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Mao R, Li L, Li P. Unveiling an oxidative stress-linked diagnostic signature and molecular subtypes in preeclampsia: novel insights into pathogenesis. Free Radic Res 2024:1-12. [PMID: 38788124 DOI: 10.1080/10715762.2024.2360015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024]
Abstract
Preeclampsia (PE) is a complex pregnancy disorder characterized by hypertension and organ dysfunction, affecting both maternal and fetal health. Oxidative stress has been implicated in the pathogenesis of PE, but the underlying molecular mechanisms remain poorly understood. In this study, we aimed to identify a diagnostic signature and molecular subtypes associated with oxidative stress in PE to gain novel insights into its pathogenesis. The ssGSEA algorithm evaluated oxidative stress-related pathway scores using transcriptional data from the GSE75010 dataset. Oxidative stress-related genes (ORGs) were co lected from these pathways, and hub ORGs associated with PE were identified using the LASSO and logistic regression models. A nomogram prediction model was constructed using the identified ORGs. Consensus clustering identified two molecular subgroups related to oxidative stress, labeled as C1 and C2, with unique immune characteristics and inflammatory pathway profiles. Seventy ORGs associated with oxidative stress, ce l death, and inflammation-related pathways were identified in PE. EGFR, RIPK3, and ALAD were confirmed as core ORGs for PE biomarkers. The C1 and C2 subgroups exhibited distinct immune characteristics and inflammatory pathway profiles. This study provides novel insights into the role of oxidative stress in PE pathogenesis. A diagnostic signature and molecular subtypes associated with oxidative stress were identified, which may improve understanding, diagnosis, and management of PE.
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Affiliation(s)
- Rurong Mao
- Sichuan Jinxin Xinan Women and Children's Hospital, Chengdu, Sichuan, China
| | - Li Li
- Sichuan Jinxin Xinan Women and Children's Hospital, Chengdu, Sichuan, China
| | - Penghao Li
- Sichuan Jinxin Xinan Women and Children's Hospital, Chengdu, Sichuan, China
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Zhong Q, Yao C, Zhong W. Causal Relationship Between Inflammation and Preeclampsia: Genetic Evidence from a Mendelian Randomization Study. Twin Res Hum Genet 2023; 26:231-235. [PMID: 37458219 DOI: 10.1017/thg.2023.27] [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] [Indexed: 09/14/2023]
Abstract
Preeclampsia (PE) is a hypertensive disorder of pregnancy. PE patients were reported to have higher serum levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) than those in healthy controls. However, whether the expressions of these inflammation biomarkers have a causal relationship with PE is unspecified. We applied the Mendelian randomization method to infer the causal relationship between inflammation biomarkers (e.g., CRP, IL-6, interleukin 1 receptor antagonist [IL-1ra] and TNF-α) and PE. Single nucleotide polymorphisms (SNPs) strongly related to inflammation biomarkers were used as instrumental variables. CRP, IL-1ra and IL-6 levels showed no significant effect on PE progression, while the genetic predicted higher level of TNF-α significantly increased the risk of PE (OR per 1-SD increase in TNF-α: 4.33; 95% CI [1.99, 9.39]; p = .00021). The findings suggest that pro-inflammatory activity of TNF-α could be a determinant for PE progression. More antenatal care should be given to those pregnant women with higher level of inflammation biomarkers, especially TNF-α.
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Affiliation(s)
- Qiongxiang Zhong
- No.2 Obstetrics and Gynecology Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Chanjiao Yao
- No.2 Obstetrics and Gynecology Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Wei Zhong
- No.2 Obstetrics and Gynecology Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
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Ramli I, Posadino AM, Giordo R, Fenu G, Fardoun M, Iratni R, Eid AH, Zayed H, Pintus G. Effect of Resveratrol on Pregnancy, Prenatal Complications and Pregnancy-Associated Structure Alterations. Antioxidants (Basel) 2023; 12:antiox12020341. [PMID: 36829900 PMCID: PMC9952837 DOI: 10.3390/antiox12020341] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Adverse pregnancy outcomes are considered significant health risks for pregnant women and their offspring during pregnancy and throughout their lifespan. These outcomes lead to a perturbated in-utero environment that impacts critical phases of the fetus's life and correlates to an increased risk of chronic pathological conditions, such as diabetes, obesity, and cardiovascular diseases, in both the mother's and adult offspring's life. The dietary intake of naturally occurring antioxidants promotes health benefits and disease prevention. In this regard, maternal dietary intake of polyphenolic antioxidants is linked to a reduced risk of maternal obesity and cardio-metabolic disorders, positively affecting both the fetus and offspring. In this work, we will gather and critically appraise the current literature highlighting the effect/s of the naturally occurring polyphenol antioxidant resveratrol on oxidative stress, inflammation, and other molecular and physiological phenomena associated with pregnancy and pregnancy conditions, such as gestational diabetes, preeclampsia, and preterm labor. The resveratrol impact on prenatal complications and pregnancy-associated structures, such as the fetus and placenta, will also be discussed. Finally, we will draw conclusions from the current knowledge and provide future perspectives on potentially exploiting resveratrol as a therapeutic tool in pregnancy-associated conditions.
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Affiliation(s)
- Iman Ramli
- Departement de Biologie Animale, Université des Frères Mentouri Constantine 1, Constantine 25000, Algeria
| | - Anna Maria Posadino
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Roberta Giordo
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
| | - Grazia Fenu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Manal Fardoun
- Department of Pharmacology and Toxicology, American University of Beirut, Beirut 11-0236, Lebanon
| | - Rabah Iratni
- Department of Biology, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
| | - Ali H. Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar
| | - Hatem Zayed
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
| | - Gianfranco Pintus
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Correspondence:
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Zhang X, Zhang X. MicroRNA-135b-5p regulates trophoblast cell function by targeting phosphoinositide-3-kinase regulatory subunit 2 in preeclampsia. Bioengineered 2022; 13:12338-12349. [PMID: 35588255 PMCID: PMC9275860 DOI: 10.1080/21655979.2022.2073655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The level of miR‑135b-5p is lower in patients with preeclampsia (PE) superimposed on chronic hypertension than in healthy controls. However, the function of miR‑135b-5p in PE progression remains unknown. In the present study, we investigated the role of miR‑135b-5p in PE development and its possible mechanism for the first time. HTR8/SVneo cells (trophoblast cell line) were exposed to hypoxia/reoxygenation (H/R) to mimic PE in vitro. Hypoxia-inducible factor-1α (HIF-1α), forkhead box O3A (FOXO3a), and miR-135b-5p levels were measured using Real-time PCR. Cell proliferation, apoptosis and migration/invasion were evaluated using the Cell Counting Kit-8 (CCK-8), flow cytometry and transwell assays, respectively. Real-time PCR and Western blotting were performed to determine the levels of several pro- and anti-angiogenic factors. The binding of miR-135b-5p to the PIK3R2-3’ untranslated region (3ʹUTR) was confirmed by bioinformatics analysis and a dual-luciferase reporter assay. H/R exposure greatly upregulated HIF-1α, FOXO3a, and PIK3R2 levels, while downregulating miR-135b-5p levels in HTR8/SVneo cells. H/R exposure resulted in the inhibition of proliferation, migration, invasion, angiogenesis, and the induction of apoptosis. MiR-135b-5p overexpression reversed the effects of H/R on trophoblast cell function, while miR-135b-5p knockdown enhanced the effects. PIK3R2 knockdown had similar effects as miR-135b-5p overexpression on proliferation, apoptosis and angiogenesis. The effect of miR-135b-5p overexpression on H/R-exposed cells was enhanced by PIK3R2 knockdown. MiR-135b-5p downregulated PIK3R2 expression by pairing with its 3ʹUTR. Therefore, miR-135b-5p may regulate trophoblast function by targeting PIK3R2 in PE and could serve as a novel therapeutic target for PE.
