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Sgayer I, Cohen M, Rosenbaum Y, Kruzel-Davila E, Shasha-Lavsky H, Lowenstein L, Wolf MF. Obstetrical outcomes of women with new-onset isolated proteinuria diagnosed after 24 weeks' gestation. Arch Gynecol Obstet 2024; 310:1063-1070. [PMID: 38739292 DOI: 10.1007/s00404-024-07535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To assess a possible association between marked proteinuria and the risk of preeclampsia with severe features, as defined by the American College of Obstetricians and Gynecologists. METHODS This retrospective study included data recorded at a tertiary university-affiliated hospital between 2017 and 2022. Women at or beyond 24 weeks of gestation with proteinuria (protein levels > 300 mg in a 24 h urine collection) and normal blood pressure during the initial 48 h of admission were included. Obstetrical and neonatal outcomes were compared between women with mild proteinuria (300-1000 mg/24 h) and marked proteinuria (≥ 1000 mg/24 h). RESULTS Among the women with marked proteinuria (n = 48) compared to those with mild proteinuria (n = 108), the incidences were higher of preeclampsia (50.0% vs. 22.2%, p = 0.001) and of preeclampsia with severe features (18.8% vs. 2.8%, p < 0.001). In multivariate analysis that adjusted for maternal age, primiparity, multiple pregnancy, uric acid level > 6 mg/dL and aspirin treatment, marked proteinuria was a risk factor for preeclampsia with severe features (adjusted odds ratio [aOR] = 10.2, confidence interval [CI] 95% 1.9-54.0, p = 0.007) and for small-for-gestational-age infants (aOR = 2.4, 95% CI 1.02-5.6, p = 0.001). Among women with marked compared to mild proteinuria, rates were also higher of labor induction (58.3% vs. 25.9%, p < 0.001), indicated preterm delivery (41.7% vs. 25.0%, p = 0.04) and admission to the neonatal intensive care unit (44.1% vs. 25.8%, p = 0.017). CONCLUSIONS Women with marked compared to mild isolated proteinuria showed higher risk of developing preeclampsia with severe features and of delivering small-for-gestational-age neonates.
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Affiliation(s)
- Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Milton Cohen
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Etty Kruzel-Davila
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Nephrology Department, Galilee Medical Center, Nahariya, Israel
| | - Hadas Shasha-Lavsky
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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Ellerbrock J, Hubers E, Ghossein-Doha C, Schiffer V, Alers RJ, Jorissen L, van Neer J, Zelis M, Janssen E, Landewé-Cleuren S, van Haarlem A, Kramer B, Spaanderman M. Second-Trimester Constituents of the Metabolic Syndrome and Pregnancy Outcome: An Observational Cohort Study. Nutrients 2022; 14:nu14142933. [PMID: 35889890 PMCID: PMC9325303 DOI: 10.3390/nu14142933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Gestational diabetes mellitus (GDM) increases the risk of type 2 diabetes mellitus and cardiovascular disease (CVD) in women in later life. In the general population, metabolic syndrome (MetS) shows identical associations. The aim of this study was to evaluate the association between GDM, constituents of MetS and pregnancy outcomes. Methods: Of 2041 pregnant women undergoing an oral glucose tolerance test (OGTT) between 22 and 30 weeks of gestation, data were collected to evaluate the constituents of MetS. Odds ratios (ORs) were calculated to determine the associations between MetS and pregnancy outcomes. Results: GDM and obesity did not affect the risk of fetal growth abnormalities (SGA/LGA), preterm birth or preeclampsia (PE). Hypertension significantly increased the risk of SGA (OR—1.59), PE (OR—3.14), and preterm birth <37 weeks (OR—2.17) and <34 weeks (OR—2.96) and reduced the occurrence of LGA (OR—0.46). Dyslipidemia increased the risk of PE (OR—2.25), while proteinuria increased the risk of PE (OR—12.64) and preterm birth (OR—4.72). Having ≥2 constituents increased the risk of PE and preterm birth. Conclusions: Constituents of metabolic syndrome, rather than treating impaired glucose handling, increased the risk of preeclampsia, altered fetal growth and preterm birth. Obesity was not related to adverse outcomes.
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Affiliation(s)
- Jonas Ellerbrock
- School for Oncology and Developmental Biology (GROW), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (C.G.-D.); (V.S.); (R.-J.A.); (L.J.); (E.J.); (M.S.)
