Preeclampsia up to date-What's going on?

Prevalence of hypertensive disorders of pregnancy and chronic hypertension increased throughout the COVID-19 pandemic in South Carolina (2015-2021)

Hypertensive disorders of pregnancy (HDP) and chronic hypertension (CHTN) are related to maternal and infant morbidity and mortality. We aimed to assess HDP and CHTN prevalence changes before (January 2015-February 2020) and during the COVID-19 pandemic (March 2020-December 2021) in South Carolina (SC). SC live births (2015-2021) were included (194,841 non-Hispanic White [NHW]); 108,195 non-Hispanic Black [NHB]; 25,560 Hispanic; 16,346 other race/ethnicity). Linked birth certificate and hospitalization/ED data was used. Relative risks (RRs) and 95 percent CIs adjusted for potential confounders estimated HDP and CHTN risk before and during the pandemic. HDP risk is associated with a one-year increase in calendar time pre-pandemic differed by race/ethnicity. Corresponding RRs (95 percent CIs) were 1.06 (1.05-1.06) in NHW, 1.07 (1.06-1.07) in NHB, 1.07 (1.06-1.09) in Hispanic and 1.09 (1.07-1.12) for other races/ethnicities. During the pandemic, RRs (95 percent CIs) attenuated slightly remaining significant (NHW, 1.03 [1.01-1.04]; NHB, 1.04 [1.02-1.05]; Hispanic, 1.04 [1.02-1.07]; other races/ethnicities, 1.06 [1.04-1.09]). Increasing race-ethnic group-specific trends from 2015 to 2021 were reported for CHTN (NHW, 1.09 [1.08-1.10]; NHB, 1.09 [1.08-1.10]; Hispanic, 1.08 [1.05-1.12]; other races/ethnicities, 1.15 [1.11-1.19]). HDP and CHTN's increasing prevalence from 2015 to 2021 differed by race/ethnicity, with HDP impacted by the pandemic and upward trends observed for both conditions after adjustment. Screening, diagnostic, and reporting practices across different data sources and actual changes may impact HDP and CHTN prevalence.

Evaluation of placental growth factor, Vitamin D, and systemic inflammatory index as predictive biomarkers for preeclampsia severity: a retrospective cohort study

AIM

Our study aimed to evaluate the predictive value of Placental growth factor (PlGF), Vitamin D, and systemic inflammatory index for assessing preeclampsia risk and severity.

MATERIALS AND METHODS

This retrospective cohort study included 457 pregnant individuals who delivered at our hospital between March 2023 and October 2024. Participants were divided into three groups: control (n = 217), mild preeclampsia (n = 101), and severe preeclampsia (n = 67). A separate validation cohort (n = 72) was used to test model performance. Data on demographic, clinical, and laboratory characteristics, including PlGF, Vitamin D, neutrophil, lymphocyte, and monocyte counts, were collected between 16 and 20 weeks of gestation. Logistic regression analysis was performed to identify independent risk factors, and receiver operating characteristic (ROC) curve analysis was used to assess the predictive power of PlGF, Vitamin D, lymphocyte count, and Pan-immune-inflammation value (PIV). The regression models adjusted for potential confounders, including maternal age, body mass index (BMI), and parity.

RESULTS

In the training cohort, significant differences were observed among control, mild, and severe preeclampsia groups, with severe cases showing elevated PIV (515.8 ± 126.7) and reduced levels of PlGF (12.5 ± 5.8 pg/mL) and Vitamin D (8.4 ± 1.9 ng/mL) compared to controls (P < 0.001). Logistic regression identified lower levels of PlGF (P < 0.001) and Vitamin D (P < 0.001) as significant independent risk factors for severe preeclampsia. PIV was also a strong predictor, showing a high hazard ratio (P < 0.001). In the training and validation cohorts, ROC analysis showed AUC values of 0.774 and 0.751 for PlGF, 0.805 and 0.796 for Vitamin D, 0.688 and 0.675 for Lymphocyte, and 0.724 and 0.752 for PIV, respectively, indicating strong predictive value for PlGF, Vitamin D, and PIV in assessing preeclampsia risk.

CONCLUSION

Lower levels of PlGF and Vitamin D, along with higher PIV, were independently associated with an increased risk of severe preeclampsia. These findings suggest that PlGF, Vitamin D, and PIV are valuable biomarkers for early identification of high-risk preeclampsia patients, potentially aiding in timely intervention and improved outcomes.