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Affiliation(s)
- Xia Zhang
- Department of Obstetrics and Gynecology, The Eighth Hospital of Wuhan, Wuhan, China
| | - Xiufeng Zhang
- Department of Cardiology, WuHan FangTai Hospital, Wuhan, China
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da Costa TX, Azeredo FJ, Ururahy MAG, da Silva Filho MA, Martins RR, Oliveira AG. Population Pharmacokinetics of Magnesium Sulfate in Preeclampsia and Associated Factors. Drugs R D 2021; 20:257-266. [PMID: 32642964 PMCID: PMC7419390 DOI: 10.1007/s40268-020-00315-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Objective The pharmacokinetic basis of magnesium sulphate (MgSO4) dosing regimens for preeclampsia (PE) prophylaxis and treatment is not clearly established. The aim of study is to develop a population pharmacokinetic (PK) model of MgSO4 in PE, and to determine key covariates having an effect in MgSO4 pharmacokinetics in preeclampsia (PE) and to determine key covariates having an effect in MgSO4 PK. Methods A prospective cohort study was conducted from June 2016 to February 2018 in patients with PE administered MgSO4 as a 4-g bolus followed by continuous infusion at a rate of 1 g/h. Serum magnesium concentrations were obtained before treatment administration and 2, 6, 12, and 18 h after the initial dose. The software Monolix was used to estimate population PK parameters of MgSO4 [clearance (CL), volume of distribution (V), half-life] and to develop a PK model with baseline patient demographic, clinical, and laboratory covariates. Results The study population consisted of 109 patients. The PK profile of MgSO4 was adequately described by a one-compartment PK model. The model estimate of the population CL was 1.38 L/h; for V, it was 13.3 L; and the baseline magnesium concentration was 0.77 mmol/L (1.87 mg/dL). The baseline body weight and serum creatinine statistically influenced MgSO4 CL and V, respectively. The model was parameterized as CL and V. Conclusion The PK of MgSO4 in pregnant women with PE is significantly affected by creatinine and body weight. Pregnant women with PE and higher body weight have a higher V and, consequently, a lower elimination rate of MgSO4. Pregnant women with PE and a higher serum creatinine value show lower CL and, therefore, lower MgSO4 elimination rate.
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Affiliation(s)
- Tatiana Xavier da Costa
- Postgraduate Program in Pharmaceutical Sciences, Health Science Center, Federal University of Rio Grande do Norte, Natal, Brazil. .,Maternity School Januário Cicco, Health Science Center, Federal University of Rio Grande do Norte, Natal, Brazil. .,Faculty of Pharmacy, Health Science Center, Federal University of Rio Grande do Norte, Natal, Brazil.
| | | | | | | | - Rand Randall Martins
- Department of Pharmacy, Health Science Center, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Antonio Gouveia Oliveira
- Department of Pharmacy, Health Science Center, Federal University of Rio Grande do Norte, Natal, Brazil
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Oxidative stress: Normal pregnancy versus preeclampsia. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165354. [DOI: 10.1016/j.bbadis.2018.12.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 02/03/2023]
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Wang F, Cao G, Yi W, Li L, Cao X. Effect of Metformin on a Preeclampsia-Like Mouse Model Induced by High-Fat Diet. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6547019. [PMID: 31886236 PMCID: PMC6925815 DOI: 10.1155/2019/6547019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Metformin has been reported to decrease insulin resistance and is associated with a lower risk of pregnancy-induced hypertension and preeclampsia. It is widely accepted that the placenta plays a crucial role in the development of preeclampsia. Our aim is to explore the effect of metformin on preeclampsia. STUDY DESIGN We examined control diet-fed (isocaloric diet) pregnant mice (CTRL group), pregnant mice fed a high-fat diet (HF group), and high-fat-diet-fed pregnant mice treated with metformin (HF-M group). The HF mice were fed a high-fat diet six weeks before pregnancy to establish a preeclampsia-like model; then, the group was randomly divided into a HF group and a HF-M group after pregnancy. Blood pressure, urine protein, pregnancy outcomes, protein expression, and histopathological changes in the placentas of all groups were examined and statistically analysed. RESULTS We observed that metformin significantly improved high blood pressure, proteinuria, and foetal and placental weights in the HF-M group compared with the HF group. Metformin significantly improved placental labyrinth and foetal vascular development in preeclampsia. In addition, metformin effectively increased matrix metalloproteinase-2 (MMP-2) and vascular endothelial growth factor (VEGF) levels in the placenta. CONCLUSIONS Our results suggest that metformin can improve preeclamptic symptoms and pregnancy outcomes.
