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Yadav BK, Maskey S, Bhattarai A, Pradhananga S, Shakya S, Regmi A. Association of serum homocysteine with vitamin B12 and folate levels in women with pre-eclampsia in a tertiary health care center in Nepal. BMC Womens Health 2024; 24:451. [PMID: 39123143 PMCID: PMC11311945 DOI: 10.1186/s12905-024-03284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Pre-eclampsia is a syndrome that chiefly includes the development of new-onset hypertension and proteinuria after 20 weeks of pregnancy. Pre-eclampsia is one of the major causes of mortality and morbidity in Nepal. Hyperhomocysteinemia may be a cause of the endothelial dysfunction provoked by oxidative stress in pre-eclampsia. This study was designed to evaluate the association of homocysteine with Vitamin B12 and folate in patients with pre-eclampsia. METHOD An observational cross sectional study was performed in the Gynecology and Obstetrics Department of TUTH involving seventy two subjects with pre-eclampsia. Blood pressure, urinary protein levels, serum homocysteine, Vitamin B12 and folate levels were compared in both mild and severe forms of pre-eclampsia. Concentration of Vitamin B12 and folate were measured using Vitros ECI and homocysteine was measured using CLIA. SPSS 23.0 was used to analyze the data. Tests were performed with Mann Whitney Test and Spearman's rank correlation test. A p-value < 0.05 was considered statistically significant. RESULTS This study showed no significant difference in age and weeks of gestation in both mild and severe forms of pre-eclampsia. Mean concentration of homocysteine was higher (13.1 ± 6.4 micromol/L) in severe Pre-eclampsia as compared to mild cases (7.6 ± 2.8 micromol/L). Mean concentration of folate was lower in severe cases (35.4 ± 24.1 micromol/L) when compared with mild cases of pre-eclampsia (57 ± 23.4 micromol/L). CONCLUSION Homocysteine levels were increased in severe Pre-eclampsia when compared with mild pre-eclampsia and this finding can be used to predict and prevent complications in patients with pre-eclampsia.
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Affiliation(s)
- Binod Kumar Yadav
- Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Suvana Maskey
- Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Aseem Bhattarai
- Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Salina Pradhananga
- Kantipur Dental College Teaching Hospital and Research Center, Kathmandu, Nepal.
| | - Sabina Shakya
- Kathmandu Path Lab and Diagnostic Center, Kathmandu, Nepal
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Kim HY, Seok YS, Moon HY, Cho GJ, Ahn KH, Hong SC, Oh MJ, Kim HJ. The Role of the Aryl Hydrocarbon Receptor in Vascular Factors Related to Preeclampsia in a Smoking Mouse Model. Curr Issues Mol Biol 2024; 46:741-752. [PMID: 38248350 PMCID: PMC10814390 DOI: 10.3390/cimb46010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
Smoking cigarettes is known to lower the risk of preeclampsia. The objective of this study is to evaluate the effect of smoking on the expression of soluble FMS-like tyrosine kinase-1 (sFlt-1), vascular endothelial growth factor (VEGF), and endoglin (sEng)-1 and the role of the aryl hydrocarbon receptor (AhR) in pregnant mice. We developed a smoking mouse model using a gas-filling system. One or two cigarettes per day were exposed to each of the five pregnant mice for five days a week throughout pregnancy. AhR agonist and antagonist were injected. Serum levels and expression in the placenta of sFlt-1, VEGF, and sEng-1 were analyzed and compared among the cigarette smoke and no-exposure groups after delivery. Compared to the no-smoke exposure group, the serum level of sFlt-1 was significantly decreased in the two-cigarette-exposed group (p < 0.001). When the AhR antagonist was added to the two-cigarette-exposed group, sFlt-1 levels were significantly increased compared to the two-cigarette group (p = 0.002). The levels of sFlt-1 in the AhR antagonist group did not change regardless of two-cigarette exposure (p = 0.064). With the AhR agonist, sFlt-1 decreased significantly compared to the control (p = 0.001) and AhR antagonist group (p = 0.002). The sFlt-1 level was significantly decreased after the injection of the AhR agonist compared to the control group (p = 0.001). Serum levels of VEGF were significantly decreased in the one-cigarette-exposed group compared to the control group; however, there was no difference between the control and the two-cigarette-exposed groups. The placental expression of sFlt-1, VEGF, and sEng were inconsistent. This study offers insights into the potential role of AhR on antiangiogenic sFlt-1 associated with preeclampsia. It may support the invention of a new treatment strategy for preeclampsia using AhR activation.
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Affiliation(s)
- Ho-Yeon Kim
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Ye-Seon Seok
- Department of Obstetric and Gynecology, Korea University Guro Hospital, Seoul 08308, Republic of Korea;
| | - Hye-Yeon Moon
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Geum-Joon Cho
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Ki-Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul 02841, Republic of Korea; (H.-Y.K.); (H.-Y.M.); (K.-H.A.); (S.-C.H.); (H.-J.K.)
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Askins L, Orimoloye HT, Deng C, Hansen J, Olsen J, Ritz B, Janzen C, Heck JE. Preeclampsia, antihypertensive medication use in pregnancy and risk of childhood cancer in offspring. Cancer Causes Control 2024; 35:43-53. [PMID: 37535154 PMCID: PMC10764520 DOI: 10.1007/s10552-023-01745-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/26/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Preeclampsia is a serious pregnancy complication that presents a significant risk to both the mother and the fetus. Preeclampsia and medications associated with its treatment are potentially linked to increased childhood cancer risk. Therefore, we examined the association between preeclampsia, antihypertensive medications, and childhood cancer in offspring. METHODS Cases (n = 6,420) and controls (n = 160,484) were obtained from Danish national registries. We performed conditional logistic regression analyses to estimate the association between preeclampsia and childhood cancer risk, and examined the effects of antihypertensive medication use in pregnancy in relation to childhood cancer risk in the offspring with adjustment for relevant covariates. RESULTS We observed an increased risk of acute lymphoblastic leukemia (ALL) among those whose mothers had preeclampsia (OR = 1.36, 95% CI 1.03, 1.79), especially for severe preeclampsia (OR = 2.36, 95% CI 1.37, 4.08). We also estimated an increased cancer risk in children born to mothers who were prescribed diuretics during pregnancy [OR = 2.09, 95% confidence interval (CI) 1.39, 3.14]. Intake of other antihypertensive medications was not associated with childhood cancer (OR = 0.78, 95% CI 0.50, 1.23). Among women who did not take diuretics in pregnancy, preeclampsia was associated with neuroblastoma (OR = 2.22, 95% CI 1.08, 4.55). CONCLUSION Our findings suggested an increased risk for certain types of cancer in the offspring of mothers with preeclampsia and an increased risk of cancer with diuretic intake during pregnancy.
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Affiliation(s)
- Lexie Askins
- Department of Epidemiology, Fielding School of Public Health, University of California (UCLA), Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Helen T Orimoloye
- College of Health and Public Service, University of North Texas, 1155 Union Circle #311340, Denton, TX, 76203-5017, USA
| | - Chuanjie Deng
- Department of Epidemiology, Fielding School of Public Health, University of California (UCLA), Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Jorn Olsen
- Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California (UCLA), Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, University of California, Box 951740, Los Angeles, CA, USA
| | - Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California (UCLA), Box 951772, Los Angeles, CA, 90095-1772, USA.
- College of Health and Public Service, University of North Texas, 1155 Union Circle #311340, Denton, TX, 76203-5017, USA.
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Nichols HB, House MG, Yarosh R, Mitra S, Goldberg M, Bertrand KA, Eliassen AH, Giles GG, Jones ME, Milne RL, O'Brien KM, Palmer JR, Sandin S, Willett WC, Yin W, Sandler DP, Swerdlow AJ, Schoemaker MJ. Hypertensive conditions of pregnancy, preterm birth, and premenopausal breast cancer risk: a premenopausal breast cancer collaborative group analysis. Breast Cancer Res Treat 2023; 199:323-334. [PMID: 37020102 PMCID: PMC11314296 DOI: 10.1007/s10549-023-06903-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/17/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Women with preeclampsia are more likely to deliver preterm. Reports of inverse associations between preeclampsia and breast cancer risk, and positive associations between preterm birth and breast cancer risk are difficult to reconcile. We investigated the co-occurrence of preeclampsia/gestational hypertension with preterm birth and breast cancer risk using data from the Premenopausal Breast Cancer Collaborative Group. METHODS Across 6 cohorts, 3096 premenopausal breast cancers were diagnosed among 184,866 parous women. We estimated multivariable hazard ratios (HR) and 95% confidence intervals (CI) for premenopausal breast cancer risk using Cox proportional hazards regression. RESULTS Overall, preterm birth was not associated (HR 1.02, 95% CI 0.92, 1.14), and preeclampsia was inversely associated (HR 0.86, 95% CI 0.76, 0.99), with premenopausal breast cancer risk. In stratified analyses using data from 3 cohorts, preterm birth associations with breast cancer risk were modified by hypertensive conditions in first pregnancies (P-interaction = 0.09). Preterm birth was positively associated with premenopausal breast cancer in strata of women with preeclampsia or gestational hypertension (HR 1.52, 95% CI: 1.06, 2.18), but not among women with normotensive pregnancy (HR = 1.09, 95% CI: 0.93, 1.28). When stratified by preterm birth, the inverse association with preeclampsia was more apparent, but not statistically different (P-interaction = 0.2), among women who did not deliver preterm (HR = 0.82, 95% CI 0.68, 1.00) than those who did (HR = 1.07, 95% CI 0.73, 1.56). CONCLUSION Findings support an overall inverse association of preeclampsia history with premenopausal breast cancer risk. Estimates for preterm birth and breast cancer may vary according to other conditions of pregnancy.
