b Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina , Instituto Politécnico Nacional , México , D.F. , México
- c Subdirección de Enseñanza e Investigación , Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado , México , D.F. , México
| | - David Rojano-Mejía
- d Unidad de Medicina Física y Rehabilitación, Región Centro, UMAE Lomas Verdes , Instituto Mexicano del Seguro Social , México , D.F. , México
| | - Sergio Pérez Godoy
- e Servicio Prenatal, del Hospital Materno Infantil, S.S. , Mérida , México
| | - Agustín Coronel
- f División de Investigación Biomédica, Subdirección de Enseñanza e Investigación , Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado , México , D.F. , México
| | - Patricia Canto
- g Unidad de Investigación en Obesidad, Facultad de Medicina , Universidad Nacional Autónoma de México & Clínica de Obesidad, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , México , D.F. , México
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Caillon H, Tardif C, Dumontet E, Winer N, Masson D. Evaluation of sFlt-1/PlGF Ratio for Predicting and Improving Clinical Management of Pre-eclampsia: Experience in a Specialized Perinatal Care Center. Ann Lab Med 2018; 38:95-101. [PMID: 29214752 PMCID: PMC5736685 DOI: 10.3343/alm.2018.38.2.95] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/04/2017] [Accepted: 10/23/2017] [Indexed: 11/19/2022] Open
Abstract
Background Management of pregnant women at high risk of pre-eclampsia (PE) requires frequent monitoring, with referral to specialized perinatal care centers. Reliable tests are necessary to improve prediction of PE and related complications and to assess disease severity and progression. An imbalance in two biomarkers, soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF), is involved in PE pathogenesis. The sFlt-1 to PlGF ratio is increased in pregnant women before the onset of PE. An elevated ratio is highly predictive of PE, whereas the diagnosis of PE can be ruled out within one week for low ratios. The main objective of this study was to assess whether a low sFlt-1/PlGF ratio, below a cutoff of 38, can predict the absence of PE within one week. Methods We performed a prospective, monocentric, observational study to evaluate serum sFlt-1/PlGF ratio (Roche Diagnostics Cobas e411 system) for predicting -PE in a group of 67 high-risk pregnant women (20–37 gestation weeks). Results Among the 67 patients included, 53 had a sFlt-1/PlGF ratio lower than 38; none developed subsequent PE leading to a negative predictive value of 100%. Eight patients developed clinical PE. The positive predictive value was 21% at one week and 18% at four weeks, in accordance with previous studies. Conclusions The serum sFlt-1/PlGF ratio showed highly predictive performances for ruling out PE. Using these biomarkers in routine management of PE may improve clinical care and avoid inappropriate hospitalization, which has a significant economic impact.
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Affiliation(s)
- Hélène Caillon
- Department of Biochemistry, Nantes University Hospital, France.
| | - Cécile Tardif
- Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France
| | - Erwan Dumontet
- Department of Biochemistry, Nantes University Hospital, France
| | - Norbert Winer
- Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France
| | - Damien Masson
- Department of Biochemistry, Nantes University Hospital, France
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Zafer E, Yenisey C, Kurek Eken M, Ozdemir E, Kurt Omurlu I, Yuksel H. Second trimester maternal serum-amniotic fluid nitric oxide and vascular endothelial growth factor levels in relation to uterine artery Doppler indices in pregnancies with normal outcome. J OBSTET GYNAECOL 2018; 38:1088-1092. [PMID: 29884106 DOI: 10.1080/01443615.2018.1454409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The aim of the present study was to explore the possible relations of maternal serum and amniotic fluid nitric oxide (NO) and of vascular endothelial growth factor A (VEGF-A) concentrations with uterine artery Doppler indices (UtADs) in a healthy second trimester obstetric population. In this regard, the levels of NO and VEGF-A were measured in maternal sera and the amniotic fluid samples were in 36 subjects who were in their early second trimester of pregnancy. The mean levels for VEGF-A were 110.3 ± 31.5 pg/ml in maternal serum and 149.6 ± 31.3 pg/ml in amniotic fluid. Mean levels for NO were 5.7 ± 4.7 µmol in maternal serum and 12.9 ± 3.4 µmol in amniotic fluid. UtADs were measured concurrently with the sample collections. The mean value for uterine artery pulsatility index (PI) was 1.3 ± 0.4. The measurements were then analysed for possible correlations, whereby no correlation was found between UtAD and maternal serum levels of either molecule (p = .828 and p = .662 for VEGF-A and NO, respectively). However, a positive correlation was found between the NO levels in the amniotic fluid compartment and UtAD (r = 0.432, p = .009 for PI). Therefore, a correlation of UtAD with amniotic fluid NO can be expected in pregnancies with a normal outcome. Impact Statement What is already known on this subject? Nitric oxide (NO) and vascular endothelial growth factor A (VEGF-A) are important vasoactive molecules that play significant roles in early angiogenesis and placentation. What the results of this study add? There is a positive correlation between the amniotic fluid NO levels and the uterine artery Doppler indices (UtADs) in the second trimester of pregnancies with normal outcomes. What the implications are of these findings for clinical practice and/or future research? A correlation between amniotic fluid NO levels and UtAD may indicate a normal trophoblastic invasion. Disturbance of this balance may be expected in certain adverse pregnancy outcomes. Additional studies are needed to further explore the molecular signs of early abnormal placentation and their clinical reflection.