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, H. Dunantstraat 5, 6419 PC Heerlen, The Netherlands;
- Correspondence: ; Tel.: +31-433874145
| | - Esmee Hubers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
| | - Chahinda Ghossein-Doha
- School for Oncology and Developmental Biology (GROW), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (C.G.-D.); (V.S.); (R.-J.A.); (L.J.); (E.J.); (M.S.)
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 29, 6229 HX Maastricht, The Netherlands
| | - Veronique Schiffer
- School for Oncology and Developmental Biology (GROW), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (C.G.-D.); (V.S.); (R.-J.A.); (L.J.); (E.J.); (M.S.)
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, H. Dunantstraat 5, 6419 PC Heerlen, The Netherlands;
| | - Robert-Jan Alers
- School for Oncology and Developmental Biology (GROW), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (C.G.-D.); (V.S.); (R.-J.A.); (L.J.); (E.J.); (M.S.)
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P. Debyelaan 29, 6229 HX Maastricht, The Netherlands;
| | - Laura Jorissen
- School for Oncology and Developmental Biology (GROW), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (C.G.-D.); (V.S.); (R.-J.A.); (L.J.); (E.J.); (M.S.)
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P. Debyelaan 29, 6229 HX Maastricht, The Netherlands;
| | - Jolijn van Neer
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P. Debyelaan 29, 6229 HX Maastricht, The Netherlands;
| | - Maartje Zelis
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, H. Dunantstraat 5, 6419 PC Heerlen, The Netherlands;
| | - Emma Janssen
- School for Oncology and Developmental Biology (GROW), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (C.G.-D.); (V.S.); (R.-J.A.); (L.J.); (E.J.); (M.S.)
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P. Debyelaan 29, 6229 HX Maastricht, The Netherlands;
| | - Sabine Landewé-Cleuren
- Department of Internal Medicine, Maastricht University Medical Center, P. Debyelaan 29, 6229 HX Maastricht, The Netherlands; (S.L.-C.); (A.v.H.)
| | - Annemie van Haarlem
- Department of Internal Medicine, Maastricht University Medical Center, P. Debyelaan 29, 6229 HX Maastricht, The Netherlands; (S.L.-C.); (A.v.H.)
| | - Boris Kramer
- Department of Pediatrics, Maastricht University Medical Center, P. Debyelaan 29, 6229 HX Maastricht, The Netherlands;
| | - Marc Spaanderman
- School for Oncology and Developmental Biology (GROW), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (C.G.-D.); (V.S.); (R.-J.A.); (L.J.); (E.J.); (M.S.)
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P. Debyelaan 29, 6229 HX Maastricht, The Netherlands;
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Higami S, Kondo E, Shibata E, Fujimoto S, Hagimoto M, Urakawa R, Matsumiya T, Uchimura T, Sakuragi T, Amimoto S, Kuwazuru T, Mori H, Aramaki S, Yoshino K. A case of preeclampsia developing massive ascites after delivery. Clin Case Rep 2022; 10:e05830. [PMID: 35600020 PMCID: PMC9107923 DOI: 10.1002/ccr3.5830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/26/2022] [Accepted: 04/05/2022] [Indexed: 11/11/2022] Open
Abstract
We experienced a case of preeclampsia in which massive ascites became apparent in the postpartum period. The patient had isolated proteinuria without hypertension before delivery. The infant had fatal growth restriction and neonatal distress. Massive ascites and isolated proteinuria are important symptoms for predicting the aggravation of PE.