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Affiliation(s)
- Hazel B Nichols
- Department of Epidemiology, Hazel B. Nichols, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 2104F McGavran-Greenberg Hall, 135 Dauer Drive, Chapel Hill, Chapel Hill, NC, 27599-7435, USA.
| | | | - Rina Yarosh
- Department of Epidemiology, Hazel B. Nichols, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 2104F McGavran-Greenberg Hall, 135 Dauer Drive, Chapel Hill, Chapel Hill, NC, 27599-7435, USA
| | - Sara Mitra
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Mandy Goldberg
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, USA
| | | | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Graham G Giles
- Cancer Epidemiology Division Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Michael E Jones
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Roger L Milne
- Cancer Epidemiology Division Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, USA
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston University, Boston, USA
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Solna, Sweden
- Department of Psychiatry Icahn School of Medicine at Mount Sinai, New York, USA
- Seaver Autism Center for Research and Treatment at Mount Sinai Icahn School of Medicine at Mount Sinai, New York, USA
| | - Walter C Willett
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Weiyao Yin
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Solna, Sweden
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, USA
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Real World Solutions IQVIA, Amsterdam, The Netherlands
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Vacher CM, Bonnin A, Mir IN, Penn AA. Editorial: Advances and perspectives in neuroplacentology. Front Endocrinol (Lausanne) 2023; 14:1206072. [PMID: 37274324 PMCID: PMC10236794 DOI: 10.3389/fendo.2023.1206072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Affiliation(s)
- Claire-Marie Vacher
- Department of Pediatrics, NewYork Presbyterian Hospital, New York, NY, United States
- Columbia University Irving Medical Center, Columbia University, New York, NY, United States
| | - Alexandre Bonnin
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Imran N. Mir
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Anna A. Penn
- Department of Pediatrics, NewYork Presbyterian Hospital, New York, NY, United States
- Columbia University Irving Medical Center, Columbia University, New York, NY, United States
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Chen L, Pi Y, Chang K, Luo S, Peng Z, Chen M, Yu L. Screening models combining maternal characteristics and multiple markers for the early prediction of preeclampsia in pregnancy: a nested case–control study. J OBSTET GYNAECOL 2022; 42:1889-1896. [PMID: 35634766 DOI: 10.1080/01443615.2022.2054675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Li Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Pi
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Chang
- Department of Clinical Laboratory Medicine, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Sifu Luo
- Department of Obstetrics and Gynecology, Institute of Surgery Research, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhuyun Peng
- Department of Obstetrics and Gynecology, Institute of Surgery Research, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ming Chen
- Department of Clinical Laboratory Medicine, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lili Yu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Negi R, Haritha V, Aziz N, Siddiqui AH. Biochemical markers in the pathogenesis of preeclampsia: novel link between placental growth factor and interleukin-6. Mol Cell Biochem 2022; 477:1765-1774. [PMID: 35292877 DOI: 10.1007/s11010-022-04403-6] [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] [Received: 08/08/2021] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
Abstract
Preeclampsia (PE) is a multisystem disorder of pregnancy characterized by sudden onset of hypertension and proteinuria. The appearance and diagnosis of the disease remain elusive and the only treatment is the termination of pregnancy. The onset of the disease is preceded by a shift in the balance of the angiogenic and antiangiogenic proteins in the maternal circulation. We surmised that the assessment of the levels of these proteins during pregnancy could lead to a proper diagnosis of the disease. In this study, we determined the levels of angiogenic and antiangiogenic proteins and IL-6 in maternal circulation during normotensive and hypertensive pregnancy, including PE. Serum isolated from pregnant women during antenatal visits was used to determine the concentrations of these proteins. The levels of antiangiogenic proteins, sFlt-1 and sEng, were higher in hypertensive disorders [gestational hypertension (GH), mild PE, and PE] of pregnancy and were significantly higher for PE than for GH. The levels of sFlt-1 and sEng were higher in PE samples compared to those in GH and NT samples. These proteins may have contributed to increased blood pressure. The levels of PlGF were decreased in pregnant women having GH, mild PE, and PE. The levels of the inflammatory intermediate, IL-6, were increased in PE samples compared to those in the GH and normotensive samples. The evaluation of the altered levels of antiangiogenic and angiogenic proteins can be useful for diagnosis of PE.
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Affiliation(s)
- Rahul Negi
- School of Medical Sciences, University of Hyderabad, Professor C. R. Rao Road, Gachibowli, Hyderabad, TS, 500046, India
| | - Vemanamanda Haritha
- Fernandez Hosp Educational & Research Foundation, Bogulkunta, Hyderabad, TS, 500001, India
| | - Nuzhat Aziz
- Fernandez Hosp Educational & Research Foundation, Bogulkunta, Hyderabad, TS, 500001, India
| | - Athar H Siddiqui
- School of Medical Sciences, University of Hyderabad, Professor C. R. Rao Road, Gachibowli, Hyderabad, TS, 500046, India.
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Civieri G, Iop L, Tona F. Antibodies against Angiotensin II Type 1 and Endothelin 1 Type A Receptors in Cardiovascular Pathologies. Int J Mol Sci 2022; 23:ijms23020927. [PMID: 35055116 PMCID: PMC8778295 DOI: 10.3390/ijms23020927] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/14/2022] [Indexed: 12/19/2022] Open
Abstract
Angiotensin II receptor type 1 (AT1R) and endothelin-1 receptor type A (ETAR) are G-protein-coupled receptors (GPCRs) expressed on the surface of a great variety of cells: immune cells, vascular smooth cells, endothelial cells, and fibroblasts express ETAR and AT1R, which are activated by endothelin 1 (ET1) and angiotensin II (AngII), respectively. Certain autoantibodies are specific for these receptors and can regulate their function, thus being known as functional autoantibodies. The function of these antibodies is similar to that of natural ligands, and it involves not only vasoconstriction, but also the secretion of proinflammatory cytokines (such as interleukin-6 (IL6), IL8 and TNF-α), collagen production by fibroblasts, and reactive oxygen species (ROS) release by fibroblasts and neutrophils. The role of autoantibodies against AT1R and ETAR (AT1R-AAs and ETAR-AAs, respectively) is well described in the pathogenesis of many medical conditions (e.g., systemic sclerosis (SSc) and SSc-associated pulmonary hypertension, cystic fibrosis, and allograft dysfunction), but their implications in cardiovascular diseases are still unclear. This review summarizes the current evidence regarding the effects of AT1R-AAs and ETAR-AAs in cardiovascular pathologies, highlighting their roles in heart transplantation and mechanical circulatory support, preeclampsia, and acute coronary syndromes.
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Middendorf L, Gellhaus A, Iannaccone A, Köninger A, Dathe AK, Bendix I, Reisch B, Felderhoff-Mueser U, Huening B. The Impact of Increased Maternal sFlt-1/PlGF Ratio on Motor Outcome of Preterm Infants. Front Endocrinol (Lausanne) 2022; 13:913514. [PMID: 35846340 PMCID: PMC9279729 DOI: 10.3389/fendo.2022.913514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio serves as a clinical biomarker to predict the hypertensive, placenta-derived pregnancy disorder pre-eclampsia which is often associated with placental dysfunction and fetal growth restriction. Additionally elevated levels also indicate an increased risk for prematurity. However, its predictive value for subsequent neonatal neurological outcome has not been studied. OBJECTIVE This study aimed to evaluate the correlation of maternal sFlt-1/PlGF ratio with early motor outcome of preterm infants. Design/Methods: 88 preterm infants (gestational age ≤ 34 + 0) born between February 2017 and August 2020 at the Department of Obstetrics and Gynecology, University Hospital Essen in Germany, were included, when the following variables were available: maternal sFlt-1/PlGF levels at parturition and general movement assessment of the infant at the corrected age of 3 to 5 months. The infants were stratified into high and low ratio groups according to maternal sFlt-1/PlGF cut-off values of 85. To investigate the early motor repertoire and quality of spontaneous movements of the infant, the Motor Optimality Score (MOS-R) based on antigravity movements and posture patterns, was applied. In the given age, special attention was paid to the presence of fidgety movements. Linear regressions were run to test differences in infants motor repertoire according to the maternal sFlt-1/PIGF ratio. RESULTS Linear regression analysis showed that the sFlt-1/PlGF ratio does not predict the MOS-R score (β=≤0.001; p=0.282). However, children with birth weight below the 10th percentile scored significantly lower (mean 20.7 vs 22.7; p=0.035). These children were 91% in the group with an increased ratio, which in turn is a known predictor of low birth weight (β= -0.315; p <0.001). In the group with a high sFlt-1/PLGF ratio above 85 the mothers of female infants had a lower average sFlt-1/PlGF ratio compared to a male infant (median: 438 in female vs. 603 in male infant, p=0.145). CONCLUSIONS In our cohort, especially low birth weight, which correlated with an elevated sFlt-1/PlGF ratio, had a negative effect on the outcome in the MOS-R. A direct correlation between an increased ratio and a worse motor outcome was not demonstrated.
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Affiliation(s)
- Lisa Middendorf
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexandra Gellhaus
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Angela Köninger
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
- Department of Obstetrics and Gynecology, University of Regensburg, Clinic St Hedwig of the Order of St. John, Regensburg, Germany
| | - Anne-Kathrin Dathe
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Ivo Bendix
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Beatrix Reisch
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Britta Huening
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- *Correspondence: Britta Huening,
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10
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Huang Q, Hao S, You J, Yao X, Li Z, Schilling J, Thyparambil S, Liao WL, Zhou X, Mo L, Ladella S, Davies-Balch SR, Zhao H, Fan D, Whitin JC, Cohen HJ, McElhinney DB, Wong RJ, Shaw GM, Stevenson DK, Sylvester KG, Ling XB. Early-pregnancy prediction of risk for pre-eclampsia using maternal blood leptin/ceramide ratio: discovery and confirmation. BMJ Open 2021; 11:e050963. [PMID: 34824115 PMCID: PMC8627403 DOI: 10.1136/bmjopen-2021-050963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to develop a blood test for the prediction of pre-eclampsia (PE) early in gestation. We hypothesised that the longitudinal measurements of circulating adipokines and sphingolipids in maternal serum over the course of pregnancy could identify novel prognostic biomarkers that are predictive of impending event of PE early in gestation. STUDY DESIGN Retrospective discovery and longitudinal confirmation. SETTING Maternity units from two US hospitals. PARTICIPANTS Six previously published studies of placental tissue (78 PE and 95 non-PE) were compiled for genomic discovery, maternal sera from 15 women (7 non-PE and 8 PE) enrolled at ProMedDx were used for sphingolipidomic discovery, and maternal sera from 40 women (20 non-PE and 20 PE) enrolled at Stanford University were used for longitudinal observation. OUTCOME MEASURES Biomarker candidates from discovery were longitudinally confirmed and compared in parallel to the ratio of placental growth factor (PlGF) and soluble fms-like tyrosine kinase (sFlt-1) using the same cohort. The datasets were generated by enzyme-linked immunosorbent and liquid chromatography-tandem mass spectrometric assays. RESULTS Our discovery integrating genomic and sphingolipidomic analysis identified leptin (Lep) and ceramide (Cer) (d18:1/25:0) as novel biomarkers for early gestational assessment of PE. Our longitudinal observation revealed a marked elevation of Lep/Cer (d18:1/25:0) ratio in maternal serum at a median of 23 weeks' gestation among women with impending PE as compared with women with uncomplicated pregnancy. The Lep/Cer (d18:1/25:0) ratio significantly outperformed the established sFlt-1/PlGF ratio in predicting impending event of PE with superior sensitivity (85% vs 20%) and area under curve (0.92 vs 0.52) from 5 to 25 weeks of gestation. CONCLUSIONS Our study demonstrated the longitudinal measurement of maternal Lep/Cer (d18:1/25:0) ratio allows the non-invasive assessment of PE to identify pregnancy at high risk in early gestation, outperforming the established sFlt-1/PlGF ratio test.
