Preeclampsia

Research Hotspots and Thematic Trends in the Management of Preeclampsia: A Bibliometric Analysis from 2000 to 2022

Preeclampsia (PE) is one of the serious complications of pregnancy, and the management of PE remains an important problem for obstetricians. This study aims to identify the characteristics and trends of published articles on PE management through bibliometric analysis. We searched the Web of Science database for articles related to PE management from 2000 to 2022. Metadata was obtained, including the titles, publication dates, authors, institutions, countries, and keywords of all articles, and then network visualization and burst keyword analysis were performed using Citespace and VOSviewer software. A total of 5190 articles were included in the analysis. The number of publications in the field of PE management has steadily increased over the years, and a visual analysis of collaborative networks of authors, institutions, and countries revealed that the United States, United Kingdom, Australia, and Canada have contributed the most to the field and formed extensive collaborations. The Journal of maternal-fetal & neonatal medicine has the most publications in this field, and the Journal of Obstetrics and gynecology has not only more publications but also 64.75 citations per article. The keywords mainly focused on prevention, diagnosis, risk factors, and outcome of PE. In addition, hypertensive disorders of pregnancy and fetal growth restriction have received a lot of attention in this field in recent years. We analyzed the partnerships in the field of PE management through bibliometrics and showed trends and developments in the field. The available results suggest that PE management will continue to be a focus of attention for obstetricians and researchers.

Association between deep learning radiomics based on placental MRI and preeclampsia with fetal growth restriction: A multicenter study

PURPOSE

Preeclampsia (PE) is associated with placental insufficiency and could lead to adverse pregnancy outcomes. The study aimed to develop a placental T2-weighted image-based automatic quantitative model for the identification of PE pregnancies and disease severity.

METHODS

Between July 2013 and September 2022, the retrospective multicenter study featured 420 pregnant women, including 140 cases of PE and 280 cases of normotensive pregnancies. The semi-supervised approach was used to gain an automatic segmentation for placental MRI. The radiomics, deep learning, and deep learning radiomics (DLR) models were built.

RESULTS

In PE pregnancies, 65 (46.4 %) fetuses developed PE with fetal growth restriction (FGR), and 75 (53.6 %) cases were PE without FGR. The Dice of semi-supervised placental segmentation was 0.917. The AUCs of the DLR signature for discriminating PE pregnancies from normotensive pregnancies were 0.839 (95 % CI: 0.793-0.886), 0.858 (95 % CI: 0.742-0.974), 0.888 (95 % CI: 0.783-0.992), and 0.843 (95 % CI: 0.731-1.000) in the training, test, internal validation, and external validation sets, respectively. This DLR analysis model performed well in discriminating between PE with FGR and normotensive pregnancies (AUC = 0.918, 95 % CI: 0.879-0.957) and PE without FGR (AUC = 0.742, 95 % CI: 0659-0.824).

CONCLUSION

The automatic radiomics analysis has been developed to identify PE pregnancies by determining DLR features on placental T2-weighted images, and to predict FGR exposed to PE.

Insulin and myometrial contractility; Are there any links? A narrative review

Contrary to the evidence supporting the role for insulin in stimulating uterine contraction, only a limited number of studies have highlighted the inhibitory effect of insulin on myometrial contractions in human and rodent. A hypothetical narrative review of the current literature was conducted, revealing the current literature and shows the potential inhibitory effects of insulin on myometrial contractility. These inhibitory mechanisms include activation of adenylyl cyclase signaling pathways, an increase in cAMP production, a decrease in Ca2 + influx and cytosolic Ca2+, hyperpolarization of the cell membrane, and stimulation of NO synthesis. Altered oxytocin sensitivity, structural similarity to relaxin, modulating abscisic acid (ABA) effect, and synergistic interaction with progesterone, adiponectin, and leptin may also represent additional mechanisms for the inhibitory effects of insulin on myometrial contractions. The literature indicates that insulin exhibits inhibitory effects on myometrial contractility. Confirming such a conclusion through future studies may propose insulin as a possible uterine quiescent.

Blood pressure patterns of gestational hypertension or non-severe pre-eclampsia beyond 36 weeks' gestation and the adverse maternal outcomes: Secondary analysis of the HYPITAT study

OBJECTIVES

To identify patterns in changes of blood pressure for women with gestational hypertension (GH) or non-severe pre-eclampsia (PE) beyond 36 gestational weeks, and assess their association with a composite adverse maternal outcome.

STUDY DESIGN

Secondary analysis of a randomized controlled trial (HYPITAT).

MAIN OUTCOME MEASURES

We investigated patterns of one-week blood pressure changes post-admission, explored factors contributing to diverse patterns using ANOVA and Chi-square tests, and assessed the correlation between these patterns and a composite adverse maternal outcome defined as severe maternal morbidity, mortality, post-partum hemorrhage and cesarean section. Among 384 women, 187 developed the composite outcome.

RESULTS

We identified three and four typical patterns in systolic and diastolic blood pressure changes, respectively. Diastolic blood pressure patterns statistically significantly varied across maternal ethnicity and diagnosis at admission. Compared to a pattern of steady diastolic blood pressure, the odds ratio (95 % confidence interval) for the composite adverse maternal outcome was 2.59 (1.31, 5.13) or 2.09 (1.02, 4.26), contingent on covariates, when a pattern of increasing diastolic blood pressure was present. The results of sensitivity analysis excluding severe hypertension from the composite outcome indicated that the main findings are robust.

CONCLUSIONS

Maternal ethnicity and diagnosis may affect diastolic blood pressure patterns, and a pattern of increasing diastolic blood pressure was likely associated with elevated risk of the composite adverse maternal outcome. This underscores the potential significance of recognizing these patterns for sequential risk assessment and individualized management in late GH and non-severe PE.

The relationship between renal function indicators and preeclampsia in the second trimester of pregnancy: a retrospective study

Background

To investigate the relationship between serum renal function indicators and preeclampsia (PE) in pregnant women at second trimester of pregnancy, determine the optimal critical values of the above indicators, and further identify the independent risk factors of PE.

Methods

We assessed the renal function indicators in second trimesters of 137 pregnant women with PE and 137 normal pregnant women who delivered at Shijiazhuang Fourth Hospital between January 2020 to December 2022. Paired t-tests, paired Mann-Whitney U tests, and Chi-square tests were used to evaluate differences of clinical data between the two groups. Receiver operating characteristic (ROC) curves was employed to establish the optimal critical values of the above indicators. A 1:1 matched case-control logistic regression analysis was conducted to identify the independent risk factors for PE.

Results

The levels of serum uric acid and the ratio of serum uric acid to serum creatinine were significantly higher in the PE group compared to the control (P < 0.001), while the serum creatinine levels were higher in control group (P = 0.002). The incidence of adverse maternal (P < 0.001) and neonatal outcomes (P < 0.001) in the PE group were higher than those in the control group. A ROC analysis based on the occurrence of PE showed that the levels of serum uric acid (P < 0.001), serum creatinine (P = 0.006) and the ratio of serum uric acid to serum creatinine (P < 0.001) were statistically significant. After adjusting for confounding factors, elevated serum uric acid (a OR = 1.012, 95% CI [1.005-1.019], P < 0.001) and an increased serum uric acid to serum creatinine ratio (a OR = 1.190, 95% CI [1.053-1.346], P = 0.005) were identified as independent risk factors for PE. There was no significant difference in renal function between maternal and newborn group in relation to the occurrence of adverse outcomes (P > 0.05 vs. all groups).

Conclusions

Through the analysis of renal function indicators in patients with PE in the second trimester of pregnancy and those in a normal control group, it is found that elevated serum uric acid and serum uric acid to serum creatinine ratio in PE individual may serve as indicative markers for the onset of PE. Targeting this subset of the population for monitoring and management during the second trimester could enhance the efficacy of medical interventions.

Risk of preeclampsia and other pregnancy complications in frozen single euploid embryo transfers after natural versus artificial endometrial preparation: A truncated randomized controlled trial

INTRODUCTION

To determine for the first time the incidence of preeclampsia and other pregnancy complications according to the mode of endometrial preparation for frozen embryo transfer (FET) in a randomized fashion.

METHODS

Women about to undergo FET of a single euploid blastocyst were randomly assigned to a modified natural cycle (MNC) or an artificial cycle (AC). Inclusion criteria were as follows: Caucasian; non-obese; 18-43 years of age; nulliparity; regular menstrual cycles; and autologous oocytes. Exclusion criteria were as follows: uterine alterations; moderate-heavy smokers; gamete donation; and chronic diseases. A pilot sub-study of first-trimester markers of preeclampsia was performed in 60 of the patients.

RESULTS

Of the 1260 patients estimated, 591 met the inclusion criteria and were willing to participate; of these, 306 and 285 were randomly assigned to a MNC or AC, respectively. After exclusion, 242 and 227 patients finally underwent a MNC or AC, resulting in 131 and 103 clinical pregnancies, 121 and 92 live births, and 91 and 70 questionnaires obtained concerning pregnancy complications, respectively. The incidence of preeclampsia was double in the AC group (10.00 % versus 4.39 %), though not significantly different. In the AC group, the prevalence of first trimester bleeding was significantly higher (42.85 % versus 15.38 %), and there was a significant reduction in live birth rates (40.53 % versus 50.00 %) in the per protocol analysis. No differences in early markers of preeclampsia were detected between the two groups.