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Affiliation(s)
- Shota Higami
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Emi Kondo
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Eiji Shibata
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Shigeki Fujimoto
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Marina Hagimoto
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Ruka Urakawa
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Tamaki Matsumiya
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Takayuki Uchimura
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Toshihide Sakuragi
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Shoko Amimoto
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Tomoichiro Kuwazuru
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Hiroshi Mori
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Satoshi Aramaki
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
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Chadha A, Tayade S. Urinary Protein-to-Creatinine Ratio: An Indicator of Adverse Clinical Outcomes in Preeclampsia With Proteinuria. Cureus 2022; 14:e23341. [PMID: 35464597 PMCID: PMC9017718 DOI: 10.7759/cureus.23341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background and objective Preeclampsia is a major contributor to morbidity and mortality among pregnant women and leads to poor fetomaternal outcomes. Predicting fetal and maternal health outcomes will enable early interventions so as to reduce further damage. Various biochemical tests like beta-human chorionic gonadotropin (β-HCG), inhibin A, activin A, pregnancy-associated plasma protein-A (PAPP-A), fetal DNA, and color Doppler have been studied for their ability to predict fetal and maternal health outcomes; however, most of these tests are complex and costly. Among the many variables that indicate the severity of outcomes in hypertensive disorders of pregnancy, the urinary protein-to-creatinine ratio (UPCR) is an important index. The aim of the study was to find out the association between UPCR and fetomaternal outcomes in preeclampsia. Material and methods A prospective observational study was conducted among 141 women with preeclampsia presenting with proteinuria, who were divided into two groups: 11% with UPCR <0.3 and 89% with UPCR ≥0.3. These patients were followed up till delivery to look for maternal and fetal outcomes. Results The sensitivity of UPCR for predicting adverse maternal outcomes was 79.37% (95% CI: 71.25-86.06), specificity was 46.67% (95% CI: 21.27-73.41), positive predictive value (PPV) was 92.59% (95% CI: 88.53-95.29), negative predictive value (NPV) was 21.21% (95% CI: 12.43-33.81), and the accuracy was 75.79% (95% CI: 67.97-82.69); for adverse fetal outcomes, the sensitivity was 76.98% (95% CI: 68.65-84.01), specificity was 13.33% (95% CI: 1.66-40.46), PPV was 88.18% (95% CI: 85.69-90.29), NPV was 6.45% (95% CI: 1.79-20.67), and the accuracy was 70.21% (95% CI: 61.94-77.62). Conclusion Based on our findings, UPCR is a simple laboratory tool that can help predict abnormal fetomaternal outcomes in preeclampsia with good sensitivity and PPV and can be used as an adjunct to assist in clinical decisions.
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Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. Am J Obstet Gynecol 2022; 226:S819-S834. [PMID: 32882208 DOI: 10.1016/j.ajog.2020.08.108] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022]
Abstract
Qualitative and quantitative measurement of urine protein excretion is one of the most common tests performed during pregnancy. For more than 100 years, proteinuria was necessary for the diagnosis of preeclampsia, but recent guidelines recommend that proteinuria is sufficient but not necessary for the diagnosis. Still, in clinical practice, most patients with gestational hypertension will be diagnosed as having preeclampsia based on the presence of proteinuria. Although the reference standard for measuring urinary protein excretion is a 24-hour urine collection, spot urine protein-to-creatinine ratio is a reasonable "rule-out" test for proteinuria. Urine dipstick screening for proteinuria does not provide any clinical benefit and should not be used to diagnose proteinuria. The classic cutoff cited to define proteinuria during pregnancy is a value of >300 mg/24 hours or a urine protein-to-creatinine ratio of at least 0.3. Using this cutoff, the rate of isolated proteinuria in pregnancy may reach 8%, whereas preeclampsia occurs among 3% to 8% of pregnancies. Although this threshold is widely accepted, its origin is not based on evidence on adverse pregnancy outcomes but rather on expert opinion and results of small studies. After reviewing the available data, the most important factor that influences maternal and neonatal outcome is the severity of blood pressures and presence of end organ damage, rather than the excess protein excretion. Because the management of gestational hypertension and preeclampsia without severe features is almost identical in frequency of surveillance and timing of delivery, the separation into 2 disorders is unnecessary. If the management of women with gestational hypertension with a positive assessment of proteinuria will not change, we believe that urine assessment for proteinuria is unnecessary in women who develop new-onset blood pressure at or after 20 weeks' gestation. Furthermore, we do not recommend repeated measurement of proteinuria for women with preeclampsia, the amount of proteinuria does not seem to be related to poor maternal and neonatal outcomes, and monitoring proteinuria may lead to unindicated preterm deliveries and related neonatal complications. Our current diagnosis of preeclampsia in women with chronic kidney disease may be based on a change in protein excretion, a baseline protein excretion evaluation is critical in certain conditions such as chronic hypertension, diabetes, and autoimmune or other renal disorders. The current definition of superimposed preeclampsia possesses a diagnostic dilemma, and it is unclear whether a change in the baseline proteinuria reflects another systemic disease such as preeclampsia or whether women with chronic disease such as chronic hypertension or diabetes will experience a different "normal" pattern of protein excretion during pregnancy. Finally, limited data are available regarding angiogenic and other biomarkers in women with chronic kidney disease as a potential aid in distinguishing the worsening of baseline chronic kidney disease and chronic hypertension from superimposed preeclampsia.