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Affiliation(s)
- Fuchuan Wang
- Department of Obstetrics and Gynecology, Beijing Di-Tan Hospital, Capital Medical University, Beijing 100015, China
| | - Guangming Cao
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Wei Yi
- Department of Obstetrics and Gynecology, Beijing Di-Tan Hospital, Capital Medical University, Beijing 100015, China
| | - Li Li
- Department of Obstetrics and Gynecology, Beijing Di-Tan Hospital, Capital Medical University, Beijing 100015, China
| | - Xiuzhen Cao
- Department of Obstetrics and Gynecology, Beijing Di-Tan Hospital, Capital Medical University, Beijing 100015, China
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Jieyu L, Yingying C, Tian G, Jiaxiang W, Jiawen L, Yingjie G, Qingzhou Y, Haoyue T, Jieyun Y, Chenwei P. Visit-to-visit blood pressure variability is associated with gestational hypertension and pre-eclampsia. Pregnancy Hypertens 2019; 18:126-131. [PMID: 31610398 DOI: 10.1016/j.preghy.2019.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/01/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Visit-to-visit blood pressure variability (VVV) was an independent risk factor for cardiovascular events. In pregnant women whose hemodynamic changes are unique, the role of VVV in hypertensive disorders is still obscure. Therefore, we aimed to investigate the association of VVV with gestational hypertension (GH) and pre-eclampsia (PE). METHODS 14,702 pregnant women were recruited at around 13 weeks of their gestation. VVV during the second, third trimester and the whole pregnancy, were estimated as standard deviation (SD) or coefficient of variation (CV) of systolic blood pressure (SBP) or diastolic blood pressure (DBP). The associations between VVV, GH and PE were assessed by multivariate logistic regression models. RESULTS 878 and 131 women developed GH and PE, respectively. VVV was significantly higher in GH and PE subjects than normotensive controls, regardless of whichever metric was calculated. In maximally adjusted models, odds ratio (95% confidence interval) of SBP-CV during the whole pregnancy was 1.62 (1.56-1.68) for GH, 1.14 (1.06-1.21) for PE, and 1.51 (1.47-1.56) for either GH or PE. The cooperation of SBP-CV to other risk factors could help in discriminating pregnant women at high risk of GH and PE. CONCLUSIONS VVV during pregnancy, especially SBP-CV, was independently associated with GH and PE. These results suggested that VVV could provide additional information to identify pregnant women at high risk of GH or PE. Further studies exploring prospective association between VVV, GH and PE are warranted.
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Affiliation(s)
- Liu Jieyu
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Cao Yingying
- Maternal and Child Healthcare Center of Taicang, Jiangsu Province, China
| | - Gong Tian
- Maternal and Child Healthcare Center, Suzhou Municipal Hospital, Suzhou, Jiangsu Province, China
| | - Wang Jiaxiang
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Lu Jiawen
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Gu Yingjie
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China; Department of Obstetrics and Gynecology, International Peace Maternity & Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Qingzhou
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Teng Haoyue
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Yin Jieyun
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China.
| | - Pan Chenwei
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
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Colostrum of Preeclamptic Women Has a High Level of Polyphenols and Better Resistance to Oxidative Stress in Comparison to That of Healthy Women. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:1380605. [PMID: 30918577 PMCID: PMC6408988 DOI: 10.1155/2019/1380605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/19/2018] [Accepted: 01/01/2019] [Indexed: 11/19/2022]
Abstract
Preeclampsia is a common pregnancy complication. Abnormal development of the placenta is the prevailing cause theory of this complication. Women with preeclampsia suffer from acute oxidative stress and high lipid oxidation in plasma. The aim of this study was to compare levels of polyphenols and lipid peroxidation in colostrum of nursing mothers with and without preeclampsia. The study was conducted at the Department of Obstetrics and Gynecology at Soroka University Medical Center. The study group consisting of 18 women, who were diagnosed with preeclampsia, was compared to the control group: 22 healthy women. The total phenolic content in the colostrum was determined by using the Folin–Ciocalteu method. Lipid peroxidation was determined by measuring MDA, using the TBARS assay. Polyphenol concentrations were significantly higher (about 33%) in the colostrum of the study group compared with the control group (p = 0.00042). Lipid peroxidation levels (MDA) were significantly lower (about 20%) in the colostrum of the study group compared with the control group (p = 0.03). Negative correlation was found between MDA concentration and the polyphenol level (R = −0.41, p = 0.02). In conclusion, we showed in this study a potential compensation mechanism that protects the newborn of a mother with preeclampsia from the stress process experienced by its mother.
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Chiarello DI, Marín R, Proverbio F, Coronado P, Toledo F, Salsoso R, Gutiérrez J, Sobrevia L. Mechanisms of the effect of magnesium salts in preeclampsia. Placenta 2018; 69:134-139. [PMID: 29716747 DOI: 10.1016/j.placenta.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/18/2018] [Accepted: 04/23/2018] [Indexed: 11/16/2022]
Abstract
Preeclampsia is a heterogeneous pregnancy-specific syndrome associated with abnormal trophoblast invasion and endothelial dysfunction. Magnesium (Mg2+) level may be normal or decreased in women with preeclampsia. However, the use of Mg2+ salts, such as Mg2+ sulphate, are useful in reducing the pathophysiological consequences of preeclampsia with severe features and eclampsia. Although the mechanism of action of this Mg2+ salt is not well understood, the available evidence suggests a beneficial effect of Mg2+ for the mother and foetus. The mechanisms include a lower level of soluble fms-like tyrosine kinase 1 and endoglin, blockage of brain N-methyl-D-aspartate receptors, decreased inflammation mediators, activation of nitric oxide synthases, blockage of arginases, and reduced free radicals level. The maintenance of Mg2+ homeostasis in pregnancy is crucial for an appropriate pregnancy progression. Oral Mg2+ salts can be used for this purpose which could result in mitigating the deleterious consequences of this syndrome to the mother, foetus, and newborn.
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Affiliation(s)
- Delia I Chiarello
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Reinaldo Marín
- Center for Biophysics and Biochemistry (CBB), Venezuelan Institute for Scientific Research (IVIC), AP 21827, Caracas 1020A, Venezuela
| | - Fulgencio Proverbio
- Center for Biophysics and Biochemistry (CBB), Venezuelan Institute for Scientific Research (IVIC), AP 21827, Caracas 1020A, Venezuela
| | - Paula Coronado
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Fernando Toledo
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Basic Sciences, Faculty of Sciences, Universidad del Bío-Bío, Chillán 3780000, Chile
| | - Rocio Salsoso
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville, Spain
| | - Jaime Gutiérrez
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Cellular Signaling and Differentiation Laboratory (CSDL), School of Medical Technology, Health Sciences Faculty, Universidad San Sebastián, Santiago 7510157, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville, Spain; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Australia.