DISCUSSION

Although this randomized study was truncated, our findings are in accordance with previous reports of a higher risk of preeclampsia and other complications when the endometrium is artificially prepared for FET.

Dissecting the association of genetically predicted neuroticism with pre-eclampsia: A 2-sample Mendelian randomization study

Previous observational clinical studies have found a causal relationship between neurotic personality traits and various disorders. However, the relationship between neurotic personality characteristics and pre-eclampsia (PE) is not unclear. Two-sample Mendelian randomization (MR) was employed to examine the influence of neurotic personality traits on the risk of PE. From the Finnish genome-wide database, we identified 32 single-nucleotide polymorphisms linked to neuroticism personality traits, excluding 7 confounding variables related to blood pressure and BMI. The number of tool variables associated with PE was 25. Causality was assessed using inverse variance weighting, weighted median, MR-Egger, and weighted model methods. Sensitivity analyses, such as Cochran's Q statistic, MR-Egger intercept, MR pleiotropy residual sum and outlier, and leave-one-out analysis, were conducted to identify potential heterogeneity and horizontal pleiotropy. The present 2-sample MR study did not reveal any genetic associations between neuroticism and PE. A 2-sample Mendelian randomization analysis of 12 dichotomous neuroticism items indicated that genetic predisposition to worrying elevates the risk of PE. The inverse variance weighted method produced an odds ratio (OR) of 2.23 (95% CI: 1.36-3.65, P < .05), while the weighted median analysis indicated an OR of 2.41 (95% CI: 1.20-4.85, P < .05). However, there were no significant correlations between the MR Egger and weighted modes. This study found no genetic causal link between neuroticism and PE; however, carriers may have a genetically increased risk of PE, offering a more reliable foundation for future prevention efforts.

The potential role of the αVβ3 integrin receptor in placental biology and normal and complicated pregnancies

The αVβ3 receptor is a member of the integrin family of receptors, which includes 24 members involved in a variety of key biological processes. It is widely expressed in multiple cell types and is involved in cell adhesion and migration, angiogenesis and immune cell regulation. These processes play important roles in both normal placentation and placental progression through pregnancy. This review describes the potential roles of αVβ3 integrin receptor throughout gestation in normal and abnormal conditions, and the need for additional studies to better define its precise contributions.

Towards the Development of a Conceptual Framework of the Determinants of Pre-Eclampsia: A Hierarchical Systematic Review of Social Determinants

BACKGROUND

Existing reviews of pre-eclampsia determinants have focused on clinical and genetic risk factors.

OBJECTIVE

To evaluate social determinants for pre-eclampsia prevention.

SEARCH STRATEGY

Systematic searches were conducted from relevant electronic databases from inception of each database to 30th December 2024.

SELECTION CRITERIA

Reviews and large cohort studies (≥ 1000 participants), published between 2013 and 2024, reporting quantitative associations between social determinant exposures and pre-eclampsia outcomes.

DATA COLLECTION AND ANALYSIS

Titles and abstracts, then relevant full-texts were reviewed by two reviewers, independently. Strength of association was evaluated as 'definite' (odds ratios [OR] or relative risk [RR] ≥ 3.00 or < 0.33), 'probable' (OR or RR 1.50-2.99 or 0.33-0.67), 'possible' (OR or RR 1.10-1.49 or 0.68-0.89), or 'unlikely' (OR or RR 0.90-1.09). Quality of the evidence was high, moderate, low, or very-low, using GRADE.

MAIN RESULTS

Twenty-seven publications found 24 associations of pre-eclampsia with socioeconomic status, social support/exclusion, healthcare access, and occupational and physical environmental factors. One association (polygamy) was definite (low-quality evidence). Probable associations included: work stress, lack of antenatal care and heat exposure in early pregnancy (high-quality evidence); prolonged occupational exposure to whole body vibrations or bending, distance to health facility, and UV-B radiation exposure (protective factor), all based on moderate-quality evidence; and neighbourhood deprivation, rotating work shifts, and Asian/Oceanian origins (protective factor), all based on low-quality evidence. There were 13 possible associations, which did not include education.

CONCLUSION

Our findings support recommendations to address climate change, strengthen occupational protection, and promote early antenatal attendance. Social determinants may be indicative of upstream factors (e.g., obesity) that increase likelihood of clinical risk factors for pre-eclampsia incidence and severity.

Standardised Methods for Developing Conceptual Frameworks for Placental Disorders of Pregnancy: Pre-Eclampsia and Stillbirth

BACKGROUND

Risk factors for the placental disorders of pregnancy (pre-eclampsia, fetal growth restriction, preterm birth, and stillbirth) are complex, frequently involving the interplay between clinical factors and wider social and environmental determinants of health. Biomarkers modulate the maternal and fetal responses to biological processes that underlie the development of placental disorders.

OBJECTIVES

To develop a standardised methodology to assess the importance of, and inter-relationships between, candidate risk factors for the various placental disorders.

SEARCH STRATEGY

Systematic searches were conducted using Medline, Embase, Health Technology Assessments, Database of Abstracts of Reviews of Effects, Cochrane Library databases, Google Scholar, and reference lists of retrieved papers.

SELECTION CRITERIA

We deployed a hierarchy of reviews, systematic reviews, and cohort studies with at least 1000 participants (100 for biomarker studies), published in the prior decade.

DATA COLLECTION AND ANALYSIS

We assessed the strengths of association and quality of evidence linking risk factors with individual placental outcomes.

CONCLUSIONS

We have developed a standardised approach to assess the importance and inter-relatedness of putative risk factors for the placental disorders of pregnancy.

Intracranial Hemorrhage During Pregnancy: An Interdisciplinary Literature Review and a Rare Case Report of Early-Onset Eclampsia with Intracranial Hemorrhage and HELLP Syndrome

Intracranial hemorrhage is a rare yet potentially devastating event during pregnancy with a significant risk of maternal and fetal mortality and morbidity. The risk of intracranial hemorrhage increases during the third trimester of pregnancy and is greatest during labor and the postpartum period. Interdisciplinary diagnosis and treatment of the pregnant population often begins in the emergency department setting and is key to increasing patient survival rates through immediate and adequate treatment, including emergency medicine, neurosurgical and obstetrical procedures. A unique case report with a diagnostic pathway for intracranial hemorrhage due to eclampsia in a primipara at 24 weeks of gestation is presented, illustrating potential diagnostic dilemmas as the patient rapidly progresses into hemolysis, elevated liver enzymes and low platelets syndrome. A literature review was conducted to uncover the etiology of intracranial hemorrhage during pregnancy, as well as its diagnostic challenges and treatment. Pregnancy should not be viewed as a barrier to performing angiography or endovascular treatment for vascular causes of intracranial hemorrhage. Patient transport to a tertiary reference center and the interdisciplinary cooperation of specialists are key to achieving correct and rapid treatment. Continuous prevention of preeclampsia and patient education are necessary to decrease the incidence of eclampsia and its complications. Key message: Intracranial hemorrhage and eclampsia in pregnant patients are rare yet may result in high rates of maternal and fetal morbidity and mortality. The diagnostic process is difficult and requires interdisciplinary cooperation to start the correct treatment immediately.

Impact of pre-pregnancy body mass index on preeclampsia

Background

It remains unclear how pre-pregnancy body mass index (BMI) affects preeclampsia in the Chinese population, primarily due to insufficient large-scale research on this topic.

Objective

The study aimed to determine the relationship between pre-pregnancy BMI and (severe) preeclampsia in the Chinese population, providing a detailed description of the findings.

Methods

The retrospective study included a total of 75,773 pregnant women registered between 2016 and 2020. These participants were categorized into four groups based on their pre-pregnancy BMI: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5-<24 kg/m2), overweight (BMI 24-<28 kg/m2), and obese (BMI ≥ 28 kg/m2). The relationship between risks of preeclampsia or severe preeclampsia and pre-pregnancy BMI were further explored, with an evaluation of potential modification by maternal age.

Results

A lower risk of developing preeclampsia was observed in the underweight population, with an OR of 0.604 (95%CI, 0.507-0.719). In contrast, women who were overweight or obese during the pre-pregnancy period demonstrated a significantly higher risk of preeclampsia, with ORs of 2.211 (95%CI, 1.967-2.486) and 3.662 (95%CI, 3.026-4.431), respectively. After adjusting for confounding factors, the elevated risk of preeclampsia persisted, showing ORs of 2.152(95%CI, 1.911-2.425) for the overweight population and 3.493 (95%CI, 2.874-4.245) for those who were obese, while the risk for underweight women remained lower, with an OR of 0.609(95%CI, 0.511-0.727). For severe preeclampsia, the risk was also higher in the overweight and obese participants after adjusting for confounders, demonstrating ORs of 1.652(95%CI, 1.364-2.001) and 2.762(95%CI, 2.014-3.788), respectively. The underweight population exhibited a lower risk of severe preeclampsia, with an OR of 0.720(95%CI, 0.565-0.919). In addition, these risks were not significantly associated with maternal age.