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Shinar S, Melamed N, Abdulaziz KE, Ray JG, Riddell C, Barrett J, Murray-Davis B, Mawjee K, McDonald SD, Geary M, Berger H. Changes in rate of preterm birth and adverse pregnancy outcomes attributed to preeclampsia after introduction of a refined definition of preeclampsia: A population-based study. Acta Obstet Gynecol Scand 2021; 100:1627-1635. [PMID: 34043808 DOI: 10.1111/aogs.14199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Since 2013, various guidelines for hypertension in pregnancy have been refined, no longer requiring proteinuria as a requisite criterion for preeclampsia. We aimed to evaluate the impact of the new definition on preterm birth (PTB) and adverse pregnancy outcomes. MATERIAL AND METHODS Women delivering in Ontario between April 2012 and November 2016 were included. Delivery <24+0/7 weeks, major fetal anomalies or preexisting renal disease were excluded. The primary outcome was livebirth <37, <34 or <32 weeks. Rates, adjusted rate ratios (aRR) and ratio of the rate ratio (RRR) were used to compare outcomes in the 2 years after the new Society of Obstetricians and Gynaecologists of Canada (SOGC) guideline (December 2014-November 2016; period 2) vs the 2 years before (April 2012-March 2014; period 1), among women with and without preeclampsia. RESULTS In all, 268 543 and 267 964 births in periods 1 & 2, respectively, were included. Respective preeclampsia rates increased significantly from 3.9% to 4.4% (p < 0.001), with no change in maternal morbidity rates. In preeclamptic women, respective rates of PTB <37 weeks were 21.0% and 20.7% (aRR 1.01, 95% confidence interval [CI] 1.00-1.02), with significant aRR for PTB <34 (0.86, 95% CI 0.77-0.96) and <32 weeks (0.79, 95% CI 0.67-0.94). A similar aRR was observed in women without preeclampsia. In preeclamptic women, composite severe neonatal morbidity decreased after guideline change (aRR 0.95, 95% CI 0.91-0.99), a finding not observed in women without preeclampsia (RRR 0.95, 95% CI 0.91-0.99). CONCLUSIONS The new definition of preeclampsia was associated with increased disease rates, a modest reduction in adverse neonatal outcomes and no change in maternal outcomes.
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Affiliation(s)
- Shiri Shinar
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nir Melamed
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Joel G Ray
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, Saint Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Jon Barrett
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Beth Murray-Davis
- Department of Obstetrics and Gynecology, Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Karizma Mawjee
- Department of Obstetrics and Gynaecology, Saint Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics & Gynecology, Radiology & Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michael Geary
- Department of Obstetrics & Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Howard Berger
- Department of Obstetrics and Gynaecology, Saint Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Vidaeff AC, Saade GR, Sibai BM. Preeclampsia: The Need for a Biological Definition and Diagnosis. Am J Perinatol 2021; 38:976-982. [PMID: 31986536 DOI: 10.1055/s-0039-1701023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The centuries-old approach to the prevention of eclampsia and its associated maternal morbidity and mortality is based on the recognition of the presence of premonitory signs and symptoms such as hypertension and proteinuria. The spectrum of preceding signs and symptoms came to be known as preeclampsia, which is debatably considered to be an early stage on a clinical continuum possibly leading to eclampsia. The premonitory signs and symptoms were then construed as diagnostic criteria for the poorly understood syndrome of preeclampsia, and this led to a perpetual debate that remains subject to wide disagreement and periodic updates. In this commentary, we will draw attention to the fact that the criteria for preeclampsia should be viewed from the prism of a screening test rather than as diagnostic of a condition in itself. Focusing research on developing better diagnostic and screening methods for what is clinically important, namely maternal and perinatal morbidity and mortality from hypertensive disorders of pregnancy, a long overdue upgrade from what was possible centuries ago, will ultimately lead to better management approaches to what really matters.
