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Hilowle NM, Ahmed SA, Yusuf Ali K, Altinel E, Waberi MM, Hassan MS, Köprülü D, Ali AA, Hassan MO. Outcomes of Women with Preeclampsia and Eclampsia Admitted in the Intensive Care Unit at a Tertiary Care Hospital in Mogadishu, Somalia. Anesthesiol Res Pract 2023; 2023:6641434. [PMID: 38028204 PMCID: PMC10656204 DOI: 10.1155/2023/6641434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/09/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Intensive care for a hypertensive mother with preeclampsia or eclampsia is crucial for both maternal and neonatal outcomes. This study highlights the level of morbidity and mortality among women with preeclampsia and eclampsia admitted to the intensive care unit. Methods. This retrospective study was conducted in Mogadishu, Somalia, at the Mogadishu Somali Türkiye Training and Research Hospital from February 2019 to July 2022. The study focused on the different complications, managements, and final outcomes of preeclampsia and eclampsia mothers admitted to the intensive care unit. The data was retrieved from the electronic records of patients admitted to the intensive care unit. Results. During our study period, a total of 237 patients were identified as having preeclampsia/eclampsia, of whom 71 required intensive care admission. The mean age of the studied patients was 25 ± 6 years. The most common reason for being taken to the intensive care unit (ICU) was having a seizure (n = 33, 46.5%), followed by having very high blood pressure (n = 20, 28.2%), and being confused (n = 18, 25.3%). Peripartum infection was the most common maternal complication during ICU admission (66.7%), followed by cardiac-related arrhythmia (66.7%), postpartum bleeding (48%), acute kidney injury (18.4%), HELLP syndrome (16.4%), severe anemia (9.6%), and stroke (8.7%). Among patients, 65 (91.5%) needed mechanical ventilation. About 11.1% of these patients died during hospitalization. There were associations between mortality and some complications, particularly acute kidney injury (p value less than 0.02) and peripartum infection (p value less than 0.003). Conclusion. Hypertensive disease of pregnancy (preeclampsia/eclampsia) requiring intensive care unit admission has a very high morbidity and mortality rate.
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Affiliation(s)
- Nasra Mohamud Hilowle
- Department of Anesthesiology and Reanimation, Mogadishu Somalia Turkish Training and Research Hospital, Somalia
| | - Said Abdirahman Ahmed
- Department of Cardiology, Mogadishu Somalia Turkish Training and Research Hospital, Somalia
| | - Khadija Yusuf Ali
- Department of Obstetrics and Gynecology, Mogadishu Somalia Turkish Training and Research Hospital, Somalia
| | - Ercan Altinel
- Department of Anesthesiology and Reanimation, Mogadishu Somalia Turkish Training and Research Hospital, Somalia
| | - Mohamud Mire Waberi
- Department of Cardiology, Mogadishu Somalia Turkish Training and Research Hospital, Somalia
| | - Mohamed Sheikh Hassan
- Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Somalia
| | - Diyar Köprülü
- Department of Cardiology, Mogadishu Somalia Turkish Training and Research Hospital, Somalia
| | - Abdijalil Abdullahi Ali
- Department of Cardiovascular Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Somalia
| | - Mohamed Omar Hassan
- Department of Cardiology, Mogadishu Somalia Turkish Training and Research Hospital, Somalia
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2
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Zhang J, Zhang Z, Wu X. Long non-coding RNA DIRC3 suppresses trophoblast invasion in preeclampsia via upregulating HOXD10. Mol Cell Toxicol 2022. [DOI: 10.1007/s13273-022-00297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Kahramanoglu Ö, Schiattarella A, Demirci O, Sisti G, Ammaturo FP, Trotta C, Ferrari F, Rapisarda AMC. Preeclampsia: state of art and future perspectives. A special focus on possible preventions. J OBSTET GYNAECOL 2022; 42:766-777. [PMID: 35469530 DOI: 10.1080/01443615.2022.2048810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preeclampsia (PE) is characterised by the new onset of hypertension after the 20th week of pregnancy, with or without proteinuria or hypertension that leads to end-organ dysfunction. Since the only definitive treatment is delivery, PE still represents one of the leading causes of preterm birth and perinatal mobility and mortality. Therefore, any strategies that aim to reduce adverse outcomes are based on early primary prevention, prenatal surveillance and prophylactic interventions. In the last decade, intense research has been focussed on the study of predictive models in order to identify women at higher risk accurately. To date, the most effective screening model is based on the combination of anamnestic, demographic, biophysical and maternal biochemical factors. In this review, we provide a detailed discussion about the current and future perspectives in the field of PE. We will examine pathogenesis, risk factors and clinical features. Moreover, recent developments in screening and prevention strategies, novel therapies and healthcare management strategies will be discussed.