Conclusion

Regardless of adjustment for confounders, underweight women demonstrated a lower risk of preeclampsia, whereas the overweight/obese population exhibited a higher occurrence of both preeclampsia and severe preeclampsia. These associations were not influenced by maternal age.

Prediction Models for Late-Onset Preeclampsia: A Study Based on Logistic Regression, Support Vector Machine, and Extreme Gradient Boosting Models

Background: Preeclampsia, affecting 2-4% of pregnancies worldwide, poses a substantial risk to maternal health. Late-onset preeclampsia, in particular, has a high incidence among preeclampsia cases. However, existing prediction models are limited in terms of the early detection capabilities and often rely on costly and less accessible indicators, making them less applicable in resource-limited settings. Objective: To develop and evaluate prediction models for late-onset preeclampsia using general information, maternal risk factors, and laboratory indicators from early gestation (6-13 weeks). Methods: A dataset of 2000 pregnancies, including 110 late-onset preeclampsia cases, was analyzed. General information and maternal risk factors were collected from the hospital information system. Relevant laboratory indicators between 6 and 13 weeks of gestation were examined. Logistic regression was used as the baseline model to assess the predictive performance of the support vector machine and extreme gradient boosting models for late-onset preeclampsia. Results: The logistic regression model, only considering general information and risk factors, identified 19.1% of cases, with a false positive rate of 0.4%. When selecting 15 factors encompassing general information, risk factors, and laboratory indicators, the false positive rate increased to 0.7% and the detection rate improved to 27.3%. The support vector machine model, only considering general information and risk factors, achieved a detection rate of 27.3%, with a false positive rate of 0.0%. After including all the laboratory indicators, the false positive rate increased to 7.7% but the detection rate significantly improved to 54.5%. The extreme gradient boosting model, only considering general information and risk factors, achieved a detection rate of 31.6%, with a false positive rate of 1.5%. After including all the laboratory indicators, the false positive rate remained at 0.7% but the detection rate increased to 52.6%. Additionally, after adding the laboratory indicators, the areas under the ROC curve for the logistic regression, support vector machine, and extreme gradient boosting models were 0.877, 0.839, and 0.842, respectively. Conclusion: Compared with the logistic regression model, both the support vector machine and extreme gradient boosting models significantly improved the detection rates for late-onset preeclampsia. However, the support vector machine model had a comparatively higher false positive rate. Notably, the logistic regression and extreme gradient boosting models exhibited high negative predictive values of 99.3%, underscoring their effectiveness in accurately identifying pregnant women less likely to develop late-onset preeclampsia. Additionally, logistic regression showed the highest areas under the ROC curve, suggesting that the traditional model has unique advantages in relation to prediction.

Synchronization-based graph spatio-temporal attention network for seizure prediction

Epilepsy is a common neurological disorder in which abnormal brain waves propagate rapidly in the brain in the form of a graph network during seizures, and seizures are extremely sudden. So, designing accurate and reliable prediction methods can provide early warning for patients, which is crucial for improving their lives. In recent years, a large number of studies have been conducted using deep learning models on epileptic open electroencephalogram (EEG) datasets with good results, but due to individual differences there are still some subjects whose seizure features cannot be accurately captured and are more difficult to differentiate, with poor prediction results. Important time-varying information may be overlooked if only graph space features during seizures are considered. To address these issues, we propose a synchronization-based graph spatio-temporal attention network (SGSTAN). This model effectively leverages the intricate information embedded within EEG recordings through spatio-temporal correlations. Experimental results on public datasets demonstrate the efficacy of our approach. On the CHB-MIT dataset, our method achieves accuracy, specificity, and sensitivity scores of 98.2%, 98.07%, and 97.85%, respectively. In the case of challenging subjects that are difficult to classify, we achieved an outstanding average classification accuracy of 97.59%, surpassing the results of previous studies.

The overview of lactylation in the placenta of preeclampsia

BACKGROUND

Preeclampsia is a major challenge for obstetricians due to its severe impacts on maternal and fetal health. Lysine lactylation (Kla) derived from lactate is a novel type of post-translational modification which has been confirmed to affect the malignant progression of diseases as an epigenetic modifier. However, the systemic lactylome profiling of preeclampsia is still unclear.

MATERIAL AND METHODS

Immunohistochemistry and protein immunoassay were performed on placenta tissues from preeclamptic patients and control pregnancies to compare lactylation levels between the groups. Then liquid chromatography-tandem mass spectrometry (LC-MS/MS) was utilized for quantitative lactylomic analysis and proteomic assessment for proteins with differentially lactated modification. Bioinformatics analyses were applied to reveal the conserved motif sequences and enrichment pathways.

RESULTS

Significant differences in protein lactylation levels were evident in the placenta between preeclamptic and control groups, with modifications observed in both histone and non-histone proteins. Lactylome analysis showed significant downregulation of 59 Kla proteins and 69 Kla sites in preeclamptic placentas, whereas 44 proteins and 60 sites were upregulated. These differentially lactylated proteins were primarily mitochondrial and associated with the citrate cycle (TCA cycle). Enriched metabolic pathways linked to lactylation included those important for vascular muscle contraction, platelet activation, and several signaling pathways like PI3K-Akt, PPAR, and cholesterol metabolism.

CONCLUSIONS

Preeclamptic placentas exhibit distinct lactylation profiles compared to normal pregnancies, primarily affecting mitochondrial and TCA cycle-related energy metabolism. These changes contribute to the pathophysiology of preeclampsia by involving metabolic pathways critical for angiogenesis and endothelial function.

Consecutive prediction of adverse maternal outcomes of preeclampsia, using the PIERS-ML and fullPIERS models: A multicountry prospective observational study

BACKGROUND

Preeclampsia is a potentially life-threatening pregnancy complication. Among women whose pregnancies are complicated by preeclampsia, the Preeclampsia Integrated Estimate of RiSk (PIERS) models (i.e., the PIERS Machine Learning [PIERS-ML] model, and the logistic regression-based fullPIERS model) accurately identify individuals at greatest or least risk of adverse maternal outcomes within 48 h following admission. Both models were developed and validated to be used as part of initial assessment. In the United Kingdom, the National Institute for Health and Care Excellence (NICE) recommends repeated use of such static models for ongoing assessment beyond the first 48 h. This study evaluated the models' performance during such consecutive prediction.

METHODS AND FINDINGS

This multicountry prospective study used data of 8,843 women (32% white, 30% black, and 26% Asian) with a median age of 31 years. These women, admitted to maternity units in the Americas, sub-Saharan Africa, South Asia, Europe, and Oceania, were diagnosed with preeclampsia at a median gestational age of 35.79 weeks between year 2003 and 2016. The risk differentiation performance of the PIERS-ML and fullPIERS models were assessed for each day within a 2-week post-admission window. The PIERS adverse maternal outcome includes one or more of: death, end-organ complication (cardiorespiratory, renal, hepatic, etc.), or uteroplacental dysfunction (e.g., placental abruption). The main outcome measures were: trajectories of mean risk of each of the uncomplicated course and adverse outcome groups; daily area under the precision-recall curve (AUC-PRC); potential clinical impact (i.e., net benefit in decision curve analysis); dynamic shifts of multiple risk groups; and daily likelihood ratios. In the 2 weeks window, the number of daily outcome events decreased from over 200 to around 10. For both PIERS-ML and fullPIERS models, we observed consistently higher mean risk in the adverse outcome (versus uncomplicated course) group. The AUC-PRC values (0.2-0.4) of the fullPIERS model remained low (i.e., close to the daily fraction of adverse outcomes, indicating low discriminative capacity). The PIERS-ML model's AUC-PRC peaked on day 0 (0.65), and notably decreased thereafter. When categorizing women into multiple risk groups, the PIERS-ML model generally showed good rule-in capacity for the "very high" risk group, with positive likelihood ratio values ranging from 70.99 to infinity, and good rule-out capacity for the "very low" risk group where most negative likelihood ratio values were 0. However, performance declined notably for other risk groups beyond 48 h. Decision curve analysis revealed a diminishing advantage for treatment guided by both models over time. The main limitation of this study is that the baseline performance of the PIERS-ML model was assessed on its development data; however, its baseline performance has also undergone external evaluation.

CONCLUSIONS

In this study, we have evaluated the performance of the fullPIERS and PIERS-ML models for consecutive prediction. We observed deteriorating performance of both models over time. We recommend using the models for consecutive prediction with greater caution and interpreting predictions with increasing uncertainty as the pregnancy progresses. For clinical practice, models should be adapted to retain accuracy when deployed serially. The performance of future models can be compared with the results of this study to quantify their added value.

TIG1 triggers placental senescence in preeclampsia through LMNA/p53 axis activation

INTRODUCTION

The mechanism behind abnormal placental aging in preeclampsia (PE) is unclear. Although TIG1 is widely expressed in the human placenta, its function hasn't been well understood. Our previous study found a significant elevation of TIG1 in the placentas of PE patients. In this study, we focused on the molecular mechanism by which TIG1 functions in PE.

METHODS

TIG1 expression of placentas from PE patients and L-NAME mice were analyzed using qRT-PCR, Western blot, and immunohistochemistry. TIG1-overexpressed HTR-8/SVneo cells were constructed for transcriptomic sequencing. Senescence in the placenta was evaluated by biomarkers of p16, p21, and p53. TIG1 binding proteins were identified via co-immunoprecipitation. A co-culture system of HTR-8/SVneo and human endometrial stromal cells was developed to study the change in trophoblasts' function.