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An analysis of the risk factors of preeclampsia and prediction based on combined biochemical indexes. Kaohsiung J Med Sci 2017; 34:109-112. [PMID: 29413226 DOI: 10.1016/j.kjms.2017.10.001] [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: 05/19/2017] [Revised: 09/20/2017] [Accepted: 10/05/2017] [Indexed: 12/12/2022] Open
Abstract
This study aims to investigate the risk factors and the joint biochemical indicators predictive value for preeclampsia. Related factors and biochemical indicators were investigated in 558 patients with preeclampsia and 435 normal pregnant women. Multiplicity analysis was performed by logistic regression. The predictive value of the biochemical index and joint biochemical indicators for predicting the incidence of pregnant women preeclampsia were analyzed by ROC curve. A progestation BMI of >24 kg/m2 (OR = 5.412, 95% CI: 1.169-9.447), hypertension history (OR = 7.487, 95% CI: 2.541-11.247) and advanced age (>35 years old, OR = 6.321, 95% CI: 3.142-20.342) are risk factors for preeclampsia. Tumor necrosis factor-α and plasma protein-A are valuable for preeclampsia prediction. The predictive success of preeclampsia could be improved by clinical risk factors associated with biochemical indicators detection.
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Lakhno IV. The Autonomic Repercussions of Fetal and Maternal Interaction in Pre-eclampsia. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2017. [DOI: 10.1515/sjecr-2017-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Pre-eclampsia (PE) is one of the severe complications of pregnancy that leads to fetal deterioration. The aim of the investigation was to determine the role of maternal respiratory sinus arrhythmia (RSA) in regulation of fetal circulatory system in case of healthy pregnancy and in PE.
The investigation of maternal and fetal HRV and umbilical venous blood flow velocity spectral analysis in 106 patients at 34-40 weeks of gestation was performed. 30 of them had healthy pregnancy and were involved in the Group I. In Group II 44 pregnant women with mild-moderate PE were observed. 32 patients with severe PE were monitored in Group III. The maternal sympathetic overactivity modulated HRV in PE. The suppression of RSA was explored in preeclamptic patients. The Doppler spectrograms of the umbilical veinous blod flow had the oscillatory peak with a frequency about 0.5 Hz. The above peak characterized the participation of the maternal RSA in fetal hemodynamics. Strong relationship between maternal RMSSD and amplitude of RSA associated peak, maternal and fetal RMSSDs was found in healthy pregnancy. No considerable relationship was revealed between the maternal RMSSD and the amplitude of 0.5 Hz frequency peak, the maternal and fetal RMSSDs in the patients with severe PE. The maternal RSA propagated its influence on the fetal umbilical venous blood flow and the fetal autonomic nervous regulation in normal gestation. The control of fetal hemodynamics diminished in the mild-moderate PE and even disappeared in severe PE.
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Hoyer D, Żebrowski J, Cysarz D, Gonçalves H, Pytlik A, Amorim-Costa C, Bernardes J, Ayres-de-Campos D, Witte OW, Schleußner E, Stroux L, Redman C, Georgieva A, Payne S, Clifford G, Signorini MG, Magenes G, Andreotti F, Malberg H, Zaunseder S, Lakhno I, Schneider U. Monitoring fetal maturation-objectives, techniques and indices of autonomic function. Physiol Meas 2017; 38:R61-R88. [PMID: 28186000 PMCID: PMC5628752 DOI: 10.1088/1361-6579/aa5fca] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Monitoring the fetal behavior does not only have implications for acute care but also for identifying developmental disturbances that burden the entire later life. The concept, of 'fetal programming', also known as 'developmental origins of adult disease hypothesis', e.g. applies for cardiovascular, metabolic, hyperkinetic, cognitive disorders. Since the autonomic nervous system is involved in all of those systems, cardiac autonomic control may provide relevant functional diagnostic and prognostic information. The fetal heart rate patterns (HRP) are one of the few functional signals in the prenatal period that relate to autonomic control and, therefore, is predestinated for its evaluation. The development of sensitive markers of fetal maturation and its disturbances requires the consideration of physiological fundamentals, recording technology and HRP parameters of autonomic control. Based on the ESGCO2016 special session on monitoring the fetal maturation we herein report the most recent results on: (i) functional fetal autonomic brain age score (fABAS), Recurrence Quantitative Analysis and Binary Symbolic Dynamics of complex HRP resolve specific maturation periods, (ii) magnetocardiography (MCG) based fABAS was validated for cardiotocography (CTG), (iii) 30 min recordings are sufficient for obtaining episodes of high variability, important for intrauterine growth restriction (IUGR) detection in handheld Doppler, (iv) novel parameters from PRSA to identify Intra IUGR fetuses, (v) evaluation of fetal electrocardiographic (ECG) recordings, (vi) correlation between maternal and fetal HRV is disturbed in pre-eclampsia. The reported novel developments significantly extend the possibilities for the established CTG methodology. Novel HRP indices improve the accuracy of assessment due to their more appropriate consideration of complex autonomic processes across the recording technologies (CTG, handheld Doppler, MCG, ECG). The ultimate objective is their dissemination into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases.
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Affiliation(s)
- Dirk Hoyer
- Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Jena 07747, Germany
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Lakhno I. Autonomic imbalance captures maternal and fetal circulatory response to pre-eclampsia. Clin Hypertens 2017; 23:5. [PMID: 28191323 PMCID: PMC5297203 DOI: 10.1186/s40885-016-0061-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-eclampsia (PE) is a gestational disease featured by hypertension, arterial systemic vasculopathy, multiple organ failure and fetal compromise. The aim of the investigation was to determine the role of maternal respiratory sinus arrhythmia (RSA) in regulation of the fetal circulatory system in case of healthy pregnancy and in PE. METHODS The investigation of maternal and fetal HRV and fetal CTG variables in 106 patients at 34-40 weeks of gestation was performed. 30 of them had healthy pregnancy and were involved in the Group I. In Group II 44 pregnant women with mild-moderate PE were observed. 32 patients with severe PE were monitored in Group III. RESULT The maternal sympathetic overactivity modulated HRV in PE by suppressing total power (TP) and parasympathetic tone. The lack of RSA was explored in preeclamptic patients. The centralization of hemodynamics was a result of the hypersympatheticotonia in severe PE. Fetal circulatory response to PE featured by an increased sympathetic tone. The modulated fetal CTG variables captured the suppression of fetal biophysical activity and the development of fetal distress in severe PE. Strong relationship between maternal and fetal TPs, maternal and fetal RMSSDs was found in healthy pregnancy. The correlations between the maternal and fetal TPs, the maternal and fetal RMSSDs in the patients with severe PE were disturbed. CONCLUSION The maternal RSA propagated its influence on the fetal autonomic nervous regulation in normal gestation. The maternal and fetal hemodynamic coupling was reduced in PE.