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Affiliation(s)
- Alex C Vidaeff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Baha M Sibai
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, UT Health, Houston, Texas
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Tzur Y, Rimon E, Geva G, Herzlich J, Kupferminc MJ. Progression from isolated gestational proteinuria to preeclampsia with severe features. Acta Obstet Gynecol Scand 2021; 100:1620-1626. [PMID: 34043807 DOI: 10.1111/aogs.14198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The association between the degree of isolated gestational proteinuria and preeclampsia with severe features and other placental-mediated complications is controversial. The aim of this study was to evaluate whether a higher isolated proteinuria level is associated with an increased frequency of preeclampsia with severe features. MATERIAL AND METHODS This retrospective cohort study included pregnant women who were past 24 weeks of gestation and were diagnosed as having new-onset proteinuria ≥300 mg in a 24-h urine collection. Exclusion criteria included diagnosis of preeclampsia within 72 h from admission, chronic renal disease or chronic hypertension. The study population was divided into tertiles by proteinuria level and the association with preeclampsia with severe features was assessed in both bivariable and multivariable analysis. The main outcome measures was the development of preeclampsia with severe features. RESULTS Overall, 165 women were diagnosed with isolated gestational proteinuria, and 38 (23.0%) of them developed preeclampsia with severe features. Women in the increasing proteinuria tertile were more likely to develop preeclampsia with severe features (5.5%, 21.8%, 41.8%, respectively; p = 0.004). A multivariable logistic regression model controlling for background characteristics as well as gestational age at diagnosis, blood pressure, and kidney and liver function tests showed an increased risk of 14% to develop preeclampsia with severe features for every 500-mg rise in proteinuria level (adjusted odds ratio = 1.14, 95% confidence interval 1.03-1.27). CONCLUSIONS A higher isolated gestational proteinuria level was associated with an increased risk to develop preeclampsia with severe features among pregnant women past 24 weeks of gestation.
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Affiliation(s)
- Yossi Tzur
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
| | - Eli Rimon
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
| | - Gil Geva
- The Hebrew University Hadassah Medical School, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jacky Herzlich
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
| | - Michael J Kupferminc
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
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Lei T, Qiu T, Liao W, Li K, Lai X, Huang H, Yuan R, Chen L. Proteinuria may be an indicator of adverse pregnancy outcomes in patients with preeclampsia: a retrospective study. Reprod Biol Endocrinol 2021; 19:71. [PMID: 33990220 PMCID: PMC8120921 DOI: 10.1186/s12958-021-00751-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Proteinuria is one of the common manifestations of patients with preeclampsia (PE), but whether the severity of proteinuria is related to the pregnancy outcome of patients with preeclampsia remains controversial. The present study aimed to determine the relationship between 24-h proteinuria and adverse outcomes in patients with preeclampsia. METHODS The present retrospective study included 329 pregnant women in Chongqing, China. Patients were divided into PE group and non-PE group. PE group was stratified into three subgroups based on the level of 24-h proteinuria. Correlation analysis was used to analyze the correlation between biochemical indexes and adverse pregnancy outcome, and Logistic regression analysis was used to analyze the risk factors of adverse pregnancy outcome. The receiver operating characteristic curve (ROC) was used to evaluate the ability of 24-h urinary protein to distinguish the adverse pregnancy outcome in patients with preeclampsia. RESULTS (1) Between PE and non-PE group, cesarean section rate in PE group was significantly higher than that in non-PE group (84.4% vs. 25.9%, p < 0.001). Laboratory findings such as uric acid and creatinine level in PE group were higher than those in non-PE group. (2) Among mild (proteinuria < 0.3 g/24 h), moderate (0.3 g/24 h ≦ proteinuria < 2 g/24 h) and massive (proteinuria ≧ 2 g/24 h) groups, the frequencies of induced labor (p = 0.006) and stillbirth (p = 0.002) increased with the increase of 24-h proteinuria. (3) Adverse outcomes were positively correlated with 24-h proteinuria (adverse maternal outcomes: r = 0.239, p = 0.002; adverse fetal outcomes: r = 0.336, p < 0.001). (4) The best 24-h proteinuria cutoff values to determine stillbirth, premature and fetal distress were 3965.0 mg/24 h, 984.75 mg/24 h and 1503.85 mg/24 h and their odds ratio (95% confidence interval) were 12.46 (3.46-44.88), 2.48 (1.15-5.37) and 10.02 (2.14-46.80), respectively. CONCLUSIONS The severity of 24-h proteinuia may forecast adverse outcomes in women with preeclampsia. We suggest proteinuria should be retained as one of the monitoring indexes in patients with preeclampsia. TRIAL REGISTRATION Retrospectively registered. (LTMCMTS202001).
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Affiliation(s)
- Tingting Lei
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Ting Qiu
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Wanyu Liao
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Kangjie Li
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xinyue Lai
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Hongbo Huang
- Second Clinical College, Chongqing Medical University, Chongqing, China
| | - Rui Yuan
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing Univ-ersity Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Ling Chen
- The Center of Experimental Teaching Management, Chongqing Medical University, Chongqing, China.