RESULTS

TIG1 expression was significantly increased in the PE placentas. Elevated expression of TIG1 was associated with abnormal senescence of trophoblasts. TIG1 induced trophoblasts' senescence by regulating LMNA/p53 axis. The senescence of trophoblasts can be manifested as reduced invasion ability in the co-culture system.

DISCUSSION

Our study indicated that TIG1 was crucial in the development of PE by causing the senescence of trophoblasts and reducing their invasiveness, offering insights into the molecular mechanisms of placental dysfunction in PE.

Association of epidural labor analgesia with maternal and neonatal outcomes in women with preeclampsia: a propensity score-matched single-center retrospective cohort study

BACKGROUND

Epidural labor analgesia (ELA) is widely and safely used for labor pain relief. However, it remains unclear whether ELA affects maternal and neonatal outcomes in women suffering from preeclampsia.

METHODS

This study reviewed the medical records of women with preeclampsia at ≥ 28 weeks of gestation between January 2015 and December 2020. The medical records of women were divided into ELA and no analgesia (NA) groups. The primary endpoint was the cesarean section (CS) rate. Secondary endpoints included hypotension, operative vaginal delivery, fetal distress, neonatal intensive care unit admission, and complications. Using multivariate logistic regression analysis and propensity score matching (PSM), the association between ELA and maternal and neonatal outcomes was examined.

RESULTS

A total of medical records of 686 women were enrolled, with 242 (35.3%) receiving ELA. Of these, 126 (18.4%) had a higher incidence of CS in the ELA group than in the NA group (22.7% vs. 16.0%, P = 0.020). Multivariable analysis indicated greater risks of CS [adjusted Odds Ratio (aOR) = 1.71; 95% CI, 1.07-2.74; P = 0.025] and operative vaginal delivery (aOR = 2.810; 95% CI, 1.379-5.725; P = 0.004) in the ELA group than that of NA group. In the PSM, ELA did not increase the risk of CS (aOR = 1.56; 95% CI, 0.97-2.52; P = 0.067) and OVD (aOR = 2.048; 95% CI, 0.936-4.484; P = 0.073). The secondary endpoints showed no significant differences between the two groups.

CONCLUSION

The study indicates an association between ELA and maternal and neonatal outcomes, supporting the safety of ELA in this population.

Microbiota Dysbiosis: A Key Modulator in Preeclampsia Pathogenesis and Its Therapeutic Potential

Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Emerging evidence implicates gut and vaginal microbiota dysbiosis in preeclampsia pathogenesis through its roles in immune regulation, inflammation, and placental function. This review explores the mechanisms linking microbiota alterations to preeclampsia and evaluates the therapeutic potential of microbiota-targeted interventions. A systematic search using MeSH terms related to "preeclampsia", "microbiota", and "dysbiosis" identified studies on microbiota and preeclampsia pathophysiology. Data extraction focused on microbial alterations and mechanistic insights. Gut dysbiosis, characterized by reduced beneficial bacteria and short-chain fatty acid production, weakens the intestinal barrier, exacerbates systemic inflammation, and impairs placental development. Vaginal dysbiosis, marked by reduced Lactobacillus species, promotes local inflammation, increasing placental dysfunction risk. Therapeutic strategies, including probiotics, prebiotics, and dietary modifications, show promise in restoring microbial balance and mitigating preeclampsia risk. Microbiota dysbiosis significantly contributes to preeclampsia pathogenesis through inflammation, endothelial dysfunction, and placental impairment. Interventions targeting microbial balance, such as probiotics and dietary modifications, show promise for prevention, but further research and large-scale trials are essential to validate their efficacy and safety.

Quercetin alleviates endothelial dysfunction in preeclampsia by inhibiting ferroptosis and inflammation through EGFR binding

Preeclampsia (PE) is a pregnancy-specific complication and there remains no effective treatment. Given the limitations on medication use during pregnancy, exploring natural, safe, and effective drugs for PE is worthwhile. We investigate the causal relationship between ferroptosis, inflammation, and PE, and determine the protective effects of quercetin (QCT), a representative compound that is classified as a flavanol, against endothelial dysfunction. Then, the target of QCT is predicted and verified. The prophylactic addition of a low dose of QCT rescues endothelial dysfunction, aiding in endothelial repair. Furthermore, QCT alleviates PE-like maternal manifestations and endothelial dysfunction in the placenta of the selective reduced uteroplacental perfusion (sRUPP) rat model through binding to the epidermal growth factor receptor (EGFR). The potential applications of QCT are expanded, offering the possibility of further development as a safe and effective preventive molecule for PE.

Does preeclampsia impact the gut microbiota of preterm offspring during early infancy?

Preeclampsia (PE) is a pregnancy complication characterized by high blood pressure and organ damage. This study investigates the differences in the gut microbiota between preterm neonates born to mothers with PE and those born to mothers without PE (PR), aiming to understand how maternal health conditions like PE influence neonatal gut microbiota. The early gut microbiota plays a crucial role in neonatal health, and disturbances in its development can have long-term consequences. Fecal samples were collected from preterm neonates of PE and PR mothers at 2 and 6 weeks postpartum and analyzed using shotgun metagenomic sequencing. We found that PE significantly affected the gut microbial composition of preterm neonates, particularly at 2 weeks postpartum. The gut microbial diversity in the PE_2 group was notably lower compared to the PR_2 group, with no significant difference observed between the PR_6 and PE_6 groups. At the phylum level, Firmicutes and Proteobacteria were predominant, with significant differences observed, particularly a lower abundance of Actinobacteria in the PE_2 group. At the genus level, Escherichia, Enterococcus, and Klebsiella were more prevalent in the PE_2 group, whereas Bifidobacterium and Cutibacterium dominated the PR_2 group. The gut virome analysis showed no significant differences among the groups. Functional analysis revealed distinct metabolic pathway activities across the groups, suggesting that early disturbances due to PE impact the establishment of healthy gut microbiota. These findings underscore the substantial influence of maternal health on the early development of the neonatal gut microbiota and highlight the potential long-term health consequences. Additionally, the differences in metabolic pathways further emphasize the impact of preeclampsia on gut microbiota functionality.

Causal relationships between immune cells, inflammatory factors, and preeclampsia: A two-step, two-sample mendelian randomization study

BACKGROUND

Preeclampsia (PE) is a complex hypertensive disorder that occurs during pregnancy, with the immune system playing a key role. Although immune modulation is implicated in PE progression, the roles of specific immune cells and inflammatory mediators remain unclear.

METHODS

We conducted a two-sample, two-step Mendelian randomization (MR) analysis, primarily using the inverse-variance weighted method, to investigate the causal effect of immune cell traits on PE. Additionally, we assessed the potential mediation effects of inflammatory factors.

RESULTS

The MR analyses revealed that 22 immune cell traits exert protective effects against PE, whereas 19 are associated with an increased risk. Additionally, four inflammatory factors were suggested to be linked to PE. Mediation analysis identified the absolute count (AC) of CD33 + HLA DR+ cells, including the CD14 - subset, as causally related to PE. Both the total effect of the CD33 + HLA DR+ AC (odds ratio [OR] = 0.977, 95 % confidence interval [CI], 0.960-0.994; P = 0.010) and the effect of CD33 + HLA DR+ CD14 - cells (OR = 0.977, 95 % CI, 0.963-0.991; P = 0.001) were significant. These effects were partially mediated by STAM-binding protein levels, contributing 16.7 % and 15.0 % to the total effects of the CD33 + HLA DR+ AC and CD33 + HLA DR+ CD14 - AC, respectively.

CONCLUSION

This study establishes a causal relationship between specific immune cells and PE, potentially mediated by inflammatory factors, highlighting the importance of these traits in PE pathogenesis. Further research is needed to validate these findings based on larger, more diverse cohorts.

Role of routine uterine artery Doppler at 18-22 and 24-28 weeks' gestation following routine first-trimester screening for pre-eclampsia

OBJECTIVES

To assess the performance of mean uterine artery pulsatility index (UtA-PI) at 18-22 and 24-28 weeks of gestation in the prediction of pre-eclampsia (PE) and small-for-gestational age (SGA), and its role in reassessing the risk of PE and SGA in pregnancies screened for PE in the first trimester.

METHODS

This was a retrospective observational cohort study of 4464 women with singleton pregnancy screened routinely for PE in the first trimester, using the Gaussian algorithm, from March 2019 to May 2021, and who underwent UtA-PI assessment at 18-22 gestational weeks. Women were categorized as low risk or high risk based on the risk index obtained after first-trimester screening for PE. In high-risk patients, UtA-PI was also assessed at 24-28 weeks of gestation. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio and area under the receiver-operating-characteristics curve were calculated to assess the performance of UtA-PI at 18-22 and 24-28 weeks in predicting PE and SGA in the high-risk group. In all participants, different UtA-PI percentiles at 18-22 or 24-28 weeks, or their combination, were analyzed to explore their role in reassessing the risk of PE and SGA following first-trimester PE screening.