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Affiliation(s)
- Özge Kahramanoglu
- Department of Perinatology, Zeynep Kamil Education and Research Hospital, İstanbul, Turkey
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Education and Research Hospital, İstanbul, Turkey
| | - Giovanni Sisti
- Department of Obstetrics and Gynecology, New York Health and Hospitals/Lincoln, Bronx, NY, USA
| | - Franco Pietro Ammaturo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Trotta
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federico Ferrari
- Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Agnese Maria Chiara Rapisarda
- Department of General Surgery and Medical Surgical Specialties, Obstetrics and Gynecology Unit, University of Catania, Catania, Italy
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Li X, Liu L, Whitehead C, Li J, Thierry B, Le TD, Winter M. OUP accepted manuscript. Brief Funct Genomics 2022; 21:296-309. [PMID: 35484822 PMCID: PMC9328024 DOI: 10.1093/bfgp/elac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 11/24/2022] Open
Abstract
Preeclampsia is a pregnancy-specific disease that can have serious effects on the health of both mothers and their offspring. Predicting which women will develop preeclampsia in early pregnancy with high accuracy will allow for improved management. The clinical symptoms of preeclampsia are well recognized, however, the precise molecular mechanisms leading to the disorder are poorly understood. This is compounded by the heterogeneous nature of preeclampsia onset, timing and severity. Indeed a multitude of poorly defined causes including genetic components implicates etiologic factors, such as immune maladaptation, placental ischemia and increased oxidative stress. Large datasets generated by microarray and next-generation sequencing have enabled the comprehensive study of preeclampsia at the molecular level. However, computational approaches to simultaneously analyze the preeclampsia transcriptomic and network data and identify clinically relevant information are currently limited. In this paper, we proposed a control theory method to identify potential preeclampsia-associated genes based on both transcriptomic and network data. First, we built a preeclampsia gene regulatory network and analyzed its controllability. We then defined two types of critical preeclampsia-associated genes that play important roles in the constructed preeclampsia-specific network. Benchmarking against differential expression, betweenness centrality and hub analysis we demonstrated that the proposed method may offer novel insights compared with other standard approaches. Next, we investigated subtype specific genes for early and late onset preeclampsia. This control theory approach could contribute to a further understanding of the molecular mechanisms contributing to preeclampsia.