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Affiliation(s)
- Igor Lakhno
- Kharkiv Medical Academy of Postgraduate Education, Amosova str., 58, Kharkiv, 61176 Ukraine
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Samimi M, Kashi M, Foroozanfard F, Karamali M, Bahmani F, Asemi Z, Hamidian Y, Talari HR, Esmaillzadeh A. The effects of vitamin D plus calcium supplementation on metabolic profiles, biomarkers of inflammation, oxidative stress and pregnancy outcomes in pregnant women at risk for pre-eclampsia. J Hum Nutr Diet 2016; 29:505-15. [PMID: 26467311 DOI: 10.1111/jhn.12339] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The present study was designed to examine the effects of vitamin D plus calcium administration on metabolic profiles and pregnancy outcomes among women at risk for pre-eclampsia. METHODS In a prospective, double-blind, placebo-controlled trial, 60 women at risk for pre-eclampsia were randomised to take either 50 000 IU vitamin D3 every 2 weeks plus 1000 mg day(-1) calcium supplements (as calcium carbonate) (n = 30) or to receive placebos at the same times (n = 30) from 20 to 32 weeks of gestation. Fasting blood samples were taken at baseline and 12 weeks after intervention to determine related variables. Newborn anthropometric measurements were determined. RESULTS Taking combined cholecalciferol and calcium supplements, compared to placebo, led to significant reductions in fasting plasma glucose (FPG) [mean (SD)] [-5.7 (5.5) versus -0.6 (12.6) mg dL(-1) , P = 0.04], serum insulin concentrations [-2.8 (6.0) versus +7.7 (9.8) μIU mL(-1) , P < 0.001], homeostasis model of assessment-insulin resistance [-0.8 (1.3) versus +1.6 (2.2), P < 0.001], homeostatic model assessment-beta cell function [-8.2 (25.8) versus +32.6 (41.3, P < 0.001] and a significant rise in quantitative insulin sensitivity check index score [+0.02 (0.02) versus -0.02 (0.02, P < 0.001]. Additionally, pregnant women who received cholecalciferol plus calcium supplements had increased serum high-density lipoprotein (HDL)-cholesterol [+4.6 (8.3) versus -2.9 (7.7) mg dL(-1) , P = 0.001] and plasma total glutathione (GSH) concentrations [+23.4 (124.0) versus -94.8 (130.2) μm, P = 0.001] compared to placebo. However, after adjustment for the baseline levels, maternal age and baseline body mass index, the effects on FPG levels (P = 0.13) and systolic blood pressure (P = 0.13) disappeared. CONCLUSIONS Vitamin D plus calcium administration for 12 weeks had beneficial effects on glycaemic status, HDL-cholesterol, GSH and blood pressure among women at risk for pre-eclampsia.
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Affiliation(s)
- M Samimi
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - M Kashi
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - F Foroozanfard
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - M Karamali
- Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - F Bahmani
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Z Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Y Hamidian
- Department of Radiology, Kashan University of Medical Sciences, Kashan, Iran
| | - H R Talari
- Department of Radiology, Kashan University of Medical Sciences, Kashan, Iran
| | - A Esmaillzadeh
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Shaw J, Tang Z, Schneider H, Saljé K, Hansson SR, Guller S. Inflammatory processes are specifically enhanced in endothelial cells by placental-derived TNF-α: Implications in preeclampsia (PE). Placenta 2016; 43:1-8. [DOI: 10.1016/j.placenta.2016.04.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/08/2016] [Accepted: 04/16/2016] [Indexed: 01/17/2023]
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Lakhno I. The Use of Fetal Noninvasive Electrocardiography. SCIENTIFICA 2016; 2016:5386595. [PMID: 27006859 PMCID: PMC4783547 DOI: 10.1155/2016/5386595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
Preeclampsia (PE) is one of the severe complications of pregnancy that leads to fetal deterioration. The aim was to survey the validity of fetal distress diagnostics in case of Doppler ultrasonic umbilical vein and arteries blood flow velocity investigation and ECG parameters analysis obtained from maternal abdominal signal before labor in preeclamptic patients. Fetal noninvasive ECG and umbilical arterial and venous Doppler investigation were performed in 120 patients at 34-40 weeks of gestation. And 30 of them had physiological gestation and were involved in Group I. In Group II 52 pregnant women with mild-moderate PE were observed. 38 patients with severe PE were monitored in Group III. The most considerable negative correlation was determined in pair Apgar score 1 versus T/QRS (R = -0.50; p < 0.05). So the increased T/QRS ratio was the most evident marker of fetal distress. Fetal noninvasive ECG showed sensitivity of 96.6% and specificity of 98.4% and, therefore, was determined as more accurate method for fetal monitoring.
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Affiliation(s)
- Igor Lakhno
- Perinatology, Obstetrics and Gynecology Department, Kharkiv Medical Academy of Postgraduate Education, 58 Shalimov Street, Kharkiv 61176, Ukraine
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Valensise H, Lo Presti D, Gagliardi G, Tiralongo GM, Pisani I, Novelli GP, Vasapollo B. Persistent Maternal Cardiac Dysfunction After Preeclampsia Identifies Patients at Risk for Recurrent Preeclampsia. Hypertension 2016; 67:748-53. [PMID: 26902488 DOI: 10.1161/hypertensionaha.115.06674] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/17/2015] [Indexed: 11/16/2022]
Abstract
The purpose of our study was to assess cardiac function in nonpregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case-control study and submitted to echocardiographic examination in the nonpregnant state 12 to 18 months after the first delivery. All patients included in the study had pregnancy within 24 months from the echocardiographic examination and were followed until term. Twenty-two (29%) of the 75 patients developed recurrent preeclampsia. In the nonpregnant state, patients with recurrent preeclampsia compared with controls and nonrecurrent preeclampsia had lower stroke volume (63 ± 14 mL versus 73 ± 12 mL and 70 ± 11 mL, P<0.05), cardiac output (4.6 ± 1.2 L versus 5.3 ± 0.9 L and 5.2 ± 1.0 L, P<0.05), higher E/E' ratio (11.02 ± 3.43 versus 7.34 ± 2.11 versus 9.03 ± 3.43, P<0.05), and higher total vascular resistance (1638 ± 261 dyne · s(-1) · cm(-5) versus 1341 ± 270 dyne · s(-1) · cm(-5) and 1383 ± 261 dyne · s(-1) · cm(-5), P<0.05). Left ventricular mass index was higher in both recurrent and nonrecurrent preeclampsia compared with controls (30.0 ± 6.3 g/m(2.7) and 30.4 ± 6.8 g/m(2.7) versus 24.8 ± 5.0 g/m(2.7), P<0.05). Signs of diastolic dysfunction and different left ventricular characteristics are present in the nonpregnant state before a second pregnancy with recurrent preeclampsia. Previous preeclamptic patients with nonrecurrent preeclampsia show left ventricular structural and functional features intermediate with respect to controls and recurrent preeclampsia.