RESULTS

The performance of UtA-PI at 18-22 and 24-28 weeks in the high-risk group was good for predicting preterm PE and preterm SGA, and excellent for predicting early-onset PE and early-onset SGA, with an NPV of > 97% for all outcomes. In the low-risk group, UtA-PI ≥ 95th percentile at 18-22 weeks' gestation identified a subgroup of pregnancies with a significantly higher risk of preterm SGA compared to the low-risk group. In the high-risk group, UtA-PI < 60th percentile at 18-22 weeks' gestation, UtA-PI < 85th percentile at 24-28 weeks' gestation, and UtA-PI < 85th percentile at 24-28 weeks' gestation in women with UtA-PI ≥ 60th percentile at 18-22 weeks, identified subgroups of pregnancies with a risk of PE and SGA comparable to that of the low-risk group.

CONCLUSIONS

The performance of UtA-PI at 18-22 and 24-28 gestational weeks in high-risk pregnancies identified during first-trimester screening for PE is similar to that in the general population. The risk of PE and SGA in a high-risk cohort can be reassessed by measuring UtA-PI at 18-22 weeks, 24-28 weeks or both, allowing adjustment of follow-up, particularly de-escalation of care. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Hydralazine inhibits cysteamine dioxygenase to treat preeclampsia and senesce glioblastoma

The vasodilator hydralazine (HYZ) has been used clinically for ~ 70 years and remains on the World Health Organization's List of Essential Medicines as a therapy for preeclampsia. Despite its longstanding use and the concomitant progress toward a general understanding of vasodilation, the target and mechanism of HYZ have remained unknown. We show that HYZ selectively targets 2-aminoethanethiol dioxygenase (ADO) by chelating its metal cofactor and alkylating one of its ligands. This covalent inactivation slows entry of proteins into the Cys/N-degron pathway that ADO initiates. HYZ's capacity to stabilize regulators of G-protein signaling (RGS4/5) normally marked for degradation by ADO explains its effect on blood vessel tension and comports with prior associations of insufficient RGS levels with human preeclampsia and analogous symptoms in mice. The established importance of ADO in glioblastoma led us to test HYZ in these cell types. Indeed, a single treatment induced senescence, suggesting a potential new HYZ-based therapy for this deadly brain cancer.

A rapid diagnostic technique based on metabolomics to differentiate between preeclampsia (PE) and chronic kidney disease (CKD) using maternal urine

Similar clinical manifestations between preeclampsia and chronic kidney diseases can lead to potential misdiagnosis. Therefore, it is crucial to investigate effective diagnostic approaches that can reduce misdiagnosis and ensure the well-being of pregnant women. In this study, urine samples collected from 44 individuals with preeclampsia, 37 individuals with chronic kidney disease, and 37 healthy pregnant women were analyzed using metabolomic and proteomic strategies to distinguish between these two diseases. A total of 15 small molecules were tentatively identified as biomarkers to differentiate these two diseases, including potential internally exposed drugs and their metabolites like labetalol and SN-38, metabolites of exogenous substances like 3-phenylpropyl glucosinolate, and endogenous substances related to metabolism such as isoglobotriaose and chitobiose. Metabolic differences between preeclampsia from healthy pregnant women, as well as the differences between chronic kidney disease and healthy pregnant women were also investigated. Major mechanistic pathways were investigated based on the combination of metabolomic and proteomic, amino acid metabolisms and folate metabolism play key roles in distinguishing preeclampsia and chronic kidney disease. Two patients who were initially diagnosed with chronic kidney disease were found to have a closer association with preeclampsia following metabolomic analysis. Subsequent clinical symptoms and manifestations further supported the diagnosis of preeclampsia, and one of patient's pregnancy was ultimately terminated due to severe preeclampsia. Results of this study contribute to a better understanding of the pathogenesis and clinical diagnosis of preeclampsia, offering insights that could potentially improve future diagnostic and management approaches.

Diagnosis of preeclampsia using metabolomic biomarkers

The diagnostic criteria for preeclampsia do not accurately reflect the pathophysiological characteristics of patients with preeclampsia. Conventional biomarkers and diagnostic approaches have proven insufficient to fully comprehend the intricacies of preeclampsia. This study aimed to screen differentially abundant metabolites as candidate biomarkers for preeclampsia. A propensity score matching method was used to perform a 1:1 match between preeclampsia patients (n = 70) and healthy control individuals (n = 70). Based on univariate and multivariate statistical analysis methods, the different characteristic metabolites were screened and identified. Least absolute shrinkage and selection operator (LASSO) regression analysis was subsequently used to further screen for differentially abundant metabolites. A receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy of the metabolites. A total of 1,630 metabolites were identified and quantified in maternal serum samples. Fifty-three metabolites were significantly increased, and two were significantly decreased in preeclampsia patients. The area under the curve (AUC) of the model composed of isobutyryl-L-carnitine and acetyl-leucine was 0.878, and the sensitivity and specificity in detecting preeclampsia were 81.4% and 87.1%, respectively. There are significant differences in metabolism between preeclampsia patients and healthy pregnant women, and a range of novel biomarkers have been identified. These findings lay the foundation for the use of metabolomic biomarkers for the diagnosis of preeclampsia.

Thyroid function and preeclampsia: a two-sample bidirectional Mendelian randomization study

BACKGROUND

Thyroid dysfunction has been associated with preeclampsia (PE) during pregnancy, but the observational results are conflicting. Our study aims to investigate the causal association and direction between genetically predicted effects of thyroid function on PE and vice versa via two large summary genetic data.

METHODS

We conducted a two-sample bidirectional Mendelian randomization (MR) study using genome-wide association studies (GWAS) summary data from two primarily European cohorts: the ThyroidOmics Consortium and the FinnGen Biobank. We applied the random effects inverse variance weighted (IVW) as our main analysis. MR-Egger and weighted median were used for sensitivity analysis. Statistical analysis was performed using the R program (version 4.3.0) with the two-sample package (version 0.5.6).

RESULTS

The results suggest that genetically predicted hyperthyroidism is causally associated with PE during pregnancy [ β  = 0.06, 95% confidence interval (CI): 1.01-1.12; P  = 0.02], and genetically predicted hypothyroidism is also causally associated with PE during pregnancy ( β  = 0.11, 95% CI: 1.03-1.21; P  = 0.01). These effects were further confirmed with sensitivity analysis. Conversely, preeclampsia is not associated with the risk of thyroid dysfunction in the reverse MR results: thyroid-stimulating hormone ( β  = 0.00, P  = 0.92), free thyroxine (FT4) ( β  = -0.01, P  = 0.56), triiodothyronine (FT3) ( β  = -0.00, P  = 0.72), FT3/FT4 ( β  = -0.01, P  = 0.38), thyroid peroxidase antibodies ( β  = -0.01, P  = 0.64), hyperthyroidism ( β  = -0.11, P  = 0.29) and hypothyroidism ( β  = 0.04, P  = 0.12).

CONCLUSION

Our study suggests that hyper-/hypo-thyroidism causally affected preeclampsia, while PE is not causally associated with thyroid dysfunctions.

Maternal prediabetes as a risk factor of preeclampsia and placental dysfunction in pregnant female Sprague-Dawley rats

BACKGROUND

Prediabetes (PD) is associated with intermediate hyperglycaemia, dyslipidaemia, reduced nitric oxide (NO) bioavailability and moderate hypertension. All these factors are risk factor for preeclampsia (PE). However, the effects of the PD on placental function have not been shown. Accordingly, this study sought to investigate a possible link between maternal PD and the risk of developing PE.

METHODS

Pregnant female Sprague-Dawley rats (N = 18) were divided into normal, preeclamptic and prediabetic groups (n = 6 in each group) to study the effects of maternal PD on placenta function over the period of 19 days. Blood glucose and blood pressure were measured on gestational day (GND) 0, 9 and 18. Placental vascular endothelial growth factor (VEGF), placenta growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) mRNA expression were measured terminally. Data were analysed using ANOVA followed by the Tukey-Kramer post hoc test. Values of p < .05 were used to indicate statistical significance.

RESULTS

Maternal PD and PE significantly increased blood glucose, decrease NO concentration and increase in MAP by comparison to the normal pregnant control group. Maternal PD significantly decreased VEGF, PlGF mRNA expression with a slight increase in sFlt-1 mRNA expression comparison to the normal pregnant control group.

CONCLUSIONS

Maternal PD is associated with placental dysfunction due to impaired glucose handling, endothelial dysfunction and an imbalance in angiogenic and antiangiogenic factors. Therefore, maternal PD is a risk factor of PE.

Association Between Periodontitis and Preeclampsia: A Bidirectional Mendelian Randomisation Analysis

OBJECTIVES

Studies have increasingly focussed on the relationship between periodontitis (PD) and preeclampsia (PE). However, conclusions have not been consistent, and it is unclear whether any causal relationship exists between them and whether causality is bidirectional. This study employed Mendelian randomisation (MR) analysis to investigate the potential bidirectional causal relationship between PD and PE.

METHODS

Genetic variants strongly linked to PD (17,353 cases and 28,210 controls), chronic periodontitis (CP; 1817 cases and 2215 controls), aggressive periodontitis (AgP; 851 cases and 6580 controls), and PE (7212 cases and 194,266 controls) in the genome-wide association study (GWAS) of European ancestry were used as instrumental variables (IVs). Inverse variance weighting (IVW) served as the primary method for causal inference. MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) was utilised to analyse horizontal pleiotropy. Cochrane Q tests and leave-one-out analyses were used to assess heterogeneity and stability amongst IVs.