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Affiliation(s)
- Xiaomei Li
- UniSA STEM, University of South Australia, Mawson Lakes, 5095, SA, Australia
| | - Lin Liu
- UniSA STEM, University of South Australia, Mawson Lakes, 5095, SA, Australia
| | - Clare Whitehead
- Pregnancy Research Centre, Dept of Obstetrics & Gynaecology, University of Melbourne, Royal Women’s Hospital, Melbourne, 3052, VIC, Australia
| | - Jiuyong Li
- UniSA STEM, University of South Australia, Mawson Lakes, 5095, SA, Australia
| | - Benjamin Thierry
- Future Industries Institute, University of South Australia, Mawson Lakes, 5095, SA, Australia
| | - Thuc D Le
- Corresponding authors: Thuc D. Le, UniSA STEM, University of South Australia, Mawson Lakes, 5095, SA, Australia. E-mail: ; M. Winter, Future Industries Institute, University of South Australia, Mawson Lakes, 5095, SA, Australia. E-mail:
| | - Marnie Winter
- Corresponding authors: Thuc D. Le, UniSA STEM, University of South Australia, Mawson Lakes, 5095, SA, Australia. E-mail: ; M. Winter, Future Industries Institute, University of South Australia, Mawson Lakes, 5095, SA, Australia. E-mail:
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5
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He J, Liu K, Hou X, Lu J. Identification and validation of key non-coding RNAs and mRNAs using co-expression network analysis in pre-eclampsia. Medicine (Baltimore) 2021; 100:e25294. [PMID: 33832098 PMCID: PMC8036074 DOI: 10.1097/md.0000000000025294] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/05/2021] [Indexed: 01/05/2023] Open
Abstract
Pre-eclampsia (PE) is a common complication of pregnancy, associated with maternal and fetal morbidity and mortality. In this study, we aimed to explore important long non-coding RNAs (lncRNAs) and their possible mechanisms in PE.GSE60438 expression profile including 25 PE samples and 23 normal samples were obtained from gene expression omnibus (GEO) database. After normalization with betaqn package in R, differentially expressed lncRNAs (DElncRNAs) and mRNAs (DEmRNAs) were identified using the limma package. Gene Ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway were analyzed using DAVID 6.7 and GSEA 3.0. LncRNAs-mRNAs coexpression was implemented using weighted gene co-expression network analysis (WGCNA). MicroRNAs linked with these DElncRNAs and DEmRNAs were predicted and a competitive endogenous RNA (ceRNA) network was built.A total of 53 DElncRNAs and 301 DEmRNAs were identified between control and PE samples. These DEmRNAs were enriched into pathways such as protein digestion and absorption, osteoclast differentiation. WGCNA constructed a lncRNA-mRNA coexpression network, among which SUMO1P3, NACAP1, NCF1C, ANXA2P1, GTF2IP1, NAPSB, OR7E37P were hub genes. ceRNA network was constructed together with microRNAs (miRNAs), and functional analysis indicated cellular membrane and sugar binding were involved in PE progression. Five lncRNAsANXA2P1, GTF2IP1, NACAP1, NCF1C and OR7E37P were successfully validated in our clinical specimens.The DElncRNAs, including ANXA2P1, GTF2IP1, NACAP1, NCF1C and OR7E37P might play important roles in PE. However, the exact mechanism of these lncRNAs in prediction and diagnosis of PE should be further explored.
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Affiliation(s)
- Jing He
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Shanxi Medical University, Taiyuan, Shanxi
| | - Kang Liu
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Shanxi Medical University, Taiyuan, Shanxi
| | - Xiaohong Hou
- Department of Obstetrics and Gynecology, The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Jieqiang Lu
- Department of Obstetrics and Gynecology, The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
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Langston-Cox A, Marshall SA, Lu D, Palmer KR, Wallace EM. Melatonin for the Management of Preeclampsia: A Review. Antioxidants (Basel) 2021; 10:antiox10030376. [PMID: 33802558 PMCID: PMC8002171 DOI: 10.3390/antiox10030376] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Preeclampsia is a disease specific to pregnancy characterised by new-onset hypertension with maternal organ dysfunction and/or fetal growth restriction. It remains a major cause of maternal and perinatal morbidity and mortality. For sixty years, antihypertensives have been the mainstay of treating preeclampsia and only recently have insights into the pathogenesis of the disease opened new avenues for novel therapies. Melatonin is one such option, an endogenous and safe antioxidant, that may improve the maternal condition in preeclampsia while protecting the fetus from a hostile intrauterine environment. Here we review the evidence for melatonin as a possible adjuvant therapy for preeclampsia, including in vitro evidence supporting a role for melatonin in protecting the human placenta, preclinical models, vascular studies, and clinical studies in hypertension and pregnancy.