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Affiliation(s)
- Herbert Valensise
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.).
| | - Damiano Lo Presti
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Giulia Gagliardi
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Grazia Maria Tiralongo
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Ilaria Pisani
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Gian Paolo Novelli
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Barbara Vasapollo
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
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Zhang Y, Ma Q, Yang H, Long Y, Liu X, Zhou C. Maternal plasma TIMP-4 levels combined with clinical risk factors for the early prediction of pregnancy-induced hypertension. Arch Gynecol Obstet 2015; 292:1043-50. [PMID: 25986893 DOI: 10.1007/s00404-015-3753-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to create a model for early predicting pregnancy-induced hypertension (PIH) using plasma markers and clinical risk factors. METHODS A nested case-control study was performed at the Laboratory Department of Guangzhou Women and Children's Medical Center. From a prospective cohort of tens of thousands of unselected women with singleton pregnancies at 8-20 weeks gestation, maternal plasma samples were obtained from 73 women who subsequently developed PIH (PIH group) and 146 gestational age- and maternal age-matched women with normotensive pregnancies (control group). Proteins extracted from the plasma samples were screened by microchip and verified by ELISA. Clinical risk factor data were analyzed retrospectively. RESULTS Compared to the control group, high concentrations of tissue inhibitor of metalloproteinase-4 (TIMP-4) were found in women with PIH (P = 0.000). Univariate risk factor analysis identified three variables with significant differences between the groups: family history of PIH (P = 0.031), body mass index (BMI; P < 0.001), and non-glucose-6-phosphate dehydrogenase deficiency-induced anemia (P < 0.027). Multiple regression analyses revealed a significant relationship of PIH with TIMP-4 levels, BMI, and family history (combined area under the receiver operating characteristic curve = 0.820). CONCLUSION Upregulation of plasma TIMP-4 might contribute to PIH processes. Potential risk factors of this disease may include a family history of PIH and BMI. The combination of TIMP-4 levels and these risk factors may have some predictive values for PIH. Future multicenter studies including greater numbers of samples, analyzed proteins, and risk factors are needed to obtain a higher predictive value of the model for the clinical diagnosis of PIH.
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Affiliation(s)
- Yonggang Zhang
- Laboratory Department, Guangzhou Women and Children Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qinling Ma
- Laboratory Department, Guangzhou Women and Children Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongling Yang
- Laboratory Department, Guangzhou Women and Children Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Yan Long
- Laboratory Department, Guangzhou Women and Children Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xingxing Liu
- Laboratory Department, The 324th Hospital of Third Military Medical University, Chongqing, China
| | - Chen Zhou
- Laboratory Department, Guangzhou Women and Children Medical Center, Guangzhou Medical University, Guangzhou, China
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Karamali M, Beihaghi E, Mohammadi AA, Asemi Z. Effects of High-Dose Vitamin D Supplementation on Metabolic Status and Pregnancy Outcomes in Pregnant Women at Risk for Pre-Eclampsia. Horm Metab Res 2015; 47:867-72. [PMID: 25938886 DOI: 10.1055/s-0035-1548835] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study was designed to assess the beneficial effects of high-dose (cholecalciferol) vitamin D supplementation on metabolic profiles and pregnancy outcomes among pregnant women at risk for pre-eclampsia. This randomized double-blind placebo-controlled clinical trial was performed among 60 pregnant women at risk for pre-eclampsia according to abnormal uterine artery Doppler waveform. Subjects were randomly divided into 2 groups to receive 50 000 IU vitamin D supplements (n=30) or receive placebo (n=30) every 2 weeks from 20 to 32 weeks of gestation. Fasting blood samples were taken at baseline study and 12 weeks after the intervention to quantify relevant variables. Newborn's anthropometric measurements were determined. Pregnant women who received cholecalciferol supplements had significantly increased serum 25-hydroxyvitamin D concentrations (+17.92±2.28 vs. +0.27±3.19 ng/ml, p<0.001) compared with the placebo. The administration of cholecalciferol supplements, compared with the placebo, resulted in significant differences in serum insulin concentrations (+1.08±6.80 vs. +9.57±10.32 μIU/ml, p<0.001), homeostasis model of assessment-insulin resistance (HOMA-IR) (+0.19±1.47 vs. +2.10±2.67, p<0.001), homeostatic model assessment-beta cell function (HOMA-B) (+5.82±29.58 vs. +39.81±38.00, p<0.001) and quantitative insulin sensitivity check index (QUICKI) score (-0.009±0.03 vs. -0.04±0.03, p=0.004). Furthermore, cholecalciferol-supplemented pregnant women had increased HDL-cholesterol concentrations (+2.67 ± 8.83 vs. -3.23±7.76 mg/dl, p=0.008) compared with the placebo. Finally, cholecalciferol supplementation led to a significant rise in plasma total antioxidant capacity (TAC) concentrations (+79.00±136.69 vs. -66.91±176.02 mmol/l, p=0.001) compared with the placebo. Totally, the administration of cholecalciferol supplements among pregnant women at risk for pre-eclampsia for 12 weeks had favorable effects on insulin metabolism parameters, serum HDL-cholesterol, and plasma TAC concentrations.
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Affiliation(s)
- M Karamali
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, I. R. Iran
| | - E Beihaghi
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, I. R. Iran
| | - A A Mohammadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, I. R. Iran
| | - Z Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I. R. Iran
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Zhou A, Xiong C, Hu R, Zhang Y, Bassig BA, Triche E, Yang S, Qiu L, Zhang Y, Yao C, Xu S, Wang Y, Xia W, Qian Z, Zheng T, Zhang B. Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China. PLoS One 2015; 10:e0136291. [PMID: 26305565 PMCID: PMC4548954 DOI: 10.1371/journal.pone.0136291] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/02/2015] [Indexed: 11/24/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) are major causes of maternal death worldwide and the risk factors are not fully understood. Few studies have investigated the risk factors for HDP among Chinese women. A cohort study involving 84,656 women was conducted to investigate pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy as risk factors for HDP among Chinese women. Methods The study was conducted between 2011–2013 in Wuhan, China, utilizing data from the Maternal and Children Healthcare Information Tracking System of Wuhan. A total of 84,656 women with a live singleton pregnancy were included. Multiple unconditional logistic regression was conducted to evaluate associations between putative risk factors and HDP. Results Women who were overweight or obese before pregnancy had an elevated risk of developing HDP (overweight: OR = 2.66, 95% CI = 2.32–3.05; obese: OR = 5.53, 95% CI = 4.28–7.13) compared to their normal weight counterparts. Women with total GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 1.72 (95% CI = 1.54–1.93) for HDP compared to women who had GWG within the IOM recommendation. Women with gestational BMI gain >10 kg/m2 during pregnancy had an adjusted OR of 3.35 (95% CI = 2.89–3.89) for HDP, compared to women with a gestational BMI gain <5 kg/m2. The increased risk of HDP was also observed among women with higher early pregnancy (up to 18 weeks of pregnancy) GWG (>600g/wk: adjusted OR = 1.48, 95% CI = 1.19–1.84). Conclusion The results from this study show that maternal pre-pregnancy BMI, early GWG, and total GWG are positively associated with the risk of HDP. Weight control efforts before and during pregnancy may help to reduce the risk of HDP.