RESULTS

The MR analysis revealed no causal impacts of PD or its 2 subtypes-CP and AgP-on PE. Similarly, no significant causal effect of PE on PD was found in the reverse-MR analysis (IVW odds ratio, 0.97; 95% confidence interval, 0.91-1.05; P = .58). The findings from MR-Egger, weighted median, weighted mode, and the simple modelling approaches, as well as the pleiotropy and sensitivity analyses, aligned with those of the IVW method.

CONCLUSIONS

The MR analysis suggests no bidirectional causal relationship between PD and PE; hence, PD and PE might not increase or prevent the risk of one other.

CLINICAL RELEVANCE

Genetically, periodontitis or its subtypes chronic periodontitis and aggressive periodontitis may not require specific clinical attention to prevent the development of preeclampsia.

Ophthalmic Artery Doppler as a Predictor of Adverse Neonatal Outcomes in Women With Preeclampsia

OBJECTIVE

This study aimed to evaluate the association between ophthalmic artery (OA) Doppler indices and adverse neonatal outcomes in women with pregnancies complicated by preeclampsia (PE).

METHODS

A prospective cross-sectional study involving 110 pregnant women who were diagnosed with PE in the first 24 h of hospitalization was conducted at three hospitals in southeastern Brazil from April 2020 to December 2022. The ophthalmic parameters analyzed were the resistance index (RI), pulsatility index (PI), first peak systolic velocity (PSV1), second peak systolic velocity (PSV2), ratio of PSV2 to PSV1 (PSV ratio or the peak ratio [PR]), and end-diastolic velocity (EDV). The outcome measures were neonatal death (during hospitalization), neonatal intensive care unit (ICU) admission, gestational age at delivery < 32 weeks, birth weight < 1500 g, birth weight < 10th percentile, the presence of comorbidities associated with prematurity, the use of invasive mechanical ventilation, an Apgar score at the 5th minute < 7.0, and signs of neurological impairment.

RESULTS

Pregnant women with severe features of PE showed higher values of systolic (152.8 ± 20.7 vs. 136.3 ± 11.9, p = 0.000) and diastolic (98.1 ± 12.8 vs. 88.1 ± 10.8, p = 0.000) blood pressure values and lower gestational age at admission (31.5 ± 3.8 vs. 33.7 ± 4.3, p = 0.009) than PE without severe features. No significant differences were found between the mean values of the OA Doppler indices when comparing the presence or absence of neonatal outcomes in the women with PE.

CONCLUSIONS

OA Doppler, while valuable for the prediction, diagnosis, and evaluation of adverse maternal outcomes, does not independently predict adverse neonatal outcomes in women with severe features of PE.

Urinary biomarkers of preeclampsia: An update

Preeclampsia (PE), a pregnancy-related syndrome, has motivated extensive research to understand its pathophysiology and develop early diagnostic methods. 'Omic' technologies, focusing on genes, mRNA, proteins, and metabolites, have revolutionized biological system studies. Urine emerges as an ideal non-invasive specimen for omics analysis, offering accessibility, easy collection, and stability, making it valuable for identifying biomarkers. A comprehensive exploration of urinary omics in preeclampsia is discussed in this review. Proteomic studies identified biomarkers such as SERPINA-1 and uromodulin, showing promise for early diagnosis and severity assessment. Metabolomic analyses revealed alterations in metabolites like glycine and hippurate, providing insights into molecular mechanisms underlying PE. Challenges include methodological inconsistencies and the need for standardized protocols. Urinary omics technologies have significantly advanced our understanding of PE pathophysiology and hold promise for improved diagnosis and management. Biomarkers identified through these approaches offer potential for early detection, severity stratification, and elucidation of underlying mechanisms.

Development and Validation of a Predictive Model for Maternal Cardiovascular Morbidity Events in Patients With Hypertensive Disorders of Pregnancy

BACKGROUND

Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal morbidity, mortality, and accelerated cardiovascular (CV) disease. Comorbid conditions are likely important predictors of CV risk in pregnant people. Currently, there is no way to predict which people with HDP are at risk of acute CV complications. We developed and validated a predictive model for all CV events and for heart failure, renal failure, and cerebrovascular events specifically after HDP.

METHODS

Models were created using the Premier Healthcare Database. The inclusion criteria for the model dataset were delivery with an HDP with discharge from October 1, 2015 to December 31, 2020. Machine learning methods were used to derive predictive models of CV events occurring during delivery hospitalization (Index Model) or during readmission (Readmission Model) using a training set (60%) to estimate model parameters, a validation set (20%) to tune model hyperparameters and select a final model, and a test set (20%) to evaluate final model performance.

RESULTS

The total model cohort consisted of 553,658 deliveries with an HDP. A CV event occurred in 6501 (1.2%) of the delivery hospitalizations. Multilabel neural networks were selected for the Index Model and Readmission Model due to favorable performance compared to alternatives. This approach is designed for prediction of multiple events that share risk factors and may cooccur. The Index Model predicted all CV events with area under the receiver operating curve (AUROC) 0.878 and average precision (AP) 0.239 (cerebrovascular events: AUROC 0.941, heart failure: AUROC 0.898, and renal failure: AUROC 0.885). With a positivity threshold set to achieve ≥90% sensitivity, model specificity was 65.0%, 83.5%, 68.6%, and 65.6% for predicting all CV events, cerebrovascular events, heart failure, and renal failure, respectively. CV events within 1 year of delivery occurred in 3018 (0.6%) individuals. The Readmission Model predicted all CV events with AUROC 0.717 and AP 0.022 (renal failure: AUROC 0.748, heart failure: AUROC 0.734, and cerebrovascular events AUROC 0.698). Feature importance analysis indicated that the presence of chronic renal disease, cardiac disease, pulmonary hypertension, and preeclampsia with severe features had the greatest effect on the prediction of CV events.

CONCLUSIONS

Among individuals with HDP, our multilabel neural network model predicted CV events at delivery admission with good classification and events within 1 year of delivery with fair classification.

Arterial stiffness as a novel tool for the early prediction of preeclampsia: a perspective

Preeclampsia is a leading complication of pregnancy that lacks accurate tools for its early prediction. Improved risk stratification tools early in pregnancy would enable more efficient allocation of limited healthcare resources while ensuring that pregnant women destined to develop preeclampsia receive appropriate care. This brief perspective highlights the current state of first-trimester preeclampsia prediction. We focus on arterial stiffness, an important hemodynamic indicator of vascular health that has shown promising results for improved early prediction of preeclampsia by our and independent research groups. Further, we outline the promise, applicability, and feasibility of integrating arterial stiffness assessments into clinical practice.

Using machine learning to predict the risk of developing hypertensive disorders of pregnancy using a contemporary nulliparous cohort

Background

Hypertensive disorders of pregnancy (HDP) are significant drivers of maternal and neonatal morbidity and mortality. Current management strategies include early identification and initiation of risk mitigating interventions facilitated by a rules-based checklist. Advanced analytic techniques, such as machine learning, can potentially offer improved and refined predictive capabilities.

Objective

To develop and internally validate a machine learning prediction model for hypertensive disorders of pregnancy (HDP) when initiating prenatal care.

Study Design

We developed a prediction model using data from the prospective multisite cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) among low-risk individuals without a prior history of aspirin utilization for preeclampsia prevention. The primary outcome was the development of HDP. Random forest modeling was utilized to develop predictive models. Recursive feature elimination (RFE) was employed to create a reduced model for each outcome. Area under the curve (AUC), 95% confidence intervals (CI), and calibration curves were utilized to assess discrimination and accuracy. Sensitivity analyses were conducted to compare the sensitivity and specificity of the reduced model compared to existing risk factor-based algorithms.

Results

Of 9,124 assessed low risk nulliparous individuals, 21% (n=1,927) developed HDP. The prediction model for HDP had satisfactory discrimination with an AUC of 0.73 (95% CI: 0.70, 0.75). After RFE, a parsimonious reduced model with 30 features was created with an AUC of 0.71 (95% CI: 0.68, 0.74). Variables included in the model after RFE included body mass index at the first study visit, pre-pregnancy weight, first trimester complete blood count results, and maximum systolic blood pressure at the first visit. Calibration curves for all models revealed relatively stable agreement between predicted and observed probabilities. Sensitivity analysis noted superior sensitivity (AUC 0.80 vs 0.65) and specificity (0.65 vs 0.53) of the model compared to traditional risk factor-based algorithms.

Conclusion

In cohort of low-risk nulliparous pregnant individuals, a prediction model may accurately predict HDP diagnosis at the time of initiating prenatal care and aid employment of close interval monitoring and prophylactic measures earlier in pregnancy.

Placental growth factor at 24-28 weeks for aspirin discontinuation in pregnancies at high risk for preterm preeclampsia: Post hoc analysis of StopPRE trial

INTRODUCTION

This study aims to evaluate the safety of discontinuing aspirin treatment at 24-28 weeks in women at high risk after first-trimester combined screening for preeclampsia (PE) and normal placental growth factor (PlGF) levels at 24-28 weeks of gestation.