Soluble guanylate cyclase stimulators and activators as potential antihypertensive drugs

Poor blood pressure control in treated patients with hypertension is an important topic in the field of hypertension, and an unmet need for new therapeutic drugs remains. Soluble guanylate cyclase (sGC), a key signal transduction enzyme responsible for vasodilation, has attracted increasing interest as a therapeutic target in various cardiovascular diseases. Two different sGC agonists, sGC stimulators and activators, can increase its enzymatic activity in reduced and oxidized/apo forms, respectively. With some sGC agonists being already in clinical use, drugs in this category are expected to become new therapeutic agents for various conditions, including hypertension. In this review, we summarize the current knowledge on the antihypertensive effects of sGC agonists in various preclinical studies involving animal models of spontaneous hypertension, salt-sensitive hypertension, nitric oxide-deficient hypertension, renin-angiotensin-aldosterone system-dependent hypertension, malignant hypertension, metabolic syndrome, renoprival hypertension, renovascular hypertension, drug-induced hypertension, pregnancy hypertension, and treatment-resistant hypertension. Our compilation provides a comprehensive rationale for advancing the clinical development of sGC agonists for the treatment of hypertension.

Early-onset preeclampsia/gestational hypertension may be associated with a low incidence of cerebral palsy at 3 years old in singleton very low-birth-weight infants born at 28-31 weeks of gestation (EOPE-DQ study): a multi-center retrospective cohort study in 2013-2016

Our aim was to evaluate the effects of any types of hypertensive disorders of pregnancy (HDP) on the development of either cerebral palsy (CP) or developmental delay (DD) at 3 years old in singleton very low-birth-weight (VLBW) infants born at 24-31 weeks of gestation. This was a retrospective cohort study of VLBW infants born at 24-31 weeks in 2013-2016 in Japan, using a nationwide obstetrical database, and Neonatal Research Network Japan (NRNJ) Database, accompanied by a secondary survey of women complicated with HDP (EOPE-DQ study). In 529 candidates for long-term follow-up in 7 tertiary centers, the percentage undergoing follow-up for CP at 3 years old was 56.1%, and the percentage receiving follow-up for DD at 3 years old was 54.1%. The percentage of PE/SPE/GH was significantly lower in infants with CP than in controls (1/22 [4.5%] vs. 66/274 [24.1%], p = 0.034); especially, in infants born at 28-31 weeks, the percentage of PE/SPE/GH was significantly lower in infants with CP than in controls (0/13 [0%] vs. 44/151 [29.1%], p = 0.021). The percentage of PE/SPE/GH was not different between infants with DD and controls (9/49 [18.4%] vs. 54/237 [22.8%], p = 0.574). The percentage of composite risk factors (either bronchopulmonary dysplasia at a postmenstrual age of 36 weeks, intraventricular hemorrhage, hypoxic ischemic encephalopathy, sepsis, necrotizing enterocolitis, or periventricular leukomalacia) was significantly higher in infants with DD than in controls. In conclusion, PE/SPE/GH around 30 weeks may be associated with a low incidence of CP.

Gene therapy in preeclampsia: the dawn of a new era

Preeclampsia is a severe complication of pregnancy, affecting an estimated 4 million women annually. It is one of the leading causes of maternal and fetal mortality worldwide, and it has life-long consequences. The maternal multisystemic symptoms are driven by poor placentation, which causes syncytiotrophoblastic stress and the release of factors into the maternal bloodstream. Amongst them, the soluble fms-like tyrosine kinase-1 (sFLT-1) triggers extensive endothelial dysfunction by acting as a decoy receptor for the vascular endothelial growth factor (VEGF) and the placental growth factor (PGF). Current interventions aim to mitigate hypertension and seizures, but the only definite treatment remains induced delivery. Thus, there is a pressing need for novel therapies to remedy this situation. Notably, CBP-4888, a siRNA drug delivered subcutaneously to knock down sFLT1 expression in the placenta, has recently obtained Fast Track approval from the Food and Drug Administration (FDA) and is undergoing a phase 1 clinical trial. Such advance highlights a growing interest and significant potential in gene therapy to manage preeclampsia. This review summarizes the advances and prospects of gene therapy in treating placental dysfunction and illustrates crucial challenges and considerations for these emerging treatments.

Identification of genetic and immune mechanisms linking preeclampsia and endometrial cancer: a prognostic model for survival and treatment response

Preeclampsia (PE) and endometrial cancer (EC) are two distinct conditions that share common genetic and molecular mechanisms involving immune dysregulation, endothelial dysfunction, and angiogenesis. This study aimed to investigate the potential genetic links between PE and EC, identify key prognostic genes, and develop a risk model to predict overall survival in EC patients. We conducted comprehensive genetic and molecular analyses, revealing significant overlaps in immune and angiogenic pathways between PE and EC. Through LASSO regression and multivariate Cox analysis, we identified five core prognostic genes-FSTL3, PRSS23, IGFBP4, MYDGF, and TSC22D3-that were used to construct a risk model. This model effectively stratified EC patients into high- and low-risk groups, with significant differences in overall survival. Patients in the low-risk group exhibited better 1-, 3-, and 5-year survival outcomes and had higher immune cell infiltration and expression of immune checkpoint-related genes, indicating a more favorable tumor microenvironment. Additionally, the analysis showed that these genes are also implicated in the pathogenesis of PE, highlighting potential shared molecular mechanisms. Our findings suggest that these PE-related genes may serve as valuable prognostic biomarkers for EC and could lead to improved prognostic tools and personalized treatment strategies for EC patients.