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Affiliation(s)
| | - Shiying Hao
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Jin You
- Department of Bioengineering, University of California Riverside, Riverside, California, USA
| | | | - Zhen Li
- Department of Surgery, Stanford University, Stanford, California, USA
- Binhai Industrial Technology Research Institute, Zhejiang University, Tianjin, China
- School of Electrical Engineering, Southeast University, Nanjing, China
| | | | | | | | - Xin Zhou
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Lihong Mo
- Department of Obstetrics and Gynecology, University of California San Francisco, Fresno, California, USA
| | - Subhashini Ladella
- Department of Obstetrics and Gynecology, University of California San Francisco, Fresno, California, USA
| | | | - Hangyi Zhao
- Department of Mathematics, Stanford University, Stanford, California, USA
| | - David Fan
- Department of Statistics and Applied Probability, University of California Santa Barbara, Santa Barbara, California, USA
| | - John C Whitin
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Harvey J Cohen
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Karl G Sylvester
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Xuefeng B Ling
- Department of Surgery, Stanford University, Stanford, California, USA
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11
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Mulrenin IR, Garcia JE, Fashe MM, Loop MS, Daubert MA, Urrutia RP, Lee CR. The impact of pregnancy on antihypertensive drug metabolism and pharmacokinetics: current status and future directions. Expert Opin Drug Metab Toxicol 2021; 17:1261-1279. [PMID: 34739303 DOI: 10.1080/17425255.2021.2002845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDP) are rising in prevalence, and increase risk of adverse maternal and fetal outcomes. Physiologic changes occur during pregnancy that alter drug pharmacokinetics. However, antihypertensive drugs lack pregnancy-specific dosing recommendations due to critical knowledge gaps surrounding the extent of gestational changes in antihypertensive drug pharmacokinetics and underlying mechanisms. AREAS COVERED This review (1) summarizes currently recommended medications and dosing strategies for non-emergent HDP treatment, (2) reviews and synthesizes existing literature identified via a comprehensive Pubmed search evaluating gestational changes in the maternal pharmacokinetics of commonly prescribed HDP drugs (notably labetalol and nifedipine), and (3) offers insight into the metabolism and clearance mechanisms underlying altered HDP drug pharmacokinetics during pregnancy. Remaining knowledge gaps and future research directions are summarized. EXPERT OPINION A series of small pharmacokinetic studies illustrate higher oral clearance of labetalol and nifedipine during pregnancy. Pharmacokinetic modeling and preclinical studies suggest these effects are likely due to pregnancy-associated increases in hepatic UGT1A1- and CYP3A4-mediated first-pass metabolism and lower bioavailability. Accordingly, higher and/or more frequent doses may be needed to lower blood pressure during pregnancy. Future research is needed to address various evidence gaps and inform the development of more precise antihypertensive drug dosing strategies.
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Affiliation(s)
- Ian R Mulrenin
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Julian E Garcia
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Muluneh M Fashe
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew Shane Loop
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Melissa A Daubert
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Rachel Peragallo Urrutia
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Craig R Lee
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
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12
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Awe O, Sinkway JM, Chow RP, Wagener Q, Schulz EV, Yu JY, Nietert PJ, Wagner CL, Lee KH. Differential regulation of a placental SAM68 and sFLT1 gene pathway and the relevance to maternal vitamin D sufficiency. Pregnancy Hypertens 2020; 22:196-203. [PMID: 33068876 PMCID: PMC7688503 DOI: 10.1016/j.preghy.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/04/2020] [Accepted: 09/05/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The goal of this study was to determine if an axis of placental gene expression associated with early onset and severe preeclampsia (EOSPE) was operative in term pregnancy and correlated with vitamin D sufficiency. METHODS qPCR analysis of NKX2-5, SAM68, sFLT1 and membrane bound VEGFR1/FLT1 mRNA expression was conducted in placentas from 43 subjects enrolled in a vitamin D3 pregnancy supplementation trial. Pair-wise rank order correlations between patient-specific gene expression levels were calculated, and their relationship to maternal 25(OH)D status was assessed by a two-sample Wilcoxon test. Additionally, we probed the mechanistic link between SAM68 and sFLT1 using siRNA depletion in a human trophoblast cell line model. RESULTS Positive and highly significant correlations were found between SAM68 vs. sFLT1 and SAM68 vs. FLT1 expression levels, as were significant and differential correlations between the expression of these genes and perinatal 25(OH)D status. The variability when stratified by race/ethnicity was qualitatively distinct from those previously observed in EOSPE. Mechanistic studies confirmed a functional role for SAM68 protein in the regulation of sFLT1 expression. NKX2-5 expression was not significantly correlated with sFLT1 or SAM68 expression in these samples, suggesting that its expression may be significant at earlier stages of pregnancy or be restricted to pathological settings. CONCLUSIONS These data further support our overarching hypothesis that SAM68 expression is a key determinant of VEGFR1 isoform expression in the placenta, and provide additional insights into how this gene pathway may be differentially deployed or modified in normal and pathological pregnancies.
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Affiliation(s)
- Oyindamola Awe
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - James M Sinkway
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Rebecca P Chow
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Quentell Wagener
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Elizabeth V Schulz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Jeremy Y Yu
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Kyu-Ho Lee
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States; Regenerative Medicine and Cell Biology Department, Medical University of South Carolina, Charleston, SC 29425, United States; Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, United States.
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13
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Prior exposure to placental ischemia causes increased salt sensitivity of blood pressure via vasopressin production and secretion in postpartum rats. J Hypertens 2020; 37:1657-1667. [PMID: 30950978 DOI: 10.1097/hjh.0000000000002091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Women with a history of preeclampsia exhibit increased salt sensitivity of blood pressure at postpartum, which might be responsible for their increased risk of future cardiovascular diseases. However, it is unclear whether preeclampsia can cause increased salt sensitivity at postpartum. Vasopressin may play a role in the pathogenesis of preeclampsia and salt-sensitive hypertension. Therefore, the aim of this study was to determine whether the exposure to preeclampsia, as elicited by placental ischemia, causes increased salt sensitivity at postpartum, and if so, whether vasopressin is involved in its process. METHODS AND RESULTS We used a reduced uterine perfusion pressure (RUPP) rat model of preeclampsia. Pregnant Sprague-Dawley rats were categorized into the following two groups: RUPP-operated and sham-operated (SHAM) control groups. A 1-week-long high-salt diet was initiated at 3 weeks postpartum. The high-salt diet-induced increase in mean arterial pressure was significantly greater in the RUPP group than in the SHAM group. In addition, the plasma levels of copeptin, a substitute for plasma vasopressin, increased and serum osmolality decreased in the RUPP group. Double immunostaining revealed that the expression of c-Fos, a marker of neural activity, in vasopressin-producing neurons and presympathetic neurons in the hypothalamic paraventricular nucleus was significantly elevated in the RUPP group. The oral administration of conivaptan, the dual V1a/V2 vasopressin receptor antagonist, during high-salt diet abolished the enhanced increase in mean arterial pressure in RUPP rats. CONCLUSION Prior exposure to placental ischemia causes increased salt sensitivity of blood pressure at postpartum probably due to enhanced vasopressin production and secretion.
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Cao W, Dong M, Sun X, Liu X, Xiao J, Feng B, Zeng W, Hu J, Li X, Guo L, Wan D, Sun J, Ning D, Wang J, Chen D, Zhang Y, Du Q, Ma W, Liu T. Associations of maternal ozone exposures during pregnancy with maternal blood pressure and risk of hypertensive disorders of pregnancy: A birth cohort study in Guangzhou, China. ENVIRONMENTAL RESEARCH 2020; 183:109207. [PMID: 32050130 DOI: 10.1016/j.envres.2020.109207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/14/2020] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
Although studies have assessed the associations of maternal exposure to ozone (O3) during pregnancy with blood pressure and the risk of hypertensive disorders of pregnancy (HDP), the results were inconsistent. Furthermore, no studies have been conducted in China where the ambient O3 concentration continuedly increased. The present study aimed to estimate the effects of maternal exposure to O3 during pregnancy on the HDP risk, systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP). All participants of pregnant women were selected from the prospective birth cohort study on Prenatal Environments and Offspring Health conducted in Guangzhou, China. A spatiotemporal land-use-regression model was used to estimate individual monthly air pollution exposure from three months before pregnancy to childbirth date. Information on HDP, SBP, DBP and PP was obtained from maternal medical records. A Logistic regression model and a mixed linear model were used to estimate the associations of maternal exposure to O3 with the risk of HDP and blood pressure (SBP, DBP and PP), respectively. We found significant associations of maternal exposure to O3 during the third (OR = 1.31, 95%CI: 1.07, 1.60) and the second month (OR = 1.25, 95%CI: 1.02, 1.51) before pregnancy with the risk of HDP. Observed significantly positive associations of O3 exposures with SBP, DBP and PP during the two months before pregnancy and during the early pregnancy. The peak effects of O3 exposure on SBP, DBP and PP were respectively observed during the second month of pregnancy (β = 1.07 mmHg, 95%CI: 0.84, 1.31 mmHg), the first month before pregnancy (β = 0.40 mmHg, 95%CI: 0.21, 0.50 mmHg) and the second month of pregnancy (β = 0.78 mmHg, 95%CI: 0.59, 0.97 mmHg). Our results suggest that maternal exposure to O3 were positively associated with blood pressure and the risk of HDP, and the period from three months before pregnancy to the first trimester might be the critical exposure window.
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Affiliation(s)
- Wenjun Cao
- General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528200, China
| | - Moran Dong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xiaoli Sun
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Xin Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Baixiang Feng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Donghua Wan
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China; General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528200, China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Dan Ning
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Jiaqi Wang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Dengzhou Chen
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Yonghui Zhang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Qingfeng Du
- General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528200, China
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China; General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528200, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
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15
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Park YS, Kim Y, Kim HY, Ahn KH, Cho GJ, Hong SC, Oh MJ, Kim HJ. Serum sFlt-1, cystatin C and cathepsin B are potential severity markers in preeclampsia: a pilot study. Arch Gynecol Obstet 2020; 301:955-962. [PMID: 32140809 DOI: 10.1007/s00404-020-05478-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/25/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Preeclampsia is associated with abnormal invasion of the trophoblast through decidua and subsequently altered remodeling of the maternal spiral arteries and endothelial dysfunction. This phenomenon is explained by the dysregulation of various kinds of vascular factors and proteases. The purpose of this study was to compare the circulating levels of sFlt-1, cathepsin B, and cystatin C in preeclamptic and normotensive pregnancies. STUDY DESIGN Sixty-two pregnant women were enrolled in this prospective study. Twenty women were preeclamptic and 42 were normotensive. Serum levels of sFlt-1, cathepsin B, and cystatin C were measured using an enzyme-linked immunosorbent assay kit. RESULTS Circulating levels of sFlt-1, cathepsin B, and cystatin C were significantly higher in preeclamptic than in normotensive pregnant women (p < 0.001; p = 0.017; p = 0.003). Preeclamptic women with severe features demonstrated significantly higher levels of cathepsin B (p = 0.05). Serum sFlt-1 and cystatin C levels were positively correlated with elevated systolic and diastolic blood pressure. The levels of cathepsin B were positively correlated with alanine and aspartate aminotransferase. The amount of 24 h proteinuria was positively, but non-significantly correlated with sFlt-1 and cystatin C. CONCLUSIONS In addition to sFlt-1 levels, the serum levels of cathepsin B and cystatin C significantly change when preeclampsia develops. These markers are associated with severity markers of elevated blood pressure and liver injury in preeclampsia.