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Affiliation(s)
- Annie Langston-Cox
- The Ritchie Centre, Department of Obstetrics and Gynecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia; (A.L.-C.); (S.A.M.); (D.L.); (K.R.P.)
| | - Sarah A. Marshall
- The Ritchie Centre, Department of Obstetrics and Gynecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia; (A.L.-C.); (S.A.M.); (D.L.); (K.R.P.)
| | - Daisy Lu
- The Ritchie Centre, Department of Obstetrics and Gynecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia; (A.L.-C.); (S.A.M.); (D.L.); (K.R.P.)
| | - Kirsten R. Palmer
- The Ritchie Centre, Department of Obstetrics and Gynecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia; (A.L.-C.); (S.A.M.); (D.L.); (K.R.P.)
- Monash Health, Clayton, VIC 3168, Australia
| | - Euan M. Wallace
- The Ritchie Centre, Department of Obstetrics and Gynecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia; (A.L.-C.); (S.A.M.); (D.L.); (K.R.P.)
- Correspondence: ; Tel.: +61-3-9594-5145; Fax: +61-3-9594-5003
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7
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Neuroprotective effect of magnesium supplementation on cerebral ischemic diseases. Life Sci 2021; 272:119257. [PMID: 33631176 DOI: 10.1016/j.lfs.2021.119257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/31/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023]
Abstract
Ischemic encephalopathy is associated with a high mortality and rate of disability. The most common type of ischemic encephalopathy, ischemic stroke, is the second leading cause of death in the world. At present, the main treatment for ischemic stroke is to reopen blocked blood vessels. However, despite revascularization, many patients are not able to achieve good functional results. At the same time, the strict time window (<4.5 h) of thrombolytic therapy limits clinical application. Therefore, it is important to explore effective neuroprotective drugs for the treatment of ischemic stroke. Magnesium is a natural calcium antagonist, which exerts neuroprotective effects through various mechanisms. However, while most basic studies have shown that magnesium supplementation can help treat cerebral ischemia, intravenous magnesium supplementation in large clinical trials has failed to improve prognosis of ischemic patients. Therefore, we review the basic and clinical studies of magnesium supplementation for cerebral ischemia. According to the route of administration, treatment can be divided into intraperitoneal magnesium supplementation, intravenous magnesium supplementation, arterial magnesium supplementation and intracranial magnesium supplementation. We also summarized the potential influencing factors of magnesium ion intervention in cerebral ischemia injury. Finally, in combination with influencing factors derived from basic research, this article proposes three future research directions, including magnesium supplementation into the circulatory system combined with magnesium supplementation in the lateral ventricle, magnesium supplementation in the lateral ventricle combined with hypothermia therapy, and lateral ventricle magnesium supplementation combined with intracarotid magnesium supplementation combined with selective hypothermia.
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8
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Langston-Cox A, Leo CH, Tare M, Wallace EM, Marshall SA. Sulforaphane improves vascular reactivity in mouse and human arteries after "preeclamptic-like" injury. Placenta 2020; 101:242-250. [PMID: 33032098 DOI: 10.1016/j.placenta.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The widespread maternal endothelial dysfunction that underlies the manifestations of preeclampsia is thought to arise from excessive placental production of antiangiogenic factors and enhanced oxidative stress. Therefore, we assessed whether the natural antioxidant sulforaphane could improve vascular function. METHODS Cell viability of human umbilical vein endothelial cells (HUVECs) was assessed after 24 or 48 h in normoxia (20% O2) or hypoxia (1% O2) with or without sulforaphane. To model vascular dysfunction associated with preeclampsia, mouse mesenteric arteries were incubated in trophoblast conditioned media (TCM), and human omental arteries incubated in preeclamptic explant media (PEM) with or without sulforaphane. Both media are rich in antiangiogenic compounds associated with preeclampsia. TCM was generated from primary cytotrophoblast cells from term placentae of normotensive, while PEM was generated from explants from preeclamptic women. Reactivity was assessed by wire myography. sulforaphane's actions as a vasodilator were also investigated. RESULTS Under conditions of hypoxia, sulforaphane improved HUVEC viability. In mouse mesenteric arteries, sulforaphane reduced contraction evoked by potassium (p < 0.001), phenylephrine and endothelin 1 (all p < 0.001). Sulforaphane also inhibited Ca2+-induced contraction (p = 0.014). Sulforaphane prevented TCM-induced augmentation of phenylephrine and angiotensin II-mediated contraction of mouse mesenteric arteries. In human omental arteries, sulforaphane induced vasodilation (p < 0.001), and prevented PEM-induced endothelial dysfunction by restoring arterial sensitivity to the endothelium-dependent vasodilator bradykinin (p = 0.008). DISCUSSION Sulforaphane causes relaxation in arteries and protects against arterial dysfunction induced by placental-derived antiangiogenic factors, which are known to contribute to the preeclampsia.