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Affiliation(s)
- Aifen Zhou
- Wuhan Women and Children Health Care Center, Wuhan, Hubei, People’s Republic of China
| | - Chao Xiong
- Wuhan Women and Children Health Care Center, Wuhan, Hubei, People’s Republic of China
- Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Ronghua Hu
- Wuhan Women and Children Health Care Center, Wuhan, Hubei, People’s Republic of China
| | - Yiming Zhang
- Wuhan Women and Children Health Care Center, Wuhan, Hubei, People’s Republic of China
| | - Bryan A. Bassig
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Elizabeth Triche
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Shaoping Yang
- Wuhan Women and Children Health Care Center, Wuhan, Hubei, People’s Republic of China
| | - Lin Qiu
- Wuhan Women and Children Health Care Center, Wuhan, Hubei, People’s Republic of China
| | - Yaqi Zhang
- Wuhan Women and Children Health Care Center, Wuhan, Hubei, People’s Republic of China
| | - Cong Yao
- Wuhan Women and Children Health Care Center, Wuhan, Hubei, People’s Republic of China
| | - Shunqing Xu
- Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Youjie Wang
- Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Wei Xia
- Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Zhengmin Qian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, MO, United States of America
| | - Tongzhang Zheng
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States of America
- * E-mail: (BZ); (TZ)
| | - Bin Zhang
- Wuhan Women and Children Health Care Center, Wuhan, Hubei, People’s Republic of China
- * E-mail: (BZ); (TZ)
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Osol G, Bernstein I. Preeclampsia and maternal cardiovascular disease: consequence or predisposition? J Vasc Res 2014; 51:290-304. [PMID: 25300258 DOI: 10.1159/000367627] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 08/13/2014] [Indexed: 11/19/2022] Open
Abstract
Formerly preeclamptic women stand a higher chance of developing cardiovascular disease (CVD) later in life and may experience a shortened life span. This review updates the pathophysiology and definition of this complex disease and highlights the protective role of pregnancy by considering the relationship between pregnancy interval and likelihood of disease recurrence. The evidence for persistent maternal cardiovascular impairment following preeclampsia (PE) is considered, e.g. postpartum changes in CVD occurrence, blood pressure elevation and changes in the renin-angiotensin-aldosterone system). Since maternal endothelial dysfunction is a hallmark of PE, we summarize the evidence for reduced flow-mediated dilation in women with previous PE, and consider the utility and shortcomings of this clinical measure. In addition to viewing postpartum changes as a consequence of this disease, we consider the alternative view that PE might be the manifestation of a maternal phenotype that already has some predisposition to or is in the earlier stages of CVD; in this case, some of the postpartum residual deficits (or their antecedents) may have already been present prior to pregnancy. Finally, we consider the use of novel biomarkers for predicting or detecting PE prior to the appearance of clinical symptoms.
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Affiliation(s)
- George Osol
- Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington, Vt., USA
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Burwick RM, Easter SR, Dawood HY, Yamamoto HS, Fichorova RN, Feinberg BB. Complement Activation and Kidney Injury Molecule-1–Associated Proximal Tubule Injury in Severe Preeclampsia. Hypertension 2014; 64:833-8. [DOI: 10.1161/hypertensionaha.114.03456] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Richard M. Burwick
- From the Division of Maternal Fetal Medicine and Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland (R.M.B.); and Division of Maternal Fetal Medicine (B.B.F.), Laboratory of Genital Tract Biology (H.Y.D., H.S.Y., R.N.F.), and Department of Obstetrics, Gynecology, and Reproductive Biology (S.R.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Sarah Rae Easter
- From the Division of Maternal Fetal Medicine and Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland (R.M.B.); and Division of Maternal Fetal Medicine (B.B.F.), Laboratory of Genital Tract Biology (H.Y.D., H.S.Y., R.N.F.), and Department of Obstetrics, Gynecology, and Reproductive Biology (S.R.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Hassan Y. Dawood
- From the Division of Maternal Fetal Medicine and Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland (R.M.B.); and Division of Maternal Fetal Medicine (B.B.F.), Laboratory of Genital Tract Biology (H.Y.D., H.S.Y., R.N.F.), and Department of Obstetrics, Gynecology, and Reproductive Biology (S.R.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Hidemi S. Yamamoto
- From the Division of Maternal Fetal Medicine and Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland (R.M.B.); and Division of Maternal Fetal Medicine (B.B.F.), Laboratory of Genital Tract Biology (H.Y.D., H.S.Y., R.N.F.), and Department of Obstetrics, Gynecology, and Reproductive Biology (S.R.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Raina N. Fichorova
- From the Division of Maternal Fetal Medicine and Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland (R.M.B.); and Division of Maternal Fetal Medicine (B.B.F.), Laboratory of Genital Tract Biology (H.Y.D., H.S.Y., R.N.F.), and Department of Obstetrics, Gynecology, and Reproductive Biology (S.R.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Bruce B. Feinberg
- From the Division of Maternal Fetal Medicine and Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland (R.M.B.); and Division of Maternal Fetal Medicine (B.B.F.), Laboratory of Genital Tract Biology (H.Y.D., H.S.Y., R.N.F.), and Department of Obstetrics, Gynecology, and Reproductive Biology (S.R.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Early pregnancy waist-to-hip ratio and risk of preeclampsia: a prospective cohort study. Hypertens Res 2014; 38:80-3. [DOI: 10.1038/hr.2014.133] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/25/2014] [Accepted: 07/03/2014] [Indexed: 12/21/2022]
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Abstract
Preeclampsia is a frequent cause of maternal and fetal morbidity and mortality worldwide. The underlying causes of this hypertensive complication have remained elusive. The placenta seems to be at the origin of the disease, as its removal appears to be the only effective treatment available. Many organs can potentially be affected. Nonetheless, kidney alterations are always present: proteinuria is one of the hallmarks for a preeclampsia diagnosis. VEGF is pivotal for maintaining glomerular filtration barrier function; hence, the elevated concentrations of placental-derived VEGF inhibitors, such as sFlt-1, may largely explain the renal alterations observed. Classically, glomerular endothelial injury was considered responsible for the renal impairment present in preeclampsia. Recent findings, however, have shown that podocytes are crucial in explaining the loss of filtration capacity of the preeclamptic kidney. The aims of this manuscript are to detail the main findings that associate podocyte injury with proteinuria in preeclampsia, and discuss the eventual applications of podocyte damage biomarkers in clinical practice.