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Affiliation(s)
- Ye Sul Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yezi Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Ki-Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
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16
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Peripheral Blood Flow Intensity in Maternal Kidneys and Correlation with Blood Pressure. MATERNAL-FETAL MEDICINE 2020. [DOI: 10.1097/fm9.0000000000000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Enengl S, Mayer RB, Le Renard PE, Shebl O, Arzt W, Oppelt P. Retrospective evaluation of established cut-off values for the sFlt-1/PlGF ratio for predicting imminent delivery in preeclampsia patients. Pregnancy Hypertens 2020; 19:143-149. [DOI: 10.1016/j.preghy.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 10/25/2022]
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18
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Mogos MF, Jones LM, Robinson NS, Whitehead AO, Piscotty R, Goba GK. Prevalence, Correlates, and Outcomes of Co-Occurring Depression and Hypertensive Disorders of Pregnancy. J Womens Health (Larchmt) 2019; 28:1460-1467. [DOI: 10.1089/jwh.2018.7144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mulubrhan F. Mogos
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Lenette M. Jones
- Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, Michigan
| | - Nadia S. Robinson
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois
| | | | - Ronald Piscotty
- Department of Organizational Systems and Adult Health, University of Maryland Baltimore, Baltimore, Maryland
| | - Gelila K. Goba
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois
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Siddika N, Rantala AK, Antikainen H, Balogun H, Amegah AK, Ryti NRI, Kukkonen J, Sofiev M, Jaakkola MS, Jaakkola JJK. Synergistic effects of prenatal exposure to fine particulate matter (PM 2.5) and ozone (O 3) on the risk of preterm birth: A population-based cohort study. ENVIRONMENTAL RESEARCH 2019; 176:108549. [PMID: 31252204 DOI: 10.1016/j.envres.2019.108549] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is some evidence that prenatal exposure to low-level air pollution increases the risk of preterm birth (PTB), but little is known about synergistic effects of different pollutants. OBJECTIVES We assessed the independent and joint effects of prenatal exposure to air pollution during the entire duration of pregnancy. METHODS The study population consisted of the 2568 members of the Espoo Cohort Study, born between 1984 and 1990, and living in the City of Espoo, Finland. We assessed individual-level prenatal exposure to ambient air pollutants of interest at all the residential addresses from conception to birth. The pollutant concentrations were estimated both by using regional-to-city-scale dispersion modelling and land-use regression-based method. We applied Poisson regression analysis to estimate the adjusted risk ratios (RRs) with their 95% confidence intervals (CI) by comparing the risk of PTB among babies with the highest quartile (Q4) of exposure during the entire duration of pregnancy with those with the lower exposure quartiles (Q1-Q3). We adjusted for season of birth, maternal age, sex of the baby, family's socioeconomic status, maternal smoking during pregnancy, maternal exposure to environmental tobacco smoke during pregnancy, single parenthood, and exposure to other air pollutants (only in multi-pollutant models) in the analysis. RESULTS In a multi-pollutant model estimating the effects of exposure during entire pregnancy, the adjusted RR was 1.37 (95% CI: 0.85, 2.23) for PM2.5 and 1.64 (95% CI: 1.15, 2.35) for O3. The joint effect of PM2.5 and O3 was substantially higher, an adjusted RR of 3.63 (95% CI: 2.16, 6.10), than what would have been expected from their independent effects (0.99 for PM2.5 and 1.34 for O3). The relative risk due to interaction (RERI) was 2.30 (95% CI: 0.95, 4.57). DISCUSSION Our results strengthen the evidence that exposure to fairly low-level air pollution during pregnancy increases the risk of PTB. We provide novel observations indicating that individual air pollutants such as PM2.5 and O3 may act synergistically potentiating each other's adverse effects.
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Affiliation(s)
- Nazeeba Siddika
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland
| | - Aino K Rantala
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland
| | - Harri Antikainen
- Geography Research Unit, P.O. Box 3000, 90014, University of Oulu, Oulu, Finland
| | - Hamudat Balogun
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland
| | - A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University Post Office, University of Cape Coast, Cape Coast, Ghana
| | - Niilo R I Ryti
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland
| | - Jaakko Kukkonen
- Finnish Meteorological Institute, P.O. Box 503, FI-00101, Helsinki, Finland
| | - Mikhail Sofiev
- Finnish Meteorological Institute, P.O. Box 503, FI-00101, Helsinki, Finland
| | - Maritta S Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, P.O. Box 5000, FI-90014, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, P.O. Box 8000, FI-90014, University of Oulu, Oulu, Finland.
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Hooijschuur MCE, Ghossein-Doha C, Kroon AA, De Leeuw PW, Zandbergen AAM, Van Kuijk SMJ, Spaanderman MEA. Metabolic syndrome and pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:64-71. [PMID: 30246464 DOI: 10.1002/uog.20126] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 06/25/2018] [Accepted: 08/31/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the association between different pre-eclampsia (PE) phenotypes and the development of metabolic syndrome postpartum, in order to identify the subgroup of formerly pre-eclamptic women with a worse cardiovascular risk profile requiring tailored postpartum follow-up. METHODS This was a cohort study of 1102 formerly pre-eclamptic women in whom cardiovascular and cardiometabolic evaluation was performed at least 3 months postpartum. Women were divided into four subgroups based on PE resulting in delivery before 34 weeks (early-onset (EO)) or at or after 34 weeks (late onset (LO)) of gestation and whether they delivered a small-for-gestational-age (SGA) neonate. Metabolic syndrome was diagnosed as the presence of hyperinsulinemia along with two or more of: body mass index ≥ 30 kg/m2 ; dyslipidemia; hypertension; and microalbuminuria or proteinuria. Data were compared between groups using ANOVA after Bonferroni correction. Odds ratios (OR) were calculated using logistic regression to determine the association between metabolic syndrome and the four subgroups. We constructed receiver-operating characteristics curves and computed the area under the curve (AUC) to quantify the ability of different obstetric variables to distinguish between women who developed metabolic syndrome and those who did not. RESULTS The prevalence of metabolic syndrome was higher in women with EO-PE and SGA (25.8%) than in those with EO-PE without SGA (14.7%) (OR 2.01 (95% CI, 1.34-3.03)) and approximately five-fold higher than in women with LO-PE with SGA (5.6%) (OR 5.85 (95% CI, 2.60-13.10)). In women with LO-PE, the prevalence of metabolic syndrome did not differ significantly between women with and those without SGA. Multivariate analysis revealed that a history of SGA, a history of EO-PE and systolic blood pressure at the time of screening are the best predictors of developing metabolic syndrome postpartum. The AUC of the model combining these three variables was 74.6% (95% CI, 70.7-78.5%). The probability of the presence of metabolic syndrome was calculated as: P = 1/(1 + e-LP ), where LP is linear predictor = -8.693 + (0.312 × SGA (yes = 1)) + (0.507 × EO-PE (yes = 1)) + (0.053 × systolic blood pressure). CONCLUSIONS The incidence of metabolic syndrome postpartum was associated more strongly with EO-PE in combination with SGA as compared with LO-PE or EO-PE without SGA. Both time of onset of PE and fetal growth affect the risk of metabolic syndrome after a pre-eclamptic pregnancy. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M C E Hooijschuur
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC) and GROW, Maastricht, The Netherlands
| | - C Ghossein-Doha
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC) and GROW, Maastricht, The Netherlands
| | - A A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - P W De Leeuw
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - A A M Zandbergen
- Department of Internal Medicine, Erasmus Medical Centre (EMC), Rotterdam, The Netherlands
| | - S M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - M E A Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC) and GROW, Maastricht, The Netherlands
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Dong K, Zhang X, Ma L, Gao N, Tang H, Jian F, Ma Y. Downregulations of circulating miR-31 and miR-21 are associated with preeclampsia. Pregnancy Hypertens 2019; 17:59-63. [PMID: 31487658 DOI: 10.1016/j.preghy.2019.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/19/2019] [Accepted: 05/08/2019] [Indexed: 11/17/2022]
Abstract
MicroRNAs (miRNAs/miRs) are highly stable in circulating, which suppress target gene expression by base-pairing to the 3'-untranslated region. We compared the expressions of 3 circulating miRs (miR-31, miR-21, and miR-16), which are related to the control of cell apoptosis, invasion, angiogenesis and immune tolerance in non-pregnancy (n = 10), 20-34 gestational weeks normal pregnancy (20-34 GW NP, n = 20), early onset preeclampsia (EOPE, n = 20), 34-41 gestational weeks normal pregnancy (34-41 GW NP, n = 20) and late onset preeclampsia (LOPE, n = 20). Using quantitative RT-PCR, we found the levels of miR-31, miR-21 and miR-16 changed throughout different stages of pregnancy with the non-pregnancy as the calibrator. The plasma miR-31 levels were significantly down-regulated in EOPE rather than in LOPE when compared to gestational age matched normal pregnancy (P < 0.001). MiR-21 levels were significantly lower in LOPE compared to healthy controls (P < 0.001), while no significant difference was found between EOPE and 20-34 gestational weeks normal pregnancy (P = 0.376). The miR-16 expressions were at similar levels between preeclampsia (PE) and normal pregnancy. Receiver operating characteristic (ROC) curve analyses indicated the miR-31 differentiated EOPE patients from healthy controls with an area under the curve (AUC) of 0.875 with 95.0% sensitivity and 70.0% specificity. ROC curves also discriminated the LOPE patients from healthy pregnancy with an AUC of 0.793, 65.1% sensitivity and 90.3% specificity for plasma miR-21 levels. This study is the first to demonstrate the difference, and circulating miR-31 may serve as a diagnostic biomarker for early onset preeclampsia meanwhile miR-21 might be a diagnostic biomarker for late onset preeclampsia.
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Affiliation(s)
- Kun Dong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong Province, China; Department of Obstetrics, The Central Hospital of Zibo, Zibo, Shandong Province, China
| | - Xiangli Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
| | - Lijuan Ma
- Department of Obstetrics, Qianfo Mountain Hospital, Shandong University, Jinan, Shandong Province, China
| | - Na Gao
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
| | - Haiyang Tang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
| | - Feng Jian
- Department of Obstetrics, The Central Hospital of Zibo, Zibo, Shandong Province, China
| | - Yuyan Ma
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong Province, China.