The Hidden Relationship between Intestinal Microbiota and Immunological Modifications in Preeclampsia Pathogenesis

Preeclampsia is a multifactorial gestational syndrome characterized by increased blood pressure during pregnancy associated with multiorgan involvement. The impact of this disease on maternal and neonatal health is significant, as it can lead to various fetal comorbidities and contribute to the development of maternal comorbidities later in life. Consistent evidence has shown that the microbiota acts as a regulator of the immune system, and it may, therefore, influence the development of preeclampsia by modulating immune factors. This narrative review aims to investigate the role of the immune system in the pathogenesis of preeclampsia and to summarize the most recent literature on the possible link between preeclampsia and alterations in the intestinal microbiota. To this end, we conducted a literature search, aiming to perform a narrative review, on PubMed and Embase from January 1990 to March 2024, focusing on the latest studies that highlight the main differences in microbial composition between patients with and without preeclampsia, as well as the effects of microbial metabolites on the immune system. From the review of 28 studies assessing the intestinal microbiota in preeclamptic women, preeclampsia could be associated with a state of dysbiosis. Moreover, these patients showed higher plasmatic levels of endotoxin, pro-inflammatory cytokines, and T helper 17 cells; however, the findings on specific microbes and metabolites that could cause immune imbalances in preeclampsia are still preliminary.

Lipidomic signatures in patients with early-onset and late-onset Preeclampsia

BACKGROUND

Preeclampsia is a pregnancy-specific clinical syndrome and can be subdivided into early-onset preeclampsia (EOPE) and late-onset preeclampsia (LOPE) according to the gestational age of delivery. Patients with preeclampsia have aberrant lipid metabolism. This study aims to compare serum lipid profiles of normal pregnant women with EOPE or LOPE and screening potential biomarkers to diagnose EOPE or LOPE.

METHODS

Twenty normal pregnant controls (NC), 19 EOPE, and 19 LOPE were recruited in this study. Untargeted lipidomics based on ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was used to compare their serum lipid profiles.

RESULTS

The lipid metabolism profiles significantly differ among the NC, EOPE, and LOPE. Compared to the NC, there were 256 and 275 distinct lipids in the EOPE and LOPE, respectively. Furthermore, there were 42 different lipids between the LOPE and EOPE, of which eight were significantly associated with fetal birth weight and maternal urine protein. The five lipids that both differed in the EOPE and LOPE were DGTS (16:3/16:3), LPC (20:3), LPC (22:6), LPE (22:6), PC (18:5e/4:0), and a combination of them were a potential biomarker for predicting EOPE or LOPE. The receiver operating characteristic analysis revealed that the diagnostic power of the combination for distinguishing the EOPE from the NC and for distinguishing the LOPE from the NC can reach 1.000 and 0.992, respectively. The association between the lipid modules and clinical characteristics of EOPE and LOPE was investigated by the weighted gene co-expression network analysis (WGCNA). The results demonstrated that the main different metabolism pathway between the EOPE and LOPE was enriched in glycerophospholipid metabolism.

CONCLUSIONS

Lipid metabolism disorders may be a potential mechanism of the pathogenesis of preeclampsia. Lipid metabolites have the potential to serve as biomarkers in patients with EOPE or LOPE. Furthermore, lipid metabolites correlate with clinical severity indicators for patients with EOPE and LOPE, including fetal birth weight and maternal urine protein levels.

Association of cardiovascular risk factors and myocardial hypertrophy in women with preeclampsia history

AIMS

A historic of preeclampsia (PE) has been associated with cardiovascular disease (CVD) in women. There are substantial evidences that cardiovascular changes resulting from PE can persist even after pregnancy end. Therefore, the aims was to evaluate the prevalence of myocardial hypertrophy in young women 12 months after PE event as well as try to identify risk factors for these changes.

MATERIALS AND METHODS

Single-center observational prospective cross-sectional study that included 118 consecutive patients after 12 months of PE. Clinical and laboratory evaluations, echocardiogram were performed. Myocardial hypertrophy (LVH) was defined as an index myocardial mass ≥ 45 g/m2.7, for women. Classical risk factors for CVD were considered. Analysis included linear or logistic regression and Spearman's correlation coefficient. Significance level of 5 %.