MATERIAL AND METHODS

This is a post hoc analysis of the StopPRE trial, conducted at nine Spanish maternity hospitals from September 2019 to September 2021. In the StopPRE trial, all high-risk single pregnancies identified during first-trimester screening for PE were treated with 150 mg of daily aspirin. Out of 1604 eligible women with a soluble fms-like tyrosine kinase-1 to PlGF ratio (sFlt-1/PlGF) ≤38 at 24-28 weeks, 968 were randomly assigned in a 1:1 ratio to either continue aspirin until 36 weeks (control group) or discontinue it (intervention group). In this secondary analysis, only women with PlGF ≥100 pg/mL at 24-28 weeks were included. As in the StopPRE trial, the non-inferiority margin was set at a 1.9% difference in preterm PE incidence between the groups.

RESULTS

Among the 13 983 screened pregnant women, 1984 (14.2%) were deemed high-risk for preterm PE, of which 397 (20.0%) were ineligible, 636 declined participation, and 32 were excluded. Ultimately, 919 women with PlGF >100 pg/mL were randomized and included in this analysis. Preterm PE occurred in 0.9% of the intervention group (4 out of 465) and 1.5% of the control group (7 out of 454), indicating non-inferiority of aspirin discontinuation. There were no significant differences between the groups in adverse pregnancy outcomes before 37 weeks, at <34 weeks, or ≥37 weeks. Minor antepartum hemorrhage incidence was significantly lower in the intervention group (absolute difference, -5.96; 95% CI, -10.10 to -1.82).

CONCLUSIONS

Discontinuation of aspirin treatment at 24-28 weeks in women with PlGF levels ≥100 pg/mL was non-inferior to continuing until 36 weeks for preventing preterm PE. However, these findings should be interpreted with caution, as they originate from a subanalysis of the StopPRE trial.

Predictive and Diagnostic Value of the Angiogenic Proteins in Patients With Chronic Kidney Disease

BACKGROUND

Our objective was to investigate the predictive and diagnostic accuracy of the angiogenic proteins sFlt-1 (soluble fms-like tyrosine kinase-1) and PlGF (placental growth factor) for preterm preeclampsia and explore the relationship between renal function and these proteins.

METHODS

We completed a blinded, prospective, longitudinal, observational study of patients with chronic kidney disease followed at a tertiary center (2018-2023). Serum samples were obtained at 3 time points along gestation (planned sampling): 12-16, 18-22, and 28-32 weeks. In addition, samples were obtained whenever preeclampsia was suspected (indicated sampling). sFlt-1 and PlGF levels remained concealed until the study ended. The primary outcome was preterm preeclampsia. The planned and indicated samples were used to estimate the predictive and diagnostic accuracy of the angiogenic proteins, respectively.

RESULTS

Of the 97 participants, 21 (21.6%) experienced preterm preeclampsia. In asymptomatic patients with chronic kidney disease, the angiogenic proteins were predictive of preterm preeclampsia only when sampled in the third trimester, in which case the sFlt-1/PlGF ratio (false positive rate of 37% for a detection rate of 80%) was more predictive than either sFlt-1 or PlGF in isolation. In patients with suspected preeclampsia, the diagnostic accuracy of the sFlt-1/PlGF ratio (false positive rate of 26% for a detection rate of 80%) was higher than that of sFlt-1 and PlGF in isolation. Diminished renal function was associated with increased levels of PlGF.

CONCLUSIONS

sFlt-1 and PlGF can effectively predict and improve the diagnostic accuracy for preterm preeclampsia among patients with chronic kidney disease. The optimal sFlt-1/PlGF ratio cutoff to rule out preeclampsia may need to be lower in patients with impaired renal function.

Small RNAs in the pathogenesis of preeclampsia

Preeclampsia is a major contributor to maternal and fetal morbidity and mortality. The disorder can be classified into early- and late-onset subtypes, both of which evolve in two stages. The first stage comprises the development of pre-clinical, utero-placental malperfusion. Early and late utero-placental malperfusion have different causes and time courses. Early-onset preeclampsia (20 % of cases) is driven by dysfunctional placentation in the first half of pregnancy. In late-onset preeclampsia (80 % of cases), malperfusion is a consequence of placental compression within the confines of a limited uterine cavity. In both subtypes, the malperfused placenta releases stress signals into the maternal circulation. These stress signals trigger onset of the clinical syndrome (the second stage). Small RNA molecules, which are implicated in cellular stress responses in general, may be involved at different stages. Micro RNAs contribute to abnormal trophoblast invasion, immune dysregulation, angiogenic imbalance, and syncytiotrophoblast-derived extracellular vesicle signalling in preeclampsia. Transfer RNA fragments are placental signals known to be specifically involved in cell stress responses. Disorder-specific differences in small nucleolar RNAs and piwi-interacting RNAs have also been reported. Here, we summarise key small RNA advances in preeclampsia pathogenesis. We propose that existing small RNA classifications are unhelpful and that non-biased assessment of RNA expression, incorporation of non-annotated molecules and consideration of chemical modifications to RNAs may be important in elucidating preeclampsia pathogenesis.

Riboflavin for women's health and emerging microbiome strategies

Riboflavin (vitamin B2) is an essential water-soluble vitamin that serves as a precursor of flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD). FMN and FAD are coenzymes involved in key enzymatic reactions in energy metabolism, biosynthesis, detoxification and electron scavenging pathways. Riboflavin deficiency is prevalent worldwide and impacts women's health due to riboflavin demands linked to urogenital and reproductive health, hormonal fluctuations during the menstrual cycle, pregnancy, and breastfeeding. Innovative functional foods and nutraceuticals are increasingly developed to meet women's riboflavin needs to supplement dietary sources. An emerging and particularly promising strategy is the administration of riboflavin-producing lactic acid bacteria, combining the health benefits of riboflavin with those of probiotics and in situ riboflavin production. Specific taxa of lactobacilli are of particular interest for women, because of the crucial role of Lactobacillus species in the vagina and the documented health effects of other Lactobacillaceae taxa in the gut and on the skin. In this narrative review, we synthesize the underlying molecular mechanisms and clinical benefits of riboflavin intake for women's health, and evaluate the synergistic potential of riboflavin-producing lactobacilli and other microbiota.

Understanding the role of soluble proteins and exosomes in non-invasive urine-based diagnosis of preeclampsia

Preeclampsia is a hypertensive disorder of pregnancy that can lead to stillbirth and preterm birth if not treated promptly. Currently, the diagnosis of preeclampsia relies on clinical symptoms such as hypertension and proteinuria, along with invasive blood tests. Here, we investigate the role of soluble proteins and exosomes in noninvasive diagnosing preeclampsia non-invasively using maternal urine and urine-derived exosomes. We quantified the levels of particles and the presence of TSG101 and CD63 in urine and urinary exosomes via the biologically intact exosome separation technology (BEST) platform. Then, we obtained higher levels of soluble proteins such as fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) from urine as it was than urinary exosomes. Compared to commercial blood tests, the sensitivity of the sFlt-1/PlGF ratio was found to be 4.0 times higher in urine tests and 1.5 times higher in tests utilizing urine-derived exosomes. Our findings offer promising possibilities for the early and non-invasive identification of high-risk individuals at risk of preeclampsia, allowing for comprehensive preventive management.

Efficient isolation of encoded microparticles in a degassed micromold for highly sensitive and multiplex immunoassay with signal amplification

Multiplex detection of low-abundance protein biomarkers in biofluids can contribute to diverse biomedical fields such as early diagnosis and precision medicine. However, conventional techniques such as digital ELISA, microarray, and hydrogel-based assay still face limitations in terms of efficient protein detection due to issues with multiplexing capability, sensitivity, or complicated assay procedures. In this study, we present the degassed micromold-based particle isolation technique for highly sensitive and multiplex immunoassay with enzymatic signal amplification. Using degassing treatment of nanoporous polydimethylsiloxane (PDMS) micromold, the encoded particles are isolated in the mold within 5 min absorbing trapped air bubbles into the mold by air suction capability. Through 10 min of signal amplification in the isolated spaces by fluorogenic substrate and horseradish peroxidase labeled in the particle, the assay signal is amplified with one order of magnitude compared to that of the standard hydrogel-based assay. Using the signal amplification assay, vascular endothelial growth factor (VEGF) and chorionic gonadotropin beta (CG beta), the preeclampsia-related protein biomarkers, are quantitatively detected with a limit of detection (LoD) of 249 fg/mL and 476 fg/mL in phosphate buffer saline. The multiplex immunoassay is conducted to validate negligible non-specific detection signals and robust recovery rates in the multiplex assay. Finally, the VEGF and CG beta in real urine samples are simultaneously and quantitatively detected by the developed assay. Given the high sensitivity, multiplexing capability, and process simplicity, the presented particle isolation-based signal amplification assay holds significant potential in biomedical and proteomic fields.