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22
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Jabalie G, Ahmadi M, Koushaeian L, Eghbal‐Fard S, Mehdizadeh A, Kamrani A, Abdollahi‐Fard S, Farzadi L, Hojjat‐ Farsangi M, Nouri M, Yousefi M. Metabolic syndrome mediates proinflammatory responses of inflammatory cells in preeclampsia. Am J Reprod Immunol 2019; 81:e13086. [DOI: 10.1111/aji.13086] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/17/2018] [Accepted: 12/28/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Gisoo Jabalie
- Stem Cell Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Majid Ahmadi
- Student’s Research CommitteeTabriz University of Medical Sciences Tabriz Iran
- Reproductive Biology Department Tabriz University of Medical Sciences Tabriz Iran
| | - Ladan Koushaeian
- Stem Cell Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Shadi Eghbal‐Fard
- Stem Cell Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Amir Mehdizadeh
- Endocrine Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Amin Kamrani
- Stem Cell Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Sedigheh Abdollahi‐Fard
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences Tabriz Iran
| | - Laya Farzadi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences Tabriz Iran
| | - Mohammad Hojjat‐ Farsangi
- Department of Oncology‐Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK)Karolinska University Hospital Solna and Karolinska Institute Stockholm Sweden
| | - Mohammad Nouri
- Reproductive Biology Department Tabriz University of Medical Sciences Tabriz Iran
| | - Mehdi Yousefi
- Drug Applied Research CenterTabriz University of Medical Sciences Tabriz Iran
- Aging Research Institute Tabriz University of Medical Sciences Tabriz Iran
- Department of Immunology Tabriz University of Medical Sciences Tabriz Iran
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Abstract
PURPOSE Hypertensive disorders of pregnancy are increasing in prevalence and associated with significant maternal and perinatal morbidity and mortality. RECENT FINDINGS Increased emphasis has been placed recently on the use of out-of-office (i.e., home and ambulatory) blood pressure (BP) monitoring to diagnose and manage hypertension in the general population. Current guidelines offer limited recommendations on the use of out-of-office BP monitoring during pregnancy and postpartum. This review will discuss the recent literature on BP measurement outside of the office and its use for screening, diagnosis, and treatment in pregnancy and postpartum, and will illuminate areas for future research.
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Teimoori B, Moradi‐Shahrebabak M, Rezaei M, Mohammadpour‐Gharehbagh A, Salimi S. Renalase rs10887800 polymorphism is associated with severe pre‐eclampsia in southeast Iranian women. J Cell Biochem 2018; 120:3277-3285. [DOI: 10.1002/jcb.27595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/08/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Batool Teimoori
- Department of Obstetrics and Gynecology School of Medicine Zahedan University of Medical Sciences Zahedan Iran
| | - Maryam Moradi‐Shahrebabak
- Department of Obstetrics and Gynecology School of Medicine Zahedan University of Medical Sciences Zahedan Iran
| | - Mahnaz Rezaei
- Department of Clinical Biochemistry School of Medicine Zahedan University of Medical Sciences Zahedan Iran
- Cellular and Molecular Research Center Zahedan University of Medical Sciences Zahedan Iran
| | - Abbas Mohammadpour‐Gharehbagh
- Department of Clinical Biochemistry School of Medicine Zahedan University of Medical Sciences Zahedan Iran
- Cellular and Molecular Research Center Zahedan University of Medical Sciences Zahedan Iran
| | - Saeedeh Salimi
- Department of Clinical Biochemistry School of Medicine Zahedan University of Medical Sciences Zahedan Iran
- Cellular and Molecular Research Center Zahedan University of Medical Sciences Zahedan Iran
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Liu S, Wang F, Liu G. Knockdown of pleiotrophin increases the risk of preeclampsia following vitrified-thawed embryo transfer. Int J Oncol 2018; 53:1847-1856. [PMID: 30226583 PMCID: PMC6192765 DOI: 10.3892/ijo.2018.4540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/02/2018] [Indexed: 11/06/2022] Open
Abstract
Preeclampsia (PE) in pregnancy is associated with vitrified-thawed embryo transfer. Pleiotrophin (PTN) is important in inflammation via its receptors. The aim of the present study was to determine the effect of PTN on the risk of PE following embryo transfer. An enzyme-linked immunosorbent assay was performed to determine the levels of tumor necrosis factor (TNF)-α and PTN in serum. The knockdown of PTN was conditionally induced by tamoxifen (tax) treatment. The tail-cuff method and Bradford assay were used to monitor blood pressure and the level of urine protein, respectively. The expression patterns of PTN, receptor protein tyrosine phosphatase β/ζ, (RPTPβ/ζ), syndecan-1 (SDC1), syndecan-3 (SDC3) and anaplastic lymphoma kinase (ALK) were determined by immunohistochemistry (IHC). Western blot analysis was performed to evaluate the expression level of PTN and its receptors. The risk of PE was elevated following embryo transfer in clinical and in the tax/PTN-/- group. It was found that the level of PTN increased when pregnancy progressed in normal conditions, however, the level of PTN was reduced in the PE mice. In addition, increases in TNF-α, blood pressure and urine protein were more marked in the PE mice that lacked PTN, compared with those in other PE mice. In addition, overlapping expression of PTN and its receptors in villous mesenchyme and fetal macrophages were identified using an IHC assay. However, the positive staining of PTN and its receptors was weaker or even absent in the PE mice. The protein level of RPTPβ/ζ was lower in the PE mice that lacked PTN than that in the other PE mice. The knockdown of PTN increased the risk of PE following vitrified-thawed embryo transfer, in which its receptors, particularly RPTPβ/ζ, may be involved.
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Affiliation(s)
- Shengxian Liu
- Reproductive Medicine Center, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471000, P.R. China
| | - Fang Wang
- Reproductive Medicine Center, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471000, P.R. China
| | - Gelin Liu
- Reproductive Medicine Center, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471000, P.R. China
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26
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Karemore MN, Avari JG. Zeta potential as a novel diagnostic tool for preeclampsia. Pregnancy Hypertens 2018; 13:187-197. [DOI: 10.1016/j.preghy.2018.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/10/2018] [Accepted: 06/22/2018] [Indexed: 11/28/2022]
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27
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Zhu FQ, Hu J, Lv FH, Cheng P, Gao S. Effects of oligomeric grape seed proanthocyanidins on L-NAME-induced hypertension in pregnant mice: Role of oxidative stress and endothelial dysfunction. Phytother Res 2018; 32:1836-1847. [PMID: 29851183 DOI: 10.1002/ptr.6119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 01/26/2023]
Abstract
The aim of this study was to investigate the effects of Grape Seed Proanthocyanidins (GSP) on Nω-Nitro-L-arginine methyl ester-induced hypertension in pregnant mice. Fifty Kunming mice were randomized into control, control + GSP, model, and model + GSP. Three weeks later, the artery systolic blood pressure was examined and the related pathological changes were detected. Aorta relaxation function was assessed by aorta ring apparatus. Blood urea nitrogen and serum creatinine were measured by an automatic biochemistry analyzer. Colorimetric analysis, enzyme-linked immunosorbent assay, immunofluorescence, and western blot were applied to detect related indicator in serum, cardiac, and kidney tissues. The results showed that GSP treatment for 3 weeks could improve cardiovascular and kidney remodeling indexes and decrease blood urea nitrogen and serum creatinine content in serum, as well as could ameliorate oxidative stress status and endothelial dysfunction. Therefore, it is for the first time found that GSP exerts protective effect against Nω-Nitro-L-arginine methyl ester-induced hypertension in pregnant mice, which provided a theoretical basis for potential application in the clinic.
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Affiliation(s)
- Feng-Qin Zhu
- Dept of Obstetrics and Gynecology, the Second Peoples Hospital of Hefei, Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011, China
| | - Juan Hu
- Department of Pharmacology, Basic Medical College, Anhui Medical University, Hefei, 230032, China
| | - Fa-Hui Lv
- Dept of Obstetrics and Gynecology, the Second Peoples Hospital of Hefei, Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011, China
| | - Pan Cheng
- Department of Pharmacology, Basic Medical College, Anhui Medical University, Hefei, 230032, China
| | - Shan Gao
- Department of Pharmacology, Basic Medical College, Anhui Medical University, Hefei, 230032, China
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28
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Rivera-Romero O, Olmo A, Muñoz R, Stiefel P, Miranda ML, Beltrán LM. Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review. JMIR Mhealth Uhealth 2018; 6:e130. [PMID: 29848473 PMCID: PMC6000483 DOI: 10.2196/mhealth.9671] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 02/07/2023] Open
Abstract
Background Hypertensive disorders are the most common complications during pregnancy, occurring in 5% to 11% of pregnancies; gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality, especially in low- and middle-income countries (LMIC) where maternal and perinatal mortality ratios are still high. Pregnant women with hypertensive disorders could greatly benefit from mobile health (mHealth) solutions as a novel way to identify and control early symptoms, as shown in an increasing number of publications in the field. Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource-poor environments. Objective The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy, with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice. Methods A methodological review following a scoping methodology was conducted. Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included, categorizing articles in different groups: Diagnosis and Monitoring, mHealth Decision Support System, Education, and Health Promotion, and seven research questions were posed to study the manuscripts. Results The search in electronic research databases yielded 327 articles. After removing duplicates, 230 articles were selected for screening. Finally, 11 articles met the inclusion criteria, and data were extracted from them. Very positive results in the improvement of maternal health and acceptability of solutions were found, although most of the studies involved a small number of participants, and none were complete clinical studies. Accordingly, none of the reported prototypes were integrated in the different health care systems. Only 4 studies used sensors for physiological measurements, and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension. The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget, of special relevance in LMIC, although again, no extensive clinical validation has been carried out in these environments. Conclusions mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice. Although very positive results have been reported in terms of usability and the improvement of maternal health, rigorous complete clinical trials are still necessary to support integration in health care systems. There is a clear need for simple mHealth solutions specifically developed for resource-poor environments that meet the United Nations Sustainable Development Goal (SDG); of enormous interest in LMIC.
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Affiliation(s)
| | - Alberto Olmo
- Department of Electronic Technology, Universidad de Sevilla, Sevilla, Spain
| | - Rocío Muñoz
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain
| | - Pablo Stiefel
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - María Luisa Miranda
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luis M Beltrán
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
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29
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Zakiyah N, ter Heijne LF, Bos JH, Hak E, Postma MJ, Schuiling-Veninga CCM. Antidepressant use during pregnancy and the risk of developing gestational hypertension: a retrospective cohort study. BMC Pregnancy Childbirth 2018; 18:187. [PMID: 29843629 PMCID: PMC5975401 DOI: 10.1186/s12884-018-1825-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prior studies reported that exposure to antidepressants during pregnancy may be associated with gestational hypertension. The aim of this study is to assess the association between the use of antidepressants during pregnancy and the risk of developing gestational hypertension. METHODS A retrospective cohort study using the prescription database IADB.nl was conducted among nulliparous women with singleton pregnancies between 1994 and 2015 in the Netherlands. Logistic regression analysis was used to estimate odds ratios (OR), adjusted OR (aOR) and their corresponding 95% confidence intervals (95% CI). Gestational hypertension as main outcome measure was defined as at least one dispensed record of an antihypertensive drug (methyldopa, nifedipine, labetalol, ketanserin, nicardipine) after 20 weeks of gestation until 14 days after delivery. Sub-analyses were conducted for class of antidepressant, duration and amount of use of antidepressant (≤30, ≥30 Defined Daily Doses or DDDs), and maternal age. Sensitivity analyses to assess uncertainties were conducted. RESULTS Twenty-eight thousand twenty women were included, of which 539 (1.92%) used antidepressants. The risk of gestational hypertension was doubled for women using antidepressant (aOR 2.00 95% CI 1.28-3.13). Significant associations were also found for the subgroup selective serotonin reuptake inhibitors (SSRIs) (aOR 2.07 95% CI 1.25-3.44), ≥30 DDDs (aOR 2.50 95% CI 1.55-3.99) and maternal age of 30-34 years (aOR 2.59 95% CI 1.35-4.98). Varying the theoretical gestational age showed comparable results. CONCLUSION Prolonged use of antidepressants during the first 20 weeks of gestation appeared to be associated with an increased risk of developing gestational hypertension. When balancing the benefits and risks of using these drugs during pregnancy, this should be taken into account.