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Bajpai D. Preeclampsia for the Nephrologist: Current Understanding in Diagnosis, Management, and Long-term Outcomes. Adv Chronic Kidney Dis 2020; 27:540-550. [PMID: 33328071 DOI: 10.1053/j.ackd.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/11/2022]
Abstract
Preeclampsia is a multisystem progressive disorder of pregnancy that can be potentially catastrophic for the mother and the fetus. It involves complex perturbations of the kidney and systemic physiology, along with long-term effects on vascular and kidney health. Thus, the nephrologist plays a key role in the peripartum and long-term management of preeclampsia. Recent translational research has improved our understanding of its pathophysiology, and there is hope for novel therapies. In this review, we discuss the evolution of diagnostic criteria and dilemmas in the diagnosis of hypertensive disorders in pregnancy. We summarize the advances in the pathogenesis and prediction of preeclampsia. We describe the management and prevention of preeclampsia focusing specially on the forthcoming strategies from the nephrologist's perspective. We address the evidence regarding long-term outcomes for the mother and the child. We end with exploring areas warranting future research.
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11
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Li S, Li H, Li C, He X, Wang Y. Development and Validation of a Nomogram for Predicting the Risk of Pregnancy-Induced Hypertension: A Retrospective Cohort Study. J Womens Health (Larchmt) 2020; 30:1182-1191. [PMID: 33121332 DOI: 10.1089/jwh.2020.8575] [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: 11/12/2022] Open
Abstract
Objective: To develop and validate a prediction model for identifying pregnant women at risk of developing pregnancy-induced hypertension (PIH) to guide treatment decision and classification of management. Methods: This study retrospectively enrolled 907 consecutive pregnant women with de novo hypertension from the Antenatal Care Center of Henan Provincial People's Hospital between June 1, 2018 and May 31, 2019. The cohort was randomly divided into two subgroups: the development cohort (n = 635) and validation cohort (n = 272). Univariate analysis and backward elimination of multivariate logistic regression analyses were utilized to identify predictive factors, and a nomogram was established. The performance was assessed using the area under the curve (AUC), the mean AUC of k-fold cross-validation, and calibration plots. Based on the classification and regression tree model, risk classification was performed. Results: The score included five commonly available predictors: body mass index, proteinuria, age, uric acid, and mean arterial pressure (BPAUM score). When applied to internal validation, the score revealed good discrimination with stratified fivefold cross-validation in the development cohort (AUC = 0.91) and validation cohort (AUC: 0.89) at fixed 10% false-positive rates, and the calibration plots showed good calibration. The total score point was divided into three risk classifications: low risk (0 - 179 points), medium risk (179 - 204 points), and high risk (>204 points). Conclusions: This study established a prediction model for predicting PIH, which could be used in clinical decision-making to improve maternal health and birth outcomes.
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Affiliation(s)
- Shanshan Li
- Department of Obstetrics and Gynecology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Hongran Li
- Department of Obstetrics and Gynecology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Chunmei Li
- Department of Obstetrics and Gynecology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xinmei He
- Department of Obstetrics and Gynecology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yu Wang
- Department of Obstetrics and Gynecology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
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12
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Situmorang PC, Ilyas S, Hutahaean S. Study of Combination of Nanoherbal Andaliman (Zanthoxylum acanthopodium) and Extra Virgin Olive Oil (EVOO) Effects in the Expression of Malondialdehyde (MDA), Heat Shock Protein-70 (HSP70) and Placental Histology of Preeclamptic Rats. PHARMACEUTICAL SCIENCES 2019. [DOI: 10.15171/ps.2019.37] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Pre-eclampsia (PE) contributes to the second cause of maternal death in Indonesia. Andaliman is a typical spice of the Batak ethnic in Northern Sumatera Province, Indonesia. This study aimed to explore the potential of novel herbal medicine compound of nanoherbal andaliman and extra virgin olive oil (EVOO) as PE treatment. Methods: Nanoherbal andaliman was generated using High-energy Milling (HEM). The treatments were divided into the following five groups: K- (control): pregnant rats; K+: PE model rats; P1: PE model rats + 0.45 g of EVOO/200 g BW on the 13th–19th day of pregnancy; P2: PE model rats + nanoherbal andaliman 100 mg/200 g BW on the 13th– 19th day of pregnancy; and P3: PE model rats + combination of 0.45 EVOO/200 g BW and nanoherbal andaliman 100 mg/200 g BW on the 13th–19th day of pregnancy. Rats were dissected on the 20th day of pregnancy. The observed parameters were blood pressure, proteinuria, malondialdehyde (MDA), Heat Shock Protein-70 HSP-70 and histology of placenta. Results: A significant difference was noticed (p<0.05) in blood pressure, proteinuria, foetal weight, haematocrit, erythrocytes and trophoblastic cells after the administration of combined nanoherbal andaliman and EVOO. No significant differences in placental weight, foetal number, leukocytes, MDA and HSP-70 were found (p>0.05). Conclusion: The combination of nanoherbal andaliman and EVOO decreased systolic blood pressure and induced the expression of MDA and HSP-70, as well as placental histology of pre-eclamptic rats.