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Affiliation(s)
- A Langston-Cox
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - C H Leo
- Science, Mathematics and Technology, Singapore University of Technology & Design, Singapore
| | - M Tare
- Monash Rural Health, Monash University, Churchill, VIC, 3842, Australia; Department of Physiology, Monash University, Clayton, Australia
| | - E M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - S A Marshall
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
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9
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Abstract
Normal pregnancy is a complex and dynamic process that requires significant adaptation from the maternal system. Failure of this adaptive process in pregnancy contributes to many pregnancy related disorders, including the hypertensive disorders of pregnancy. This article discusses placental development and how abnormalities in the process of vascular remodeling contribute to the multisystem maternal and fetal disease that is preeclampsia and fetal growth restriction. We review some of the consequences of this condition on the mother and fetus, aspects of the clinical management of preeclampsia and how it can influence both mother and infant in the postnatal period and beyond.
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10
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Langston-Cox A, Muccini AM, Marshall SA, Yap, Palmer KR, Wallace EM, Ellery SJ. Sulforaphane improves syncytiotrophoblast mitochondrial function after in vitro hypoxic and superoxide injury. Placenta 2020; 96:44-54. [PMID: 32560857 DOI: 10.1016/j.placenta.2020.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/22/2020] [Accepted: 05/10/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Placental mitochondrial dysfunction contributes to the oxidative stress that underlies preeclampsia. Here, we assessed whether sulforaphane (SFN) could improve syncytiotrophoblast mitochondrial function after in vitro hypoxic and superoxide injury. METHODS Placental cytotrophoblasts were isolated from healthy term placentae (n = 12) and incubated for 48 h in 8% O2 ± 1 μM SFN before acute (4hrs) or chronic (24hrs) hypoxic (1% O2), or superoxide (xanthine/xanthine oxidase) injury. Cytotrophoblasts were also isolated from preeclamptic placentae (n = 5) and cultured in 8% O2 ± 1 μM SFN. Mitochondrial respiration was measured using the Seahorse MitoStress XF assay. Cells were stained with mitotracker red to assess mitochondrial membrane health and mitochondrial gene expression assessed using RT-qPCR. RESULTS SFN prevented significant reductions in syncytiotrophoblast mitochondrial maximal respiration, spare respiratory capacity, basal respiration and ATP production following acute hypoxia. Chronic hypoxia only reduced maximal and spare respiratory capacity. SFN prevented these negative changes and increased respiration overall. Alternatively, acute superoxide injury significantly increased mitochondrial maximal respiration and spare respiratory capacity. SFN treatment further increased basal respiration following superoxide injury and prevented significant decreases in ATP production and coupling efficiency. In preeclamptic placentae, SFN significantly increased mitochondrial maximal respiration, spare respiratory capacity, basal respiration and ATP production, and decreased proton leak. SFN up-regulated mRNA expression of mitochondrial complexes and corrected an up-regulation in fission gene expression observed after hypoxic-superoxide injury. Finally, preliminary results suggest SFN prevented hypoxia-induced impairment of mitochondrial membrane structure. DISCUSSION SFN mitigated hypoxia and superoxide induced changes to syncytiotrophoblast mitochondrial function in vitro, and improved mitochondrial respiration in trophoblast cells from preeclamptic placentae.