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Affiliation(s)
- Neily Zakiyah
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Loes F. ter Heijne
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Jens H. Bos
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Maarten J. Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Catharina C. M. Schuiling-Veninga
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Bolnick AD, Bolnick JM, Kohan-Ghadr HR, Kilburn BA, Pasalodos OJ, Singhal PK, Dai J, Diamond MP, Armant DR, Drewlo S. Enhancement of trophoblast differentiation and survival by low molecular weight heparin requires heparin-binding EGF-like growth factor. Hum Reprod 2018; 32:1218-1229. [PMID: 28402449 DOI: 10.1093/humrep/dex069] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION Does low molecular weight heparin (LMWH) require heparin-binding epidermal growth factor (EGF)-like growth factor (HBEGF) signaling to induce extravillous trophoblast differentiation and decrease apoptosis during oxidative stress? SUMMARY ANSWER LMWH increased HBEGF expression and secretion, and HBEGF signaling was required to stimulate trophoblast extravillous differentiation, increase invasion in vitro and reduce trophoblast apoptosis during oxidative stress. WHAT IS KNOWN ALREADY Abnormal trophoblast differentiation and survival contribute to placental insufficiency syndromes, including preeclampsia and intrauterine growth restriction. Preeclampsia often manifests as a pro-thrombotic state, with unsuccessful transformation of the spiral arteries that reduces oxygen supply and can produce placental infarction. LMWH improves placental function by increasing blood flow. Recent data suggest that the actions of LMWH transcend its anti-coagulative properties, but the molecular mechanism is unknown. There is evidence that LMWH alters the expression of human HBEGF in trophoblast cells, which regulates human trophoblast pathophysiology. HBEGF, itself, is capable of increasing trophoblast survival and invasiveness. STUDY DESIGN, SIZE, DURATION First-trimester placental explants and the HTR-8/SVneo cell line, established using extravillous trophoblast outgrowths from first-trimester villous explants, were treated in vitro with LMWH to examine the effects on HBEGF signaling and trophoblast function under normal physiological and pathological conditions. A highly specific antagonist of HBEGF and other inhibitors of HBEGF downstream signaling were used to determine the relationship between LMWH treatment and HBEGF. PARTICIPANTS/MATERIALS, SETTING, METHODS Placental tissues (n = 5) were obtained with IRB approval and patient consent from first-trimester terminations. Placental explants and HTR-8/SVneo cells were cultured on plastic or Matrigel™ and treated with a therapeutic dose of LMWH (Enoxaparin; 10 IU/ml), with or without CRM197, pan Erb-B2 Receptor Tyrosine Kinase (ERBB) inhibitor, anti-ERBB1 or ERBB4 blocking antibodies, or pretreatment of cells with heparitinase I. Extravillous differentiation was assessed by immunocytochemistry to determine the relative levels of integrins α6β4 and α1β1. Trophoblast invasiveness was assessed in villous explants by measuring outgrowth from villous tips cultured on Matrigel, and by invasion assays with HTR-8/SVneo cells cultured on Matrigel-coated transwell insert. Placental explants and HTR-8/SVneo cells were exposed to oxidative stress in a hypoxia-reoxygenation (H-R) model, measuring cell death by TUNEL assay, caspase 3 cleavage, and BCL-2α expression. MAIN RESULTS AND THE ROLE OF CHANCE LMWH induced extravillous differentiation, according to trophoblast invasion assays and integrin (α6β4-α1β1) switching. Treatment with LMWH rescued cytotrophoblasts and HTR-8/SVneo cells from apoptosis during exposure to reoxygenation injury, based on TUNEL, caspase 3 cleavage and BCL-2α expression. Experiments using CRM197, ERBB1 and ERBB4 blocking antibodies, pan-ERBB inhibitor and removal of cell surface heparin demonstrated that the effects of LMWH on trophoblast invasion and survival were dependent upon HBEGF signaling. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION The primary limitation of this study was the use of only in vitro experiments. Patient demographics from elective terminations were not available. WIDER IMPLICATIONS OF THE FINDINGS These data provide new insights into the non-coagulation-related aspects of perinatal LMWH treatment in the management of placental insufficiency disorders. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by grants from the National Institutes of Health (HD071408 and HL128628), the March of Dimes, and the W. K. Kellogg Foundation. There were no conflicts or competing interests.
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Affiliation(s)
- Alan D Bolnick
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Jay M Bolnick
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | | | - Brian A Kilburn
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Omar J Pasalodos
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Pankaj K Singhal
- Department of Obstetrics and Gynecology, Good Samaritan Hospital Medical Center, West Islip, NY, USA
| | - Jing Dai
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
| | - D Randall Armant
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.,Department of Anatomy and Cell Biology, Wayne State University, Detroit, MI, USA
| | - Sascha Drewlo
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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Johnson P, Montgomery M, Ewell P. Elevated Blood Pressure in Low-Income, Rural Preschool Children is Associated with Maternal Hypertension during Pregnancy. J Community Health Nurs 2018; 35:12-18. [PMID: 29323940 DOI: 10.1080/07370016.2018.1404830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hypertension (HTN) is a significant public health problem in adults, and rates of HTN are rising in children as well. The purpose of this study was to determine blood pressure (BP) and body mass index (BMI) levels in low-income, rural preschool children and investigate the relationship between child and maternal factors that impact BP and BMI in these children. Results indicated high rates of overweight/obesity and elevated BP levels in this sample. Maternal hypertension during pregnancy also emerged as a predictor of elevated BP in their children.
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Affiliation(s)
- Paige Johnson
- a Capstone College of Nursing , The University of Alabama , Tuscaloosa , Alabama
| | - Michele Montgomery
- a Capstone College of Nursing , The University of Alabama , Tuscaloosa , Alabama
| | - Patrick Ewell
- b Department of Psychology, Kenyon College, Gambier, Ohio
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Bello NA, Woolley JJ, Cleary KL, Falzon L, Alpert BS, Oparil S, Cutter G, Wapner R, Muntner P, Tita AT, Shimbo D. Accuracy of Blood Pressure Measurement Devices in Pregnancy: A Systematic Review of Validation Studies. Hypertension 2017; 71:326-335. [PMID: 29229741 DOI: 10.1161/hypertensionaha.117.10295] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/03/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022]
Abstract
The accurate measurement of blood pressure (BP) in pregnancy is essential to guide medical decision making that affects both mother and fetus. The aim of this systematic review was to determine the accuracy of ambulatory, home, and clinic BP measurement devices in pregnant women. We searched Ovid MEDLINE, The Cochrane Library, EMBASE, CINAHL EBSCO, ClinicalTrials.gov, International Clinical Trials Registry Platform, and dabl from inception through August 3, 2017 for articles that assessed the validity of an upper arm BP measurement device against a mercury sphygmomanometer in pregnant women. Two independent investigators determined eligibility, extracted data, and adjudicated protocol violations. From 1798 potential articles identified, 41, that assessed 28 devices, met the inclusion criteria. Most articles (n=32) followed a standard or modified American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization, British Hypertension Society, or European Society of Hypertension validation protocol. Several articles described the results of validation studies performed on >1 device (n=7) or in >1 population of pregnant women (n=12), comprising 64 pairwise validity assessments. The device was validated in 61% (32 of 52) of studies which used a standard or modified protocol. Only 34% (11 of 32) of the studies wherein the device was successfully validated were performed without a protocol violation. Given the implications of inaccurate BP measurement in pregnant women, healthcare providers should be aware of and try to use the BP measurement devices which have been properly validated in this population.
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Affiliation(s)
- Natalie A Bello
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham.
| | - Jonathan J Woolley
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Kirsten Lawrence Cleary
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Louise Falzon
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Bruce S Alpert
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Suzanne Oparil
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Gary Cutter
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Ronald Wapner
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Paul Muntner
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Alan T Tita
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Daichi Shimbo
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
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Pregnancy in women with corrected aortic coarctation: Uteroplacental Doppler flow and pregnancy outcome. Int J Cardiol 2017; 249:145-150. [DOI: 10.1016/j.ijcard.2017.09.167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/07/2017] [Accepted: 09/18/2017] [Indexed: 11/24/2022]
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Timofeeva AV, Gusar VA, Kan NE, Prozorovskaya KN, Karapetyan AO, Bayev OR, Chagovets VV, Kliver SF, Iakovishina DY, Frankevich VE, Sukhikh GT. Identification of potential early biomarkers of preeclampsia. Placenta 2017; 61:61-71. [PMID: 29277273 DOI: 10.1016/j.placenta.2017.11.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION It is thought that poor placental perfusion caused by inadequate remodelling of the maternal spiral arteries leads to preeclampsia (PE). To identify novel signalling pathways that contribute to PE pathogenesis and to create prerequisites for the non-invasive diagnosis of PE before clinical manifestations of the disease, this study aimed to evaluate miRNA expression levels in the placenta and blood plasma of pregnant women. METHODS miRNA deep sequencing followed by real-time quantitative RT-PCR was applied to compare miRNA expression profiles in the placenta and blood plasma from women with early- and late-onset PE relative to the control group. RESULTS A more than two-fold decrease in miR-532-5p, -423-5p, -127-3p, -539-5p, -519a-3p, and -629-5p and let-7c-5p expression levels was observed in the placenta, while a more than two-fold increase in miR-423-5p, 519a-3p, and -629-5p and let-7c-5p was observed in the blood plasma of pregnant women with PE. The above-listed miRNAs are associated with PE for the first time in this study, except for miR-519a-3p, whose role in PE has already been postulated. Using a logistic regression, plasma samples were classified into the early-onset PE group (probability p = 0.01, 80% specificity, 87.5% sensitivity and 87.5% precision) and showed increased miR-423-5p expression levels that were confirmed by the 9.8-fold up-regulation (р = 0.0002498) of miR-423-5p expression observed in the blood plasma at 11-13 GW by RT-PCR in a group of pregnant women manifesting severe PE clinical signs at 28-33 GW. CONCLUSIONS miR-423-5p may be considered a potential candidate for the early diagnosis of PE during the targeted management of high-risk pregnancies.