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Affiliation(s)
- Putri Cahaya Situmorang
- Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Sumatera Utara, Medan, Indonesia
| | - Syafruddin Ilyas
- Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Sumatera Utara, Medan, Indonesia
| | - Salomo Hutahaean
- Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Sumatera Utara, Medan, Indonesia
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13
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Kreepala C, Srila-On A, Kitporntheranunt M, Anakkamatee W, Lawtongkum P, Wattanavaekin K. The Association Between GFR Evaluated by Serum Cystatin C and Proteinuria During Pregnancy. Kidney Int Rep 2019; 4:854-863. [PMID: 31194092 PMCID: PMC6551540 DOI: 10.1016/j.ekir.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Physiological changes in pregnancy result in increased cardiac output and renal blood flow, with a consequential increase in proteinuria. Data from studies of the relationship between proteinuria caused by isolated proteinuria and glomerular filtration rate (GFR) are still limited. The objective of this study was to investigate the effects of isolated proteinuria on the cystatin C–based GFR in the third trimester of pregnancy. Methods Data were collected from pregnant women in their third trimester whose serum creatinine levels were normal. The GFR of each participant was measured using serum cystatin C levels, and proteinuria was measured using urine protein–creatinine ratios. The participants were divided into 3 groups according to their level of proteinuria: normal (<150 mg/d), physiological (150–300 mg/d), and gestational (>300 mg/d). Changes in GFR were recorded for each group. Results The study included 89 participants, of whom 66.3% had levels of proteinuria that did not differ from that of the normal population (<150 mg/d). The incidence of physiological and gestational proteinuria was 21.4% and 12.4%, respectively. The results demonstrate that proteinuria >101.50 mg/d was significantly associated with declined estimated glomerular filtration rate (eGFR) (r = –0.34, P = 0.01). The analysis found that proteinuria >491.27 mg/d led to a risk of GFR <90 ml/min with an odds ratio of 12.69, P = 0.02 when adjusted for systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index. Conclusion This study suggests that the term “physiological proteinuria” is a misnomer. When used in the traditional manner, creatinine level has inadequate sensitivity to estimate GFR in pregnant women. We found that there is a significant decline in GFR when urine protein > 101.5 mg/d, which could be an early biomarker for renal pathology rather than pregnancy physiology, suggesting that further workup and precaution is required.
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Affiliation(s)
- Chatchai Kreepala
- Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, Thailand
| | - Atitaya Srila-On
- Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, Thailand
| | - Maethaphan Kitporntheranunt
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, Thailand
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Piccoli GB, Zakharova E, Attini R, Ibarra Hernandez M, Orozco Guillien A, Alrukhaimi M, Liu ZH, Ashuntantang G, Covella B, Cabiddu G, Li PKT, Garcia-Garcia G, Levin A. Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases. J Clin Med 2018; 7:E415. [PMID: 30400594 PMCID: PMC6262338 DOI: 10.3390/jcm7110415] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 10/28/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023] Open
Abstract
Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy.
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, 101000 Moscow, Russia.
- Nephrology, Moscow State University of Medicine and Dentistry, 101000 Moscow, Russia.
- Nephrology, Russian Medical Academy of Continuous Professional Education, 101000 Moscow, Russia.
| | - Rossella Attini
- Obstetrics, Department of Surgery, University of Torino, 10100 Torino, Italy.
| | - Margarita Ibarra Hernandez
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, Guadalajara, Jal 44100, Mexico.
| | | | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, P.O. Box 20170, Dubai, UAE.
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210000, China. zhihong--
| | - Gloria Ashuntantang
- Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, P.O. Box 337, Yaounde, Cameroon.
| | - Bianca Covella
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | | | - Philip Kam Tao Li
- Prince of Wales Hospital, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong.
| | - Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, Guadalajara, Jal 44100, Mexico.