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Affiliation(s)
- A Langston-Cox
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
| | - A M Muccini
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - S A Marshall
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Yap
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - K R Palmer
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Monash Women's, Monash Health, Clayton, VIC, Australia
| | - E M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - S J Ellery
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Hudson Institute of Medical Research, Clayton, VIC, Australia
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11
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Tamargo J. Selecting emergency therapy for patients with pre-eclampsia. Expert Opin Pharmacother 2020; 21:1119-1122. [PMID: 32133877 DOI: 10.1080/14656566.2020.1727444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense , Madrid, Spain
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12
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Wertaschnigg D, Wang R, Reddy M, Costa FDS, Mol BWJ, Rolnik DL. Treatment of severe hypertension during pregnancy: we still do not know what the best option is. Hypertens Pregnancy 2019; 39:25-32. [PMID: 31880480 DOI: 10.1080/10641955.2019.1708383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intracranial hemorrhage and stroke are primary causes of maternal mortality in pregnancies affected by hypertensive disorders. As such antihypertensive therapy plays a crucial role in the management of severe hypertension. However, the target level to achieve the best outcome for both - mother and fetus - is still unclear. Moreover, given the lack of well-designed randomized controlled trials with standardized key outcomes, the current choice of antihypertensive medications depends rather on clinicians' preference. Furthermore, data on long-term outcomes of offspring is not available. Therefore, there is an urgent need for randomized trials comparing different anti-hypertensive options to address efficacy and safety questions.
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Affiliation(s)
- Dagmar Wertaschnigg
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia.,Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Rui Wang
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia
| | - Maya Reddy
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia.,Monash Women's, Monash Health, Clayton, Australia
| | - Fabricio Da Silva Costa
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia.,Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ben Willem J Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia.,Monash Women's, Monash Health, Clayton, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia.,Monash Women's, Monash Health, Clayton, Australia
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13
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Langston-Cox AG, Marshall SA, Palmer KR, Wallace EM. Prolong: a double-blind randomised placebo-controlled trial of broccoli sprout extract in women with early onset preeclampsia. A clinical trial protocol. BMJ Open 2019; 9:e027493. [PMID: 31628121 PMCID: PMC6803158 DOI: 10.1136/bmjopen-2018-027493] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. There is a need for adjuvant, targeted therapies to improve outcomes. Broccoli sprout extract, rich in the antioxidant sulforaphane, reduces oxidative stress and placental secretion of the antiangiogenic factors that contribute to vascular dysfunction in preeclampsia. We propose a phase III trial investigating broccoli sprout extract. We will assess broccoli sprout extract in women with early onset (<34 weeks) preeclampsia, investigating (1) the interval between enrolment and delivery (days), (2) biomarkers of placental and endothelial function and (3) maternal and fetal outcomes. METHODS A double-blind, placebo-controlled randomised trial will be conducted at Monash Health, Melbourne, Australia. One hundred and eighty women (45 each arm of each stratum) with early onset preeclampsia (defined as per Society for Obstetric Medicine of Australia and New Zealand guidelines) will be recruited. Consenting women will be randomised to receive an oral dose of either broccoli sprout extract (24 mg of activated sulforaphane) or identical placebo, twice daily until delivery. Maternal blood will be collected antenatally for measurement of biomarkers of preeclampsia, including soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), soluble endoglin (sEng) and activin A, as well as circulating sulforaphane metabolites. Maternal and perinatal outcomes will be monitored throughout. All clinical care decisions, including the timing of delivery, will be made by the treating team, blinded to treatment allocation. Participation in this trial will not affect routine care. At delivery, maternal and cord blood and placentae will be collected to measure sulforaphane metabolites and sFlt-1, PlGF, sEng and activin A. ETHICS AND DISSEMINATION Approval to conduct the trial has been granted by Monash Health Human Research and Ethics Committee (RES-18-0000-109A). Deidentified data will be published in peer-reviewed journals and presented at learnt society conferences, both nationally and internationally. This study has not yet commenced and is pre-results.Trial registration numberACTRN12618000216213.
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Affiliation(s)
- Annie G Langston-Cox
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Sarah A Marshall
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Kirsten R Palmer
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Monash Women's, Monash Health, Clayton, Victoria, Australia
| | - Euan M Wallace
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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