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Affiliation(s)
- Emre Zafer
- a Department of Obstetrics and Gynaecology , Adnan Menderes University Hospital , Aydin , Turkey
| | - Cigdem Yenisey
- a Department of Obstetrics and Gynaecology , Adnan Menderes University Hospital , Aydin , Turkey
| | - Meryem Kurek Eken
- a Department of Obstetrics and Gynaecology , Adnan Menderes University Hospital , Aydin , Turkey
| | - Ezgi Ozdemir
- a Department of Obstetrics and Gynaecology , Adnan Menderes University Hospital , Aydin , Turkey
| | - Imran Kurt Omurlu
- a Department of Obstetrics and Gynaecology , Adnan Menderes University Hospital , Aydin , Turkey
| | - Hasan Yuksel
- a Department of Obstetrics and Gynaecology , Adnan Menderes University Hospital , Aydin , Turkey
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Liu JX, Chen D, Li MX, Hua Y. Increased serum iron levels in pregnant women with preeclampsia: a meta-analysis of observational studies. J OBSTET GYNAECOL 2018; 39:11-16. [PMID: 29884078 DOI: 10.1080/01443615.2018.1450368] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Jia-Xin Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dan Chen
- Department of Obstetrics and Gynecology, Daqing Oil Field General Hospital, Daqing City, China
| | - Ming-Xun Li
- Department of Obstetrics and Gynecology, Daqing Oil Field General Hospital, Daqing City, China
| | - Ying Hua
- Department of Obstetrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
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Tamblyn JA, Jenkinson C, Larner DP, Hewison M, Kilby MD. Serum and urine vitamin D metabolite analysis in early preeclampsia. Endocr Connect 2018; 7:199-210. [PMID: 29217650 PMCID: PMC5793806 DOI: 10.1530/ec-17-0308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022]
Abstract
Vitamin D deficiency is common in pregnant women and may contribute to adverse events in pregnancy such as preeclampsia (PET). To date, studies of vitamin D and PET have focused primarily on serum concentrations vitamin D, 25-hydroxyvitamin D3 (25(OH)D3) later in pregnancy. The aim here was to determine whether a more comprehensive analysis of vitamin D metabolites earlier in pregnancy could provide predictors of PET. Using samples from the SCOPE pregnancy cohort, multiple vitamin D metabolites were quantified by liquid chromatography-tandem mass spectrometry in paired serum and urine prior to the onset of PET symptoms. Samples from 50 women at pregnancy week 15 were analysed, with 25 (50%) developing PET by the end of the pregnancy and 25 continuing with uncomplicated pregnancy. Paired serum and urine from non-pregnant women (n = 9) of reproductive age were also used as a control. Serum concentrations of 25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 24,25(OH)2D3 and 3-epi-25(OH)D3 were measured and showed no significant difference between women with uncomplicated pregnancies and those developing PET. As previously reported, serum 1,25(OH)2D3 was higher in all pregnant women (in the second trimester), but serum 25(OH)D2 was also higher compared to non-pregnant women. In urine, 25(OH)D3 and 24,25(OH)2D3 were quantifiable, with both metabolites demonstrating significantly lower (P < 0.05) concentrations of both of these metabolites in those destined to develop PET. These data indicate that analysis of urinary metabolites provides an additional insight into vitamin D and the kidney, with lower urinary 25(OH)D3 and 24,25(OH)2D3 excretion being an early indicator of a predisposition towards developing PET.
