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Abstract
Pre-eclampsia is a life-threatening disease of pregnancy unique to humans and a leading cause of maternal and neonatal morbidity and mortality. Women who survive pre-eclampsia have reduced life expectancy, with increased risks of stroke, cardiovascular disease and diabetes, while babies from a pre-eclamptic pregnancy have increased risks of preterm birth, perinatal death and neurodevelopmental disability and cardiovascular and metabolic disease later in life. Pre-eclampsia is a complex multisystem disease, diagnosed by sudden-onset hypertension (>20 weeks of gestation) and at least one other associated complication, including proteinuria, maternal organ dysfunction or uteroplacental dysfunction. Pre-eclampsia is found only when a placenta is or was recently present and is classified as preterm (delivery <37 weeks of gestation), term (delivery ≥37 weeks of gestation) and postpartum pre-eclampsia. The maternal syndrome of pre-eclampsia is driven by a dysfunctional placenta, which releases factors into maternal blood causing systemic inflammation and widespread maternal endothelial dysfunction. Available treatments target maternal hypertension and seizures, but the only 'cure' for pre-eclampsia is delivery of the dysfunctional placenta and baby, often prematurely. Despite decades of research, the aetiology of pre-eclampsia, particularly of term and postpartum pre-eclampsia, remains poorly defined. Significant advances have been made in the prediction and prevention of preterm pre-eclampsia, which is predicted in early pregnancy through combined screening and is prevented with daily low-dose aspirin, starting before 16 weeks of gestation. By contrast, the prediction of term and postpartum pre-eclampsia is limited and there are no preventive treatments. Future research must investigate the pathogenesis of pre-eclampsia, in particular of term and postpartum pre-eclampsia, and evaluate new prognostic tests and treatments in adequately powered clinical trials.
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Nowakowska BA, Pankiewicz K, Nowacka U, Niemiec M, Kozłowski S, Issat T. Genetic Background of Fetal Growth Restriction. Int J Mol Sci 2021; 23:ijms23010036. [PMID: 35008459 PMCID: PMC8744929 DOI: 10.3390/ijms23010036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 12/14/2022] Open
Abstract
Fetal growth restriction (FGR) is one of the most formidable challenges in present-day antenatal care. Pathological fetal growth is a well-known factor of not only in utero demise in the third trimester, but also postnatal morbidity and unfavorable developmental outcomes, including long-term sequalae such as metabolic diseases, diabetic mellitus or hypertension. In this review, the authors present the current state of knowledge about the genetic disturbances responsible for FGR diagnosis, divided into fetal, placental and maternal causes (including preeclampsia), as well as their impact on prenatal diagnostics, with particular attention on chromosomal microarray (CMA) and noninvasive prenatal testing technique (NIPT).
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Affiliation(s)
- Beata Anna Nowakowska
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland;
- Correspondence: (B.A.N.); (K.P.); Tel.: +48-22-3277131 (B.A.N.); +48-22-3277044 (K.P.)
| | - Katarzyna Pankiewicz
- Department of Obstetrics and Gynecology, Institute of Mother and Child in Warsaw, Kasprzaka 17a, 01-211 Warsaw, Poland; (U.N.); (S.K.); (T.I.)
- Correspondence: (B.A.N.); (K.P.); Tel.: +48-22-3277131 (B.A.N.); +48-22-3277044 (K.P.)
| | - Urszula Nowacka
- Department of Obstetrics and Gynecology, Institute of Mother and Child in Warsaw, Kasprzaka 17a, 01-211 Warsaw, Poland; (U.N.); (S.K.); (T.I.)
| | - Magdalena Niemiec
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland;
| | - Szymon Kozłowski
- Department of Obstetrics and Gynecology, Institute of Mother and Child in Warsaw, Kasprzaka 17a, 01-211 Warsaw, Poland; (U.N.); (S.K.); (T.I.)
| | - Tadeusz Issat
- Department of Obstetrics and Gynecology, Institute of Mother and Child in Warsaw, Kasprzaka 17a, 01-211 Warsaw, Poland; (U.N.); (S.K.); (T.I.)
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Guan C, Zhao F, Yang Z, Tang Q, Wang L, Li X, Zhang L, Deng Z, Hou H, Wang J, Xu Y, Zhang R, Lin Y, Tan P, Zhang Y, Liu S, Zhang L. A review of key cytokines based on gene polymorphism in the pathogenesis of pre-eclampsia. Am J Reprod Immunol 2021; 87:e13503. [PMID: 34599631 DOI: 10.1111/aji.13503] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022] Open
Abstract
Although a number of theories have been suggested, including roles for oxidative stress, an abnormal maternal-fetal interface, and genetic and environmental factors, the etiopathology of pre-eclampsia (PE) remains unclear. Maternal immune tolerance is important for maintaining pregnancy, and researchers have increasingly focused on the critical roles of cytokines in the pathogenesis of PE in recent years. The assessment of candidate genetic polymorphisms in PE could partially elucidate the mechanisms of susceptibility to disease, and contribute to seeking for new diagnosis and treatment methods of PE. PE can lead to severe complications, and even the death of both mother and fetus. Although the complex pathology is not yet clear, some evidence suggested that the occurrence of PE is related to inflammatory factors. We reviewed the current understandings of roles of cytokines in PE, and provided an extensive overview of the role of single nucleotide chain polymorphisms (SNPs) in the genes potentially underlying the pathophysiology of PE.
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Affiliation(s)
- Chengcheng Guan
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fei Zhao
- Department of gynecology and obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhencui Yang
- Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Tang
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ling Wang
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xueli Li
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lixia Zhang
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ziwen Deng
- Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Huabin Hou
- Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingli Wang
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yinglei Xu
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ru Zhang
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Lin
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ping Tan
- Department of gynecology and obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Zhang
- Department of gynecology and obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shiguo Liu
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lu Zhang
- Medical genetic department, The Affiliated Hospital of Qingdao University, Qingdao, China.,Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
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