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Affiliation(s)
- Daniel E Henao
- Grupo de Investigación en Salud y Comunidad. Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Avenida Sur 98-56 Belmonte, Pereira, Colombia,
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Rosenfeld CR, Roy T. Prolonged uterine artery nitric oxide synthase inhibition modestly alters basal uteroplacental vasodilation in the last third of ovine pregnancy. Am J Physiol Heart Circ Physiol 2014; 307:H1196-203. [PMID: 25128169 DOI: 10.1152/ajpheart.00996.2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Mechanisms regulating uteroplacental blood flow (UPBF) in pregnancy remain unclear, but they likely involve several integrated signaling systems. Endothelium-derived nitric oxide (NO) is considered an important contributor, but the extent of its involvement is unclear. Bolus intra-arterial infusions of nitro-l-arginine methyl ester (l-NAME) modestly decrease ovine basal UPBF; however, the doses and duration of infusion may have been insufficient. We, therefore, examined prolonged uterine artery (UA) NO synthase inhibition with l-NAME throughout the last third of ovine pregnancy by performing either continuous 30-min UA infusion dose responses (n = 4) or 72-h UA infusions (0.01 mg/ml) at 104-108, 118-125, and 131-137 days of gestation (n = 7) while monitoring mean arterial pressure (MAP), heart rate (HR), and UPBF. Uteroplacental vascular resistance (UPVR) was calculated, and uterine cGMP synthesis was measured. Thirty-minute UA l-NAME infusions did not dose dependently decrease UPBF, increase UPVR, or decrease uterine cGMP synthesis (P > 0.1); however, MAP rose and HR fell modestly. Prolonged continuous 72-h UA l-NAME infusions decreased UPBF ∼32%, increased UPVR ∼68% (P ≤ 0.001), and decreased uterine cGMP synthesis 70% at 54-72 h (P ≤ 0.004); the noninfused uterine horn was unaffected. These findings were associated with ∼10% increases in MAP and decreases in HR that were greater at 104-108 than 118-125 and 131-137 days of gestation (P = 0.006). Although uterine and UA NO and cGMP synthesis increase severalfold during ovine pregnancy, they contribute modestly to the maintenance and rise in UPBF in the last third of gestation. Thus, local UA NO may primarily modulate vasoconstrictor responses. Notably, the systemic vasculature appears more sensitive than the uterine vasculature to NO synthase inhibition.
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Affiliation(s)
- Charles R Rosenfeld
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Timothy Roy
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
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Zuniga FA, Ormazabal V, Gutierrez N, Aguilera V, Radojkovic C, Veas C, Escudero C, Lamperti L, Aguayo C. Role of lectin-like oxidized low density lipoprotein-1 in fetoplacental vascular dysfunction in preeclampsia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:353616. [PMID: 25110674 PMCID: PMC4109675 DOI: 10.1155/2014/353616] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/24/2014] [Indexed: 11/30/2022]
Abstract
The bioavailability of nitric oxide (NO) represents a key marker in vascular health. A decrease in NO induces a pathological condition denominated endothelial dysfunction, syndrome observed in different pathologies, such as obesity, diabetes, kidney disease, cardiovascular disease, and preeclampsia (PE). PE is one of the major risks for maternal death and fetal loss. Recent studies suggest that the placenta of pregnant women with PE express high levels of lectin-like oxidized LDL receptor-1 (LOX-1), which induces endothelial dysfunction by increasing reactive oxygen species (ROS) and decreasing intracellular NO. Besides LOX-1 activation induces changes in migration and apoptosis of syncytiotrophoblast cells. However, the role of this receptor in placental tissue is still unknown. In this review we will describes the physiological roles of LOX-1 in normal placenta development and the potential involvement of this receptor in the pathophysiology of PE.
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Affiliation(s)
- Felipe A. Zuniga
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, 4070386 Concepcion, Chile
| | - Valeska Ormazabal
- Department of Basic Science, Faculty of Medicine, Universidad Católica de la Santísima Concepción, 4090541 Concepcion, Chile
| | - Nicolas Gutierrez
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, 4070386 Concepcion, Chile
| | - Valeria Aguilera
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, 4070386 Concepcion, Chile
| | - Claudia Radojkovic
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, 4070386 Concepcion, Chile
| | - Carlos Veas
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, 4070386 Concepcion, Chile
| | - Carlos Escudero
- Vascular Physiology Laboratory, Group of Investigation in Tumor Angiogenesis (GIANT), Group of Research and Innovation in Vascular Health (GRIVAS Health), Department of Basic Sciences, Faculty of Sciences, Universidad del Bío-Bío, 4081112 Chillán, Chile
| | - Liliana Lamperti
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, 4070386 Concepcion, Chile
| | - Claudio Aguayo
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, 4070386 Concepcion, Chile
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Rijal JP, Giri S, Dawadi S, Dahal KV. Posterior reversible encephalopathy syndrome (PRES) in a patient with late postpartum eclampsia. BMJ Case Rep 2014; 2014:bcr-2013-203162. [PMID: 24577180 DOI: 10.1136/bcr-2013-203162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterised by seizure, headaches, visual symptoms, impaired consciousness and other focal neurological findings. It is caused by a wide variety of causes ultimately leading to a vasogenic cerebral oedema of occipital and parietal lobes of the brain. We present here a young woman with headache, generalised tonic-clonic seizures and cortical blindness in a late postpartum stage. Reversibility of the symptoms and characteristic imaging findings led us to a diagnosis of PRES in our patient.
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Affiliation(s)
- Jharendra P Rijal
- Division of Hospital Medicine, Miriam Hospital, Providence, Rhode Island, USA
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