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Affiliation(s)
- J A Tamblyn
- Institute of Metabolism and Systems Research (IMSR)College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - C Jenkinson
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
| | - D P Larner
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
| | - M Hewison
- Institute of Metabolism and Systems Research (IMSR)College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - M D Kilby
- Institute of Metabolism and Systems Research (IMSR)College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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12
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He D, Wu S, Zhao H, Zheng Z, Zhang W. High normal blood pressure in early pregnancy also contribute to early onset preeclampsia and severe preeclampsia. Clin Exp Hypertens 2017; 40:539-546. [PMID: 29172803 DOI: 10.1080/10641963.2017.1407330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study was to evaluate effects of high normal blood pressure (HNBP) in early pregnancy on total preeclampsia, early preeclampsia, and severe preeclampsia. METHODS We conducted a multicenter, national representative retrospective cohort study. HNBP was defined as systolic blood pressure between 130 and 140 mmHg or diastolic blood pressure between 85 and 90 mmHg. We used multivariable logistic regression to examine the associations of HNBP and the risks of above three types of preeclampsia. RESULTS We included 58 054 women who were normotensive and nulliparous in early pregnancy. 4 809 (8.3%) fulfilled the definition of having HNBP, 16 682 (28.7%) were in normal blood pressure group, and 36 563 (63.0%) were in optimal blood pressure group. The incidence rates of total preeclampsia, early preeclampsia, and severe preeclampsia were 2.1% (1 217), 0.8% (491), and 1.4% (814), respectively. Compared to having optimal blood pressure, women with HNBP had significantly higher odds of total preeclampsia (odds ratio (OR) = 4.028, 95% confidence interval (CI) 3.377, 4.804), severe preeclampsia (OR = 3.542, 95% CI 2.851, 4.400), and early preeclampsia (OR = 8.163, 95% CI 6.219, 10.715). Our restricted cubic spline results supported the dose-response relationship between continuous blood pressure and the odds ratio of three types of preeclampsia. The fraction of early preeclampsia associated with prehypertension was 58.6%, which was higher than those of total preeclampsia (42.2%) or severe preeclampsia (40.5%). CONCLUSION Women in early pregnancy with HNBP more likely develop total preeclampsia, early preeclampsia and severe preeclampsia, compared to those with optimal blood pressure. HNBP contribute more to early preeclampsia than severe preeclampsia. Our study provided robust epidemiological evidences for monitoring HNBP in early pregnancy to reduce the risks of preeclampsia.
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Affiliation(s)
- Dian He
- a Department of Epidemiology and Health Statistics, School of Public Health , Capital Medical University , Beijing , China.,b Beijing Municipal Key Laboratory of Clinical Epidemiology , Capital Medical University , Beijing , China
| | - Shaowen Wu
- c Beijing Obstetrics and Gynecology Hospital , Capital Medical University , Beijing , China
| | - Haiping Zhao
- a Department of Epidemiology and Health Statistics, School of Public Health , Capital Medical University , Beijing , China.,b Beijing Municipal Key Laboratory of Clinical Epidemiology , Capital Medical University , Beijing , China
| | - Zihe Zheng
- d Epidemiology Department , Johns Hopkins University Bloomberg School of Public Health , Baltimore , USA
| | - Weiyuan Zhang
- b Beijing Municipal Key Laboratory of Clinical Epidemiology , Capital Medical University , Beijing , China
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13
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Myers JE. What are the metabolic precursors which increase the risk of pre-eclampsia and how could these be investigated further. Placenta 2017; 60:110-114. [PMID: 28855067 PMCID: PMC5730540 DOI: 10.1016/j.placenta.2017.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/28/2017] [Accepted: 08/22/2017] [Indexed: 12/11/2022]
Abstract
Several maternal and pregnancy characteristics have been associated with an increased risk of preeclampsia in epidemiological studies. This review discusses metabolic risk factors in particular and their interaction with other maternal and/or pregnancy characteristics. Examples of research studies that have used data from women with specific characteristics or explored the interaction between risk factors are discussed. Suggestions for future research using large data sets and incorporating knowledge of cardiovascular disease and other metabolic diseases are also highlighted. Obesity and nulliparity account for the largest population risk of preeclampsia. Low PlGF in early pregnancy is more strongly associated with preeclampsia in obese women. There are interactions between obesity and other characteristics which amplify the risk of preeclampsia e.g. ART, ethnicity.