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Affiliation(s)
- Angelika V Timofeeva
- Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology", Ministry of Healthcare of the Russian Federation, Oparin Street, 4, Moscow, 117997, Russia.
| | - Vladyslava A Gusar
- Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology", Ministry of Healthcare of the Russian Federation, Oparin Street, 4, Moscow, 117997, Russia
| | - Nataliya E Kan
- Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology", Ministry of Healthcare of the Russian Federation, Oparin Street, 4, Moscow, 117997, Russia
| | - Kseniya N Prozorovskaya
- Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology", Ministry of Healthcare of the Russian Federation, Oparin Street, 4, Moscow, 117997, Russia
| | - Anna O Karapetyan
- Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology", Ministry of Healthcare of the Russian Federation, Oparin Street, 4, Moscow, 117997, Russia
| | - Oleg R Bayev
- Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology", Ministry of Healthcare of the Russian Federation, Oparin Street, 4, Moscow, 117997, Russia
| | - Vitaliy V Chagovets
- Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology", Ministry of Healthcare of the Russian Federation, Oparin Street, 4, Moscow, 117997, Russia
| | - Sergei F Kliver
- Theodosius Dobzhansky Center for Genome Bioinformatics, Saint Petersburg State University, 41A Sredniy Avenue, St. Petersburg, 199004, Russia; Ksivalue LLC, Russia
| | | | - Vladimir E Frankevich
- Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology", Ministry of Healthcare of the Russian Federation, Oparin Street, 4, Moscow, 117997, Russia
| | - Gennadiy T Sukhikh
- Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology", Ministry of Healthcare of the Russian Federation, Oparin Street, 4, Moscow, 117997, Russia
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Namlı Kalem M, Kalem Z, Yüce T, Soylemez F. ADAMTS 1, 4, 12, and 13 levels in maternal blood, cord blood, and placenta in preeclampsia. Hypertens Pregnancy 2017; 37:9-17. [PMID: 29135310 DOI: 10.1080/10641955.2017.1397690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this study is to compare ADAMTS (A Disintegrin and Metalloprotease Domains with Thrombospondins motifs) 1, 4, 12, and 13 levels in maternal and cord blood and placental tissue between preeclampsia and uncomplicated pregnancies. The enzyme-linked immunosorbent assay (ELISA) results showed that ADAMTS 1, 4, 12, and 13 levels in the maternal and cord blood were lower in the preeclampsia group than in the control group. Based on the immunohistochemistry (IHC) results, ADAMTS 1, 4, and 12 levels in placental tissues were higher in the preeclampsia group. According to the polymerase chain reaction (PCR) results, ADAMTS 1, 4, and 12 were higher, whereas ADAMTS 13 was lower in the preeclampsia group than in the control group.
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Affiliation(s)
| | - Ziya Kalem
- b Gurgan Clinic IVF and Women Health Center , Ankara , Turkey
| | - Tuncay Yüce
- c Ankara Universitesi, Obstetrics and Gynecology , Ankara , Turkey
| | - Feride Soylemez
- c Ankara Universitesi, Obstetrics and Gynecology , Ankara , Turkey
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36
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Daly AL, Sriram N, Woodall C, Selvakumar K, Briggs K, Garg P, Russell L, Yu M, Beetson K, Hennessy A. Risk factors associated with hypertensive disorders of pregnancy within an urban indigenous population in south western Sydney. Intern Med J 2017; 48:269-275. [PMID: 29083111 DOI: 10.1111/imj.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/24/2017] [Accepted: 10/20/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of hypertensive disorders of pregnancy (HDP) in Australia's urban indigenous women is unknown. AIM To explore the risk factors associated with HDP for a cohort of urban indigenous women in South-Western Sydney, Australia. METHODS This study was conducted in partnership with the Tharawal Aboriginal Medical Service. Women (18-45 years) were recruited at the clinic and community events. The quantitative questionnaire included obstetric history, personal and family history of hypertension. Anthropometric measurements and blood pressure were conducted. Rates were compared with Australian Bureau of Statistics (ABS) national rates. RESULTS Eighty-three participants completed the questionnaire. The rate of ever having HDP in a pregnancy was 36.1%. The overall ABS rate was 9.8% and for indigenous women, 14%. The mean maternal age at first pregnancy was 20.8 years (SD 3.7 years). The mean body mass index (BMI) of the sample population (n = 81) was 32.2 kg/m2 (SD 9.5 kg/m2 ) and BMI was not related to HDP (P = 0.197). Of those questioned, 25.3% had an individual history and 63.9% had a family history of hypertension. The effect of family history of hypertension (P = 0.020) (odds ratio (OR) 4.29; 95% confidence interval (CI); 1.42-12.93) and individual history of hypertension (P < 0.001) (OR 15.69; 95% CI; 4.50-54.76) were associated with HDP. CONCLUSION There was a higher rate of HDP in urban indigenous women compared to the national indigenous prevalence. The family history, or individual history of hypertension was the most significant risk factors and BMI was not identified as a risk factor for HDP in this population.
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Affiliation(s)
- Amy L Daly
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Nina Sriram
- Westmead Hospital, Sydney, New South Wales, Australia
| | | | | | - Kelly Briggs
- Tharawal AMS, Sydney, New South Wales, Australia
| | - Parul Garg
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Lisa Russell
- Tharawal AMS, Sydney, New South Wales, Australia
| | - Michelle Yu
- Nepean Hospital, Sydney, New South Wales, Australia
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- Tharawal Cooperation, Sydney, New South Wales, Australia
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Xu K, Bian D, Hao L, Huang F, Xu M, Qin J, Liu Y. microRNA-503 contribute to pancreatic beta cell dysfunction by targeting the mTOR pathway in gestational diabetes mellitus. EXCLI JOURNAL 2017; 16:1177-1187. [PMID: 29285014 PMCID: PMC5735340 DOI: 10.17179/excli2017-738] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/10/2017] [Indexed: 12/28/2022]
Abstract
Loss of pancreatic β cells is involved in pathogenesis of gestational diabetes mellitus (GDM). Recently, several studies have elucidated the connection between microRNAs (miRNAs) and diabetes mellitus (DM), but the role of miRNAs in GDM remains unclear. The aim of this study was to evaluate the potential functions of miRNAs in GDM and to investigate the underlying mechanisms of action. First, we explored the expression profile of miRNAs in placenta tissue from GDM patients using microarray. Validation analysis was performed in peripheral blood specimens using quantitative reverse transcription PCR (qRT-PCR). Then the role and regulating mechanism of miR-503 in weaken the function of pancreatic β cell was investigated. We found that miR-503 was markedly upregulated in placenta tissue from GDM patients, as elevated in peripheral blood specimens, and the high level was positively correlated to blood glucose concentration. Knockdown of miR-503 enhanced insulin secretion of pancreatic β-cells, promoted cell proliferation and protected cells from apoptosis, whereas overexpression of miR-503 showed the opposite effects. Furthermore, mammalian target of rapamycin (mTOR) was identified as a direct target of miR-503 and mTOR silencing could reverse the improving effects of miR-503 knockdown on insulin secretion and pancreatic β-cells proliferation. High expression of miR-503 in peripheral blood may be acted as a diagnosis biomarker of GDM. MiR-503 regulated functions of pancreatic β-cells by targeting the mTOR pathway, suggesting that targeting miR-503/mTOR axis could serve as a novel therapeutic target for GDM.
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Affiliation(s)
- Ke Xu
- Department of Endocrinology, Yancheng First City Hospital of Jiangsu Province, Yancheng, China
| | - Dezhi Bian
- Department of Endocrinology, Yancheng First City Hospital of Jiangsu Province, Yancheng, China
| | - Lanxiang Hao
- Department of Endocrinology, Yancheng First City Hospital of Jiangsu Province, Yancheng, China
| | - Fei Huang
- Department of Endocrinology, Yancheng First City Hospital of Jiangsu Province, Yancheng, China
| | - Min Xu
- Department of Obstetrics and Gynecology, Yancheng First City Hospital of Jiangsu Province, Yancheng, China
| | - Jie Qin
- Department of Pediatrics, Yancheng First City Hospital of Jiangsu Province, Yancheng, China
| | - Yanmei Liu
- Department of Endocrinology, Yancheng First City Hospital of Jiangsu Province, Yancheng, China
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Chasan-Taber L, Silveira M, Waring ME, Pekow P, Braun B, Manson JE, Solomon CG, Markenson G. Gestational Weight Gain, Body Mass Index, and Risk of Hypertensive Disorders of Pregnancy in a Predominantly Puerto Rican Population. Matern Child Health J 2017; 20:1804-13. [PMID: 27003150 DOI: 10.1007/s10995-016-1983-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objectives To prospectively evaluate the association between gestational weight gain (GWG), prepregnancy body mass index (BMI), and hypertensive disorders of pregnancy using the revised Institute of Medicine (IOM) Guidelines. Methods We examined these associations among 1359 participants in Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011 among women from the Caribbean Islands. Information on prepregnancy BMI, GWG, and incident diagnoses of hypertension in pregnancy were based on medical record abstraction. Results Four percent (n = 54) of women were diagnosed with hypertension in pregnancy, including 2.6 % (n = 36) with preeclampsia. As compared to women who gained within IOM GWG guidelines (22.8 %), those who gained above guidelines (52.5 %) had an odds ratio of 3.82 for hypertensive disorders (95 % CI 1.46-10.00; ptrend = 0.003) and an odds ratio of 2.94 for preeclampsia (95 % CI 1.00-8.71, ptrend = 0.03) after adjusting for important risk factors. Each one standard deviation (0.45 lbs/week) increase in rate of GWG was associated with a 1.74 odds of total hypertensive disorders (95 % CI 1.34-2.27) and 1.86 odds of preeclampsia (95 % CI 1.37-2.52). Conclusions for Practice Findings from this prospective study suggest that excessive GWG is associated with hypertension in pregnancy and could be a potentially modifiable risk factor in this high-risk ethnic group.