KEY FINDINGS

Systemic arterial hypertension (SAH) was identified in 52 patients (44 %), overweight/obesity (OOB) in 82 (69 %), dyslipidemia in 68 (57 %) and metabolic syndrome in 47 patients (40 %). LVH was present in 35 cases (29 %) and associated with OOB (OR = 4.51; CI95%:1.18-17.17, p < 0.001), in a model corrected for age and SAH diagnosis. When only the metabolic syndrome components were analyzed, in the multiple logistic regression model, the abdominal circumference was the only clinical variable associated with LVH (OR = 17.65; CI95%:3.70-84.17; p < 0.001).

SIGNIFICANCE

It was observed a high prevalence of ventricular hypertrophy in young women with a history of pre-eclampsia. This condition was associated with the presence of obesity.

Advancements in microRNA-based electrochemical biosensors for preeclampsia detection

Highlighting a recently proposed mechanism for early detection of preeclampsia using microRNA-based electrochemical biosensors, showcasing their transformative potential for improved prenatal care.

Clinical features of recurrent preeclampsia: a retrospective study of 109 recurrent preeclampsia patients

Our study aimed to investigate the clinical features of recurrent preeclampsia (rPE) and evaluate the preventive effect of low-dose aspirin (LDA) in rPE. We retrospectively analyzed the data of 109 patients who experienced preeclampsia in two consecutive pregnancies and delivered at Peking University First Hospital from January 2016 to December 2022. We analyzed the pregnancy outcomes of patients with rPE and assessed whether the use of LDA during pregnancy could improve these outcomes. Our results revealed that patients with rPE had a higher body mass index (BMI) and a higher incidence of diabetes during pregnancy compared to their first onset of preeclampsia (29.01 ± 4.70 kg/m2 vs. 27.13 ± 4.25 kg/m2, P < 0.05; 11.01% vs. 1.83%, P < 0.05). Furthermore, the incidence of severe preeclampsia was higher at recurrence in patients with rPE compared to their first onset (83.49% vs. 70.64%, P < 0.05), as well as the incidence of severe preeclampsia with chronic hypertension (34.86% vs. 8.26%, P < 0.05). Additionally, the incidence of gestational diabetes and postpartum hemorrhage was higher in patients with rPE compared to their first preeclampsia onset (25.69% vs. 5.50%, P < 0.05; 20.18% vs. 5.83%, P < 0.05). Compared to the first onset of preeclampsia, patients with rPE had an earlier gestational age at delivery (35.42 ± 3.06 weeks vs. 36.60 ± 2.74 weeks, P < 0.05), lower birth weight of neonates (2478.39 ± 828.44 g vs. 2883.71 ± 712.94 g, P < 0.05), and a higher risk of premature birth (67.00% vs. 47.19%, P < 0.05). However, in patients with rPE, the use of LDA delayed the gestational age at delivery, increased the birth weight of the neonate, reduced the premature birth rate, and increased the perinatal survival rate. In conclusion, patients with rPE are at an increased risk of adverse maternal and fetal outcomes. However, the use of LDA during pregnancy effectively improves these outcomes.

MicroRNA-206 Contributes to the Progression of Preeclampsia by Suppressing the Viability and Mobility of Trophocytes via the Inhibition of AGTR1

The development of preeclampsia (PE) is associated with the impaired trophoblast motility. MicroRNAs (miRs) contribute to the modulation of trophoblast invasion. In the current study, the role of miR-206/AGTR1 in the TNF-alpha-induced invasion defect of trophoblasts was explored. The levels of miR-206 and ATGR1 in clinical placenta tissues were investigated. Trophoblasts were treated with TNF-alpha, and the levels of miR-206 and ATGR1 were modulated. Changes in cell viability, invasion, and inflammation in trophoblasts were detected. The level of miR-206 was induced, while the level of AGTR1 was suppressed in placenta tissues. In in vitro assays, TNF-alpha suppressed viability, induced inflammatory response, inhibited invasion, upregulated miR-206, and down-regulated AGTR1. The inhibited expression of miR-206 or the overexpression of AGTR1 counteracted the effects of TNF-alpha, indicating the key role of the miR-206/AGTR1 in progression of PE. Collectively, miR-206 suppressed viability, induced inflammatory response, and decreased invasion of trophoblasts by inhibiting AGTR1.

The Role of Sirtuin-1 (SIRT1) in the Physiology and Pathophysiology of the Human Placenta

Sirtuins, especially SIRT1, play a significant role in regulating inflammatory response, autophagy, and cell response to oxidative stress. Since their discovery, sirtuins have been regarded as anti-ageing and longevity-promoting enzymes. Sirtuin-regulated processes seem to participate in the most prevalent placental pathologies, such as pre-eclampsia. Furthermore, more and more research studies indicate that SIRT1 may prevent pre-eclampsia development or at least alleviate its manifestations. Having considered this, we reviewed recent studies on the role of sirtuins, especially SIRT1, in processes determining normal or abnormal development and functioning of the placenta.