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Affiliation(s)
- Jenny E Myers
- Maternal & Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; St Mary's Hospital, Central Manchester Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
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Agarwal R, Chaudhary S, Kar R, Radhakrishnan G, Tandon A. Prediction of preeclampsia in primigravida in late first trimester using serum placental growth factor alone and by combination model. J OBSTET GYNAECOL 2017; 37:877-882. [DOI: 10.1080/01443615.2017.1309367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Rachna Agarwal
- Department of Obstetrics & Gynaecology, University College of Medical Sciences & Guru Teg Bahadur, Delhi, India
| | - Shweta Chaudhary
- Department of Biochemistry, University College of Medical Sciences & Guru Teg Bahadur, Delhi, India
| | - Rajarshi Kar
- Department of Obstetrics & Gynaecology, University College of Medical Sciences & Guru Teg Bahadur, Delhi, India
| | - Gita Radhakrishnan
- Department of Obstetrics & Gynaecology, University College of Medical Sciences & Guru Teg Bahadur, Delhi, India
| | - Anupama Tandon
- Department of Radiology, University College of Medical Sciences & Guru Teg Bahadur, Delhi, India
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Diguisto C, Piver E, Gouge AL, Eboue F, Vaillant CL, Maréchaud M, Goua V, Giraudeau B, Perrotin F. First trimester uterine artery Doppler, sFlt-1 and PlGF to predict preeclampsia in a high-risk population. J Matern Fetal Neonatal Med 2017; 30:1514-1519. [DOI: 10.1080/14767058.2016.1183631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Caroline Diguisto
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, 2 Boulevard Tonnellé, Tours Cedex 9, France
- Department of Medicine, University François Rabelais, Tours, France
| | - Eric Piver
- Department of Medicine, University François Rabelais, Tours, France
- Department of Biochemistry, University Hospital Tours, Tours, France
| | | | - Florence Eboue
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, 2 Boulevard Tonnellé, Tours Cedex 9, France
- Maternité Notre Dame de Bon Secours, Groupe Hospitalier Saint Joseph, Paris, France
| | | | - Martine Maréchaud
- Department of Obstetrics, University Hospital of Poitiers, Poitiers, France
| | - Valérie Goua
- Department of Obstetrics, University Hospital of Poitiers, Poitiers, France
| | - Bruno Giraudeau
- Department of Medicine, University François Rabelais, Tours, France
- INSERM CIC 1415, University Hospital Tours, Tours, France
| | - Franck Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, 2 Boulevard Tonnellé, Tours Cedex 9, France
- Department of Medicine, University François Rabelais, Tours, France
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Vieira MC, Poston L, Fyfe E, Gillett A, Kenny LC, Roberts CT, Baker PN, Myers JE, Walker JJ, McCowan LM, North RA, Pasupathy D. Clinical and biochemical factors associated with preeclampsia in women with obesity. Obesity (Silver Spring) 2017; 25:460-467. [PMID: 28008746 DOI: 10.1002/oby.21715] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/23/2016] [Accepted: 11/02/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare early pregnancy clinical and biomarker risk factors for later development of preeclampsia between women with obesity (body mass index, BMI ≥30 kg/m2 ) and those with a normal BMI (20-25 kg/m2 ). METHODS In 3,940 eligible nulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study, a total of 53 biomarkers of glucose and lipid metabolism, placental function, and known markers of preeclampsia were measured at 14 to 16 weeks' gestation. Logistic regression was performed to identify clinical and biomarker risk factors for preeclampsia in women with and without obesity. RESULTS Among 834 women with obesity and 3,106 with a normal BMI, 77 (9.2%) and 105 (3.4%) developed preeclampsia, respectively. In women with obesity, risk factors included a family history of thrombotic disease, low plasma placental growth factor, and higher uterine artery resistance index at 20 weeks. In women with a normal BMI, a family history of preeclampsia or gestational hypertension, mean arterial blood pressure, plasma endoglin and cystatin C, and uterine artery resistance index were associated with preeclampsia, while high fruit intake was protective. CONCLUSIONS Women with obesity and a normal BMI have different early pregnancy clinical and biomarker risk factors for preeclampsia.