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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Chung WH, To WWK. Outcome of pregnancy with new onset proteinuria and progression to pre-eclampsia: A retrospective analysis. Pregnancy Hypertens 2017; 12:174-177. [PMID: 29175169 DOI: 10.1016/j.preghy.2017.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/07/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine maternal and neonatal outcomes of gestational proteinuria, and to identify maternal characteristics for progression to pre-eclampsia. STUDY DESIGN Retrospective cohort. Included all pregnant women who delivered between Jan 2014-Feb 2017 with new onset proteinuria in a single obstetric unit. Demographic, maternal and neonatal outcomes were compared. RESULTS Eighteen (25%) out of 73 women with new onset gestational proteinuria developed pre-eclampsia. The incidence of gestational proteinuria was 0.54%. Compared with women that remained normotensive, those that developed hypertension had delivery at earlier gestation (p = .02), increased risk of fetal growth restriction (p = .01) and lower newborn birthweight (p = .002). Maximal proteinuria and fetal growth restriction were independent factors associated with development of pre-eclampsia. In particular, high proteinuria level ≥ 2 g/d constitute a major predictor for progression (p = .03). CONCLUSION Increased vigilance for antenatal surveillance is important in women with gestational proteinuria as a substantial portion progress to pre-eclampsia. Serial growth scan and proteinuria assay are suggested to predict possible pre-eclampsia development.
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Affiliation(s)
- Wai Hang Chung
- Department of Obstetrics and Gynecology, United Christian Hospital, Kwun Tong, Hong Kong.
| | - William Wing Kee To
- Department of Obstetrics and Gynecology, United Christian Hospital, Kwun Tong, Hong Kong.
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Chen H, Tao F, Fang X, Wang X. Association of hypoproteinemia in preeclampsia with maternal and perinatal outcomes: A retrospective analysis of high-risk women. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:98. [PMID: 28163744 PMCID: PMC5244641 DOI: 10.4103/1735-1995.193170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/08/2016] [Accepted: 07/09/2016] [Indexed: 12/31/2022]
Abstract
Background: The aim of this study was to evaluate maternal and perinatal outcomes in preeclampsia (PE), according to the value of albumin. Materials and Methods: Preeclamptic women were retrospectively divided into mild hypoproteinemia (MHP, n = 220) and severe hypoproteinemia (SHP, n = 79) PE according to the value of albumin. The maternal and perinatal outcomes were evaluated in both groups. Results: Two hundred and ninety-nine single pregnancies complicated by PE were included in this study. Gestational age at delivery was earlier in SHP than MHP (P < 0.01). Severe hypertension, abnormal liver function, abnormal renal function, ascites, and abruption occurred more frequently in SHP than in MHP (P< 0.01, 0.03, <0.01, 0.01, and 0.04, respectively). Women in SHP had a higher rate of cesarean section than those in MHP (P = 0.04). Fetal growth restriction infants were more frequent in SHP than in MHP (P < 0.01). The occupancy rate of the Neonatal Intensive Care Unit was higher in SHP than in MHP (P < 0.01). Conclusion: SHP PE is associated with a higher risk of adverse pregnancy outcome than MHP PE, deserving closer surveillance during pregnancy.
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Affiliation(s)
- Hongbo Chen
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, China; Department of Obstetrics and Gynecology and Anesthesiology, Maternal and Child Health Hospital, Anhui Province, Hefei, China
| | - Feng Tao
- Department of Obstetrics and Gynecology and Anesthesiology, Maternal and Child Health Hospital, Anhui Province, Hefei, China
| | - Xiangdong Fang
- Department of Obstetrics and Gynecology and Anesthesiology, Maternal and Child Health Hospital, Anhui Province, Hefei, China
| | - Xietong Wang
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, China
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Immunology of hepatic diseases during pregnancy. Semin Immunopathol 2016; 38:669-685. [PMID: 27324237 DOI: 10.1007/s00281-016-0573-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/18/2016] [Indexed: 02/06/2023]
Abstract
The mother's immune system has to adapt to pregnancy accepting the semi-allograft fetus and preventing harmful effects to the developing child. Aberrations in feto-maternal immune adaptation may result in disease of the mother, such as liver injury. Five pregnancy-associated liver disorders have been described so far, however, little is known concerning immune alterations promoting the respective disease. These liver disorders are pre-eclampsia, hemolysis, elevated liver enzymes, low platelet count (HELLP), acute fatty liver, hyperemesis gravidarum, and intrahepatic cholestasis of pregnancy. On the other hand, pre-existing autoimmune liver injury of the mother can be affected by pregnancy. This review intends to summarize current knowledge linking feto-maternal immunology and liver inflammation with a special emphasis on novel potential biomarkers.
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