Preeclampsia and transport of ions and small molecules: A literature review

Preeclampsia (PE) is a prevalent obstetric complication affecting approximately 3-5% of pregnancies worldwide and is a major cause of maternal and perinatal morbidity and mortality. Preeclampsia is considered a disease of the endothelial system that can progress to eclampsia, characterized by seizures. Early diagnosis and appropriate management are crucial to improving maternal and fetal outcomes, as preeclampsia can lead to severe complications such as placental abruption, fetal growth restriction, and stroke. The pathophysiology of PE is complex, involving a combination of genetic, acquired, and immunological factors. A central feature of the condition is inadequate placentation and impaired uteroplacental perfusion, leading to local hypoxia, endothelial dysfunction, vasoconstriction, and immunological dysregulation. Recent evidence suggests that dysregulation of ion transporters may play a significant role in the adaptation of uterine circulation during placentation. These transporters are essential for maintaining maternal-fetal homeostasis, influencing processes such as nutrient exchange, hormone synthesis, trophoblast cell migration, and the function of smooth muscle cells in blood vessels. In preeclampsia, adverse conditions like hypoxia and oxidative stress result in the downregulation of ion, solute, and water transporters, impairing their function. This review focuses on membrane transporters involved in PE, discussing functional alterations and their physiological implications. The goal of this investigation is to enhance understanding of how dysregulation of ion and small molecule transporters contributes to the development and progression of preeclampsia, underscoring the importance of exploring these signaling pathways for potential therapeutic interventions.

Role of circular RNAs in preeclampsia (Review)

Preeclampsia (PE) is a hypertensive disorder of pregnancy characterized by new-onset hypertension and proteinuria after 20 weeks of gestation, which affects 3-8% of pregnant individuals worldwide each year. Prevention, diagnosis and treatment of PE are some of the most important problems faced by obstetrics. There is growing evidence that circular RNAs (circRNAs) are involved in the pathogenesis of PE. The present review summarizes the research progress of circRNAs and then describes the expression patterns of circRNAs in PE and their functional mechanisms affecting PE development. The role of circRNAs as biomarkers for the diagnosis of PE, and the research status of circRNAs in PE are summarized in the hope of finding novel strategies for the prevention and treatment of PE.

Circ_0015382 Regulates the miR-942-5p/NDRG1 Axis to Suppress Trophoblast Cell Functions

Circular RNAs (circRNAs) are non-coding RNAs that exert vital function in many human diseases, including preeclampsia (PE). Circ_0015382 is considered to be a key regulator of PE progression, so more molecular mechanisms need to be further studied. Real-time quantitative PCR was used to detect the mRNA levels of circ_0015382, miR-942-5p, and N-myc downstream regulated 1 (NDRG1). Western blot analysis was conducted to assess the protein levels. MTT and EdU assays were used to assess cell proliferation. Cell invasion was analyzed by transwell assay. Tube formation assay was conducted to detect cell angiogenesis. Dual-luciferase reporter assay and RNA immunoprecipitation were used to analyze the target relationship between miR-942-5p and circ_0015382 or NDRG1. Our data showed that circ_0015382 and NDRG1 were up-regulated, while miR-942-5p was down-regulated in the placental tissues of PE patients. Trophoblast cell proliferation, invasion, and angiogenesis were promoted by knockdown of circ_0015382. Circ_0015382 could sponge miR-942-5p, and NDRG1 was a target of miR-942-5p. MiR-942-5p inhibitor could reverse the promoting effects of si-circ_0015382 on trophoblast cell functions. Besides, the enhancing effects of miR-942-5p mimic on trophoblast cell proliferation, invasion, and angiogenesis could be eliminated by NDRG1 overexpression. In conclusion, our data showed that circ_0015382 inhibited trophoblast cell proliferation, invasion, and angiogenesis through regulating miR-942-5p/NDRG1 axis, providing a new mechanism for the regulation of PE progression.

Scoping Review of Microbiota Dysbiosis and Risk of Preeclampsia

Limited studies have investigated the role of the microbiota in hypertensive disorders of pregnancy (HDP), particularly preeclampsia, which often results in preterm birth. We evaluated 23 studies that explored the relationship between gut, vaginal, oral, or placental microbiotas and HDP. Scopus, ProQuest Health Research Premium Collection, ProQuest Nursing & Allied Health Database, EBSCO, and Ovid were searched for relevant literature. Majority (18) of studies focused on the gut microbiota, and far fewer examined the oral cavity (3), vagina (3), and placenta (1). One study examined the gut, oral, and vaginal microbiotas. The consensus highlights a potential role for microbiota dysbiosis in preeclampsia and HDP. Especially in the third trimester, preeclampsia is associated with gut dysbiosis-deficient in beneficial species of Akkermansia, Bifidobacterium, and Coprococcus but enriched with pathogenic Campylobacterota and Candidatus Saccharibacteria, with low community α-diversity. Similarly, the preeclamptic vaginal and oral microbiotas are enriched with bacterial vaginosis and periodontal disease-associated species, respectively. The trend is also observed in the placenta, which is colonized by gastrointestinal, respiratory tract, and periodontitis-related pathogens. Consequently, a chronic proinflammatory state that adversely impacts placentation is implicated. These observations however require more mechanistic studies to establish the timing of the preceding immune dysfunction and any causality.

Irisin in Reproduction: Its Roles and Therapeutic Potential in Male and Female Fertility Disorders

The current study focused on identifying the potential of irisin in mammalian reproduction. The established role of irisin, a proteolytic product of FNDC5, in adipose tissue browning, energy metabolism, and thermogenesis suggests its role in reproductive health, often disturbed by metabolic imbalances. Various studies on mice demonstrated irisin's role in improving spermatogenesis, sperm count, and testosterone levels by influencing the hypothalamus-pituitary-gonadal axis. Moreover, in females, there is a fluctuation in levels of irisin during critical reproductive stages, including menstrual cycles, puberty, and pregnancy. Conditions like pregnancy complications, precocious puberty, and polycystic ovary syndrome (PCOS) are found to have an association with abnormal irisin levels. The potential role of irisin in endometrial receptivity and preventing endometritis is also discussed in this review. Overall, the influence of irisin on female and male reproduction is evident from various studies. However, further research is needed to elucidate irisin mechanism in reproduction and its potential as a therapeutic or diagnostic tool for reproductive dysfunctions and infertility.

Exploring altered free amino acids and metabolites: Insights into the metabolic landscape of preeclampsia

INTRODUCTION

Preeclampsia (PE) is a complex disease that poses a risk for maternal and perinatal morbidity and mortality. This study aimed to investigate the role of maternal serum amino acids (AAs) levels in PE.

MATERIALS AND METHODS

A total of 56 pregnant women (26 with PE and 30 controls) were included in the study. The participants had a confirmed gestational age between 24 and 37 weeks. The mean body mass index (BMI) for the PE group was 33.1 kg/m2, while the control group had a mean BMI of 29.6 kg/m2. AAs levels were quantified, and statistical analyses were performed to identify significant differences between the two groups. Receiver Operating Characteristic (ROC) curve analysis was employed the diagnostic potential of specific AAs.

RESULTS

We observed significantly elevated levels of multiple AAs in the PE group, including citrulline, lysine, ethanolamine, ornithine and histidine. Citrulline exhibited exceptional predictive power for PE with 100.0% sensitivity and specificity at a cutoff of 7.79 µmol/L, reflected in an area under the curve (AUC) of 1.000.

DISCUSSION

Our study highlights the crucial involvement of altered amino acid levels, specifically in the urea cycle, disruptions in lysine and ethanolamine metabolism in PE development. Exploring these changes may reveal new therapeutic targets, providing insights into the disease's molecular mechanisms. Understanding amino acid metabolism in PE not only informs therapeutic strategies but also holds the potential to revolutionize early diagnosis and intervention.

Are vitamin D intake and serum levels in the mid-trimester of pregnancy associated with preeclampsia? Results from a Brazilian multicentre cohort

OBJECTIVE

To explore the association between serum levels and food intake of Vitamin D (VD) among healthy women in mid-pregnancy and preeclampsia.

STUDY DESIGN

In a Brazilian multicentre cohort of healthy nulliparous pregnant women from five maternity centres we developed a nested case-control analysis comparing cases with and without preeclampsia. Women were enrolled and followed during prenatal care, including only singleton pregnancies, without any fetal malformations or previous chronic maternal disease. We matched 87 cases of preeclampsia to eligible controls randomly selected in a 1:1 ratio, by age and region.

MAIN OUTCOME MEASURES

Blood samples from these were collected, and a 24-hour recall of food intake was obtained in mid-pregnancy, between 19 and 21 weeks. VD serum levels (25-hydroxyvitamin D) were measured by liquid chromatography-tandem mass spectrometry and were categorized as deficient, insufficient, and sufficient. The dietary intake of VD was estimated with the 24-hour diet recall applied at the same time and from supplementation. Maternal characteristics and VD levels were compared between cases and controls with OR and respective 95 %CI. Multivariate analysis using the Path method was used to assess relationships among VD, PE, BMI, skin colour/ethnicity, and diet.

RESULTS

The maternal characteristics of both groups were similar, except for the higher occurrence of obesity among women with preeclampsia (OR 3.47, 95 %CI 1.48-8.65). Dietary intake of VD was similar in both groups, and most of the women in both groups consumed insufficient VD (82.2 vs 79.3 % in the groups with and without PE).

CONCLUSIONS

Levels and dietary intake of VD were not associated with PE in this Brazilian sample of healthy pregnant women; however, BMI and skin colour/ethnicity were associated with PE.