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Affiliation(s)
- Matias C Vieira
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Lucilla Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Elaine Fyfe
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alexandra Gillett
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Claire T Roberts
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, Adelaide, South Australia
| | - Philip N Baker
- College of Medicine, Biological Sciences & Psychology, University of Leicester, UK
| | - Jenny E Myers
- Division of Developmental Biology, School of Medical Sciences, The Faculty of Biology Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, UK
| | - James J Walker
- Department of Obstetrics and Gynaecology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, UK
| | - Lesley M McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robyn A North
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Dharmintra Pasupathy
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
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Herrera TT, Garcia JL, Britton GB. Blood-based biomarkers of adverse perinatal outcomes in maternal obesity. J Matern Fetal Neonatal Med 2017; 30:2991-2997. [PMID: 27936994 DOI: 10.1080/14767058.2016.1271406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Increasing maternal weight has been shown to predict adverse perinatal outcome, including increases in the relative risk of fetal death, stillbirth, neonatal death, perinatal death and infant death. In order to better understand the pathophysiological factors associated with obesity during pregnancy, the role of biomarkers associated with adverse outcomes in obese pregnant women is under investigation. The purpose of this review study was to examine potential biomarkers that could serve as effective screening strategies in obese pregnant women to reduce fetal and neonatal morbidity, as well as maternal morbidity. METHODS Electronic databases (Pubmed, Embase) were searched for previously published research studies that investigated biomarkers associated with perinatal outcomes in obese pregnant women and the putative mechanisms underlying biomarker effects on pregnancy outcomes. RESULTS It is evident that while several biomarkers predict perinatal complications in obese pregnant women, none fulfilled the criteria to be considered clinically useful. CONCLUSION There is a critical need for reliable blood-based biomarkers associated with an increased risk of adverse perinatal outcomes in obese pregnant women.
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Affiliation(s)
- Tania T Herrera
- a Department of Obstetrics and Gynecology, Maternal Fetal Medicine Center , Hospital Punta Pacifica, Affiliate of John Hopkins Medicine International , Calle Darién , Panamá
| | - Jillian L Garcia
- b University of Illinois College of Medicine , Chicago , IL , USA
| | - Gabrielle B Britton
- c Centro de Neurociencias y Unidad de Investigación Clínica , Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP) , Clayton , Panamá
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Spradley FT. Metabolic abnormalities and obesity's impact on the risk for developing preeclampsia. Am J Physiol Regul Integr Comp Physiol 2016; 312:R5-R12. [PMID: 27903516 DOI: 10.1152/ajpregu.00440.2016] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/11/2016] [Accepted: 11/29/2016] [Indexed: 02/07/2023]
Abstract
Preeclampsia (PE), a hypertensive disorder of pregnancy, is increasing as a major contributor to perinatal and long-term morbidity of mother and offspring. PE is thought to originate from ischemic insults in the placenta driving the release of prohypertensive anti-angiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1)] and proinflammatory [tumor necrosis factor-α (TNF-α)] factors into the maternal circulation. Whereas the increased incidence of PE is hypothesized to be largely due to the obesity pandemic, the mechanisms whereby obesity increases this risk are unknown. The maternal endothelium is targeted by placental and adipose tissue-derived factors like sFlt-1 and TNF-α that promote hypertension during pregnancy, resulting in vascular dysfunction and hypertension. Interestingly, not all obese pregnant women develop PE. Data suggest that obese pregnant women with the greatest metabolic abnormalities have the highest incidence of PE. Identifying obesity-related mechanisms driving hypertension in some obese pregnant women and pathways that protect normotensive obese pregnant women, may uncover novel protocols to treat PE. Metabolic abnormalities, such as increased circulating leptin, glucose, insulin, and lipids, are likely to increase the risk for PE in obese women. It is not only important to understand whether each of these metabolic factors contribute to the increased risk for PE in obesity, but also their cumulative effects. This is particularly relevant to obese pregnant women with gestational diabetes mellitus (GDM) where all of these factors are increased and the risk for PE is highest. It is speculated that these factors potentiate the anti-angiogenic and proinflammatory mechanisms of placental ischemia-induced vascular dysfunction thereby contributing to the increasing incidence of PE.
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Affiliation(s)
- Frank T Spradley
- Department of Surgery, Department of Physiology and Biophysics, Cardiovascular-Renal Research Center, Women's Health Research Center, The University of Mississippi Medical Center, Jackson, Mississippi
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Li L, Zheng Y, Zhu Y, Li J. Serum biomarkers combined with uterine artery Doppler in prediction of preeclampsia. Exp Ther Med 2016; 12:2515-2520. [PMID: 27698752 PMCID: PMC5038468 DOI: 10.3892/etm.2016.3625] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/18/2016] [Indexed: 12/20/2022] Open
Abstract
First-trimester screening may be a major advantage over a second-trimester approach since it opens prospects for early and more efficient interventions. The aim of the current study was to evaluate whether the measurement of maternal serum inhibin A, activin A and placental growth factor (PlGF) at three to four months gestation with the second-trimester uterine artery pulsatility index (PI) are useful in predicting preeclampsia in a group of nulliparous women. All the patients also underwent uterine artery Doppler examination to measure the PI at 22–24 weeks gestation. Inhibin A, activin A and PlGF were measured using an ELISA by an examiner who was blinded to the pregnancy outcome. Thirty-eight cases with preeclampsia and 100 controls were analyzed. Second-trimester uterine artery PI and marker levels were expressed as multiples of the median (MoM). The uterine artery PI was increased in pregnancies with preeclampsia compared with controls. In pregnancies that developed preeclampsia, the uterine artery PI was increased (1.61±0.047 vs. 1.02±0.049, P<0.001), as was the level of inhibin A (1.72±0.023 vs. 1.03±0.063, P<0.001) and the level of activin A (1.68±0.38 vs. 1.06±0.42, P<0.001) compared with the controls. In contrast, the level of PlGF was decreased in pregnancies that developed preeclampsia compared with the controls (0.69±0.23 vs. 1.00±0.26, P<0.001). A combination of activin A, PlGF and uterine artery PI gave an AUC of 0.915 (95% CI, 0.812–0.928; P<0.001) with a sensitivity of 91% at a specificity of 82%. In our study, we demonstrated that both serum inhibin A and activin A levels were increased, while the PlGF level was decreased in the early second-trimester in women who developed preeclampsia.
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Affiliation(s)
- Lijie Li
- Department of Obstetrics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Yanmei Zheng
- Department of Obstetrics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Ying Zhu
- Department of Obstetrics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Jianchun Li
- Department of Ultrasonic Diagnosis, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
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Spradley FT, Palei AC, Granger JP. Increased risk for the development of preeclampsia in obese pregnancies: weighing in on the mechanisms. Am J Physiol Regul Integr Comp Physiol 2015; 309:R1326-43. [PMID: 26447211 DOI: 10.1152/ajpregu.00178.2015] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/28/2015] [Indexed: 11/22/2022]
Abstract
Preeclampsia (PE) is a pregnancy-specific disorder typically presenting as new-onset hypertension and proteinuria. While numerous epidemiological studies have demonstrated that obesity increases the risk of PE, the mechanisms have yet to be fully elucidated. Growing evidence from animal and human studies implicate placental ischemia in the etiology of this maternal syndrome. It is thought that placental ischemia is brought about by dysfunctional cytotrophoblast migration and invasion into the uterus and subsequent lack of spiral arteriole widening and placental perfusion. Placental ischemia/hypoxia stimulates the release of soluble placental factors into the maternal circulation where they cause endothelial dysfunction, particularly in the kidney, to elicit the clinical manifestations of PE. The most recognized of these factors are the anti-angiogenic sFlt-1 and pro-inflammatory TNF-α and AT1-AA, which promote endothelial dysfunction by reducing levels of the provasodilator nitric oxide and stimulating production of the potent vasoconstrictor endothelin-1 and reactive oxygen species. We hypothesize that obesity-related metabolic factors increase the risk for developing PE by impacting various stages in the pathogenesis of PE, namely, 1) cytotrophoblast migration and placental ischemia; 2) release of soluble placental factors into the maternal circulation; and 3) maternal endothelial and vascular dysfunction. This review will summarize the current experimental evidence supporting the concept that obesity and metabolic factors like lipids, insulin, glucose, and leptin affect placental function and increase the risk for developing hypertension in pregnancy by reducing placental perfusion; enhancing placental release of soluble factors; and by increasing the sensitivity of the maternal vasculature to placental ischemia-induced soluble factors.
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Affiliation(s)
- Frank T Spradley
- Department of Physiology and Biophysics, Cardiovascular-Renal Research Center, Women's Health Research Center, The University of Mississippi Medical Center, Jackson, Mississippi
| | - Ana C Palei
- Department of Physiology and Biophysics, Cardiovascular-Renal Research Center, Women's Health Research Center, The University of Mississippi Medical Center, Jackson, Mississippi
| | - Joey P Granger
- Department of Physiology and Biophysics, Cardiovascular-Renal Research Center, Women's Health Research Center, The University of Mississippi Medical Center, Jackson, Mississippi
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