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Affiliation(s)
- Lisa Chasan-Taber
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, 405 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003-9304, USA.
| | - Marushka Silveira
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, 405 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003-9304, USA
| | - Molly E Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Penelope Pekow
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, 405 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003-9304, USA
| | - Barry Braun
- Department of Kinesiology, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - JoAnn E Manson
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Caren G Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Physical Activity During Pregnancy and Subsequent Risk of Preeclampsia and Gestational Hypertension: A Case Control Study. Matern Child Health J 2017; 20:1193-202. [PMID: 26910608 DOI: 10.1007/s10995-016-1919-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Physical activity (PA) is hypothesized to reduce the risk of preeclampsia, but few epidemiologic studies have simultaneously evaluated leisure time PA (LTPA), sedentary activity, occupational activity, and non-occupational, non-leisure time PA. Thus, we assessed the independent and combined effects of these different types of PA during pregnancy on preeclampsia and gestational hypertension risk. METHODS Preeclamptic (n = 258), gestational hypertensive (n = 233), and normotensive (n = 182) women identified from Iowa live birth records (2002-2005) were participants in Study of Pregnancy Hypertension in Iowa. Disease status was verified by medical chart review. All PA exposures were self-reported. Multinomial logistic regression was used to test for associations between various PA types and risk for preeclampsia or gestational hypertension. RESULTS After adjusting for prepregnancy BMI, increasing levels of LTPA were associated with a reduced risk of preeclampsia (trend, p = 0.02). Additionally, increasing amount of time spent active each day was associated with decreasing risks for preeclampsia (adjusted, trend; p = 0.03). Increasing amount of time spent sitting per day was associated with an increasing risk of preeclampsia (adjusted, trend; p = 0.10). Women whose activity averaged >8.25 h per day were at a significantly reduced risk of preeclampsia relative to women active <4.2 h per day (adjusted OR 0.58, 95 % CI 0.36, 0.95). Most analyses evaluating the risk of gestational hypertension yielded null results or results that trended in the direction opposite of the preeclampsia results. CONCLUSION Consistent with previous studies, these data suggest increasing PA during pregnancy may reduce preeclampsia risk while increasing levels of sedentary activity may increase disease risk.
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Nguyen CL, Nguyen PTH, Chu TK, Ha AVV, Pham NM, Duong DV, Do DV, Tang HK, Binns CW, Lee AH. Cohort profile: maternal lifestyle and diet in relation to pregnancy, postpartum and infant health outcomes in Vietnam: A multicentre prospective cohort study. BMJ Open 2017; 7:e016794. [PMID: 28877946 PMCID: PMC5589024 DOI: 10.1136/bmjopen-2017-016794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To determine modifiable maternal risk factors for adverse pregnancy, postpartum maternal and child health outcomes in Vietnam. PARTICIPANTS This prospective cohort study included pregnant women seeking prenatal care at six hospitals in three large cities in Vietnam. After enrolment, eligible participants who gave their consent to participate in the study were interviewed at 24-28 weeks' gestation. Glucose testing was conducted and blood pressure was measured during this period. Each participant will be assessed prospectively during their postnatal visits at delivery, 1, 3, 6, 12, 18 and 24 months, and will be followed up for 5 years. FINDINGS TO DATE Of 2248 eligible pregnant women, 2030 were recruited (participation rate 90.3%) between August 2015 and July 2016. All participants completed the baseline assessment. Their mean (SD) age was 27.6 (5.3) years. The mean pre-pregnancy body mass index (BMI) was 20.2 (SD 2.6) kg/m2, with nearly two-thirds of participants having a normal pre-pregnancy BMI (18.5 to <23.0 kg/m2) and one-quarter being underweight (pre-pregnancy BMI <18.5 kg/m2). Overweight or obese mothers (pre-pregnancy BMI ≥23.0 kg/m2) accounted for 12.8%. No pregnant women reported smoking during their pregnancy while 13.4% of them had continued drinking. 22.8% of participants had hyperglycaemia. Their mean systolic blood pressure was 105.6 (SD 8.2) mm Hg, and diastolic blood pressure was 67.4 (SD 7.5) mm Hg. FUTURE PLANS The relationships of maternal lifestyle and nutritional status with the health outcomes of pregnancy, postpartum maternity and infants will be analysed. Meanwhile, participants will be closely tracked to minimise loss to follow-up.
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Affiliation(s)
- Cong Luat Nguyen
- National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | | | - Tan Khac Chu
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Anh Vo Van Ha
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ngoc Minh Pham
- Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | | | - Dung Van Do
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hong Kim Tang
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, Australia
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, Australia
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Hoffmann J, Ossada V, Weber M, Stepan H. An intermediate sFlt-1/PlGF ratio indicates an increased risk for adverse pregnancy outcome. Pregnancy Hypertens 2017; 10:165-170. [PMID: 29153672 DOI: 10.1016/j.preghy.2017.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 08/07/2017] [Accepted: 08/10/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The sFlt-1/PlGF ratio is a valid marker in diagnosing or excluding preeclampsia. The currently used cut offs frame an intermediate zone of 33-85 (<340 weeks) or 33-110 (≥340 weeks), respectively. In this study we sought to evaluate the relevance of an intermediate sFlt-1/PlGF ratio for the clinical pregnancy course and outcome. MATERIAL AND METHODS We retrospectively analysed 533 consecutive patients with sFlt-1/PlGF ratio measurements for suspected preeclampsia. In patients with an intermediate sFlt-1/PlGF ratio, fetal and maternal characteristics and also pregnancy outcome were documented. Furthermore, we compared the patient groups with <340/340-366/≥370 gestational weeks at first visit. RESULTS 83/533 (15.6%) patients had an intermediate sFlt-1/PlGF ratio. Maternal or fetal diseases or twin pregnancies occurred in 87.9%. Preeclampsia/HELLP syndrome developed in 31.3% but were mostly mild or moderate (65.4%). However, severe adverse outcome was observed in 36.1% with severe preeclampsia in 10.8%. Even if further pregnancy duration and gestational week correlated negatively (r=-0.424; p<0.001), 92% of patients, tested with <340 weeks delivered prematurely. The overall preterm birth rate was 27.7%. CONCLUSIONS Patients with an intermediate sFlt-1/PlGF ratio are at risk for severe adverse outcome. An intermediate sFlt-1/PlGF ratio indicates a risk for preterm birth, independent from the occurrence of preeclampsia.
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Affiliation(s)
- Janine Hoffmann
- Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany.
| | - Victoria Ossada
- Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - Marie Weber
- Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany
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Toljic M, Egic A, Munjas J, Karadzov Orlic N, Milovanovic Z, Radenkovic A, Vuceljic J, Joksic I. Increased oxidative stress and cytokinesis-block micronucleus cytome assay parameters in pregnant women with gestational diabetes mellitus and gestational arterial hypertension. Reprod Toxicol 2017; 71:55-62. [DOI: 10.1016/j.reprotox.2017.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 03/30/2017] [Accepted: 04/06/2017] [Indexed: 02/07/2023]
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Laganà AS, Giordano D, Loddo S, Zoccali G, Vitale SG, Santamaria A, Buemi M, D'Anna R. Decreased Endothelial Progenitor Cells (EPCs) and increased Natural Killer (NK) cells in peripheral blood as possible early markers of preeclampsia: a case-control analysis. Arch Gynecol Obstet 2017; 295:867-872. [PMID: 28243732 DOI: 10.1007/s00404-017-4296-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/10/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Endothelial Progenitor Cells (EPCs) and Natural Killer (NK) cells were recently advocates in the pathogenesis of preeclampsia (PE), since they can be mobilized into the bloodstream and may orchestrate vascular endothelium function. The aim of our study was to evaluate in early pregnancy circulating EPCs and NK cells in peripheral blood in women who later developed PE compared to uncomplicated pregnancies. METHODS We prospectively enrolled pregnant women at 9+0-11+6 weeks of gestation at the time of first-trimester integrated screening for trisomy 21, who underwent peripheral venous blood (20 mL) sample. We included only women who later developed PE (cases) and women with uncomplicated pregnancy (controls), matched for maternal age, parity, and Body Mass Index. In these groups, we evaluated the levels of CD16+CD45+CD56+ NK cells and CD34+CD133+VEGF-R2+ EPCs in peripheral blood samples previously stored. RESULTS EPCs were significantly lower (p < 0.001), whereas NK cells were significantly higher (p < 0.001) in PE group compared to uncomplicated pregnancies during the first trimester. CONCLUSION The evaluation of EPCs and NK cells in peripheral blood during the first trimester may be considered an effective screening for the early identification of women at risk of developing PE.
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Affiliation(s)
- Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
| | - Domenico Giordano
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Saverio Loddo
- Department of Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Zoccali
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Angelo Santamaria
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Michele Buemi
- Department of Experimental Medicine, University of Messina, Messina, Italy
| | - Rosario D'Anna
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
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Draganovic D, Lucic N, Jojic D, Milicevic S. Correlation of Oxidative Stress Markers with Ultrasound and Cardiotocography Parameters with Hypertension Induced Pregnancy. Acta Inform Med 2017; 25:19-23. [PMID: 28484292 PMCID: PMC5402358 DOI: 10.5455/aim.2017.25.19-23] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Pregnancy induced hypertension (PIH), especially preeclampsia, is a state of extremely increased oxidative stress (OS), due to decrease of antioxidant capacity in comparison to normotensive pregnant women. The consequences of increased state of oxidative stress with hypertension disorder in pregnancy are disorder of placental blood flow, intrauterine hypoxia of the fetus and disturbance in transfer of O2 manifested as pathological ultrasound (US) parameters (amount of amniotic fluid and biophysical profile of fetus) and cardiotocography parameters (CTG). Aim: The aim of this research is to analyze correlation of TBARS oxidative stress markers with ultrasound parameters of pregnancy course and cardiotocography parameters in pregnant women with PIH. Patients and methods: Research has been performed at the Clinic of Gynecology and Obstetrics, University Clinical Centre of the Republic of Srpska. It covered 200 pregnant women, 100 of them with PIH and 100 healthy pregnant women, at gestational age from 28 to 40 weeks. All pregnant women were analyzed for US parameters of pregnancy course and CTG records as well as oxidative stress biomarker, values of Thiobarbituric Acid (TBARS). Results: Pregnant women with PIH had high statistical significant (pre)pathological CTG records and US- biophysical profile, less amount of amniotic fluid and delivered in lower gestation compared to healthy pregnant women. TBARS high values are statistical high significant frequent with pregnant women with PIH, who had pathological and pre-pathological biophysical profile and CTG records, as well as with US less amount of amniotic fluid (p<0.01). The highest TBARS values were presented with PIH pregnant women and US of less amount of amniotic fluid 42.3 µmol. Conclusion: There is statistical strong connection between TBARS values, being used as oxidative stress markers, and diagnostic methods used in PIH diagnostics, ultrasound (amount of amniotic fluid, fetus biophysical profile) and cardiotocography recording. TBARS could also be significant in clinical application for assessment of pregnant women with PIH in order to make decisions on pregnancy termination period.
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Affiliation(s)
- Dragica Draganovic
- Clinic of Gynecology and Obstetrics, University Clinical Centre of the Republic of Srpska, Banjaluka, Bosnia and Herzegovina
| | - Nenad Lucic
- Clinic of Gynecology and Obstetrics, University Clinical Centre of the Republic of Srpska, Banjaluka, Bosnia and Herzegovina
| | - Dragica Jojic
- Clinic of Pediatric, University Clinical Centre of the Republic of Srpska, Banjaluka, Bosnia and Herzegovina
| | - Snjezana Milicevic
- Clinic for Urology, University Clinical Centre of the Republic of Srpska, Banjaluka, Bosnia and Herzegovina
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Risk of gestational hypertension and preeclampsia in women who discontinued or continued antidepressant medication use during pregnancy. Arch Womens Ment Health 2016; 19:1051-1061. [PMID: 27558246 DOI: 10.1007/s00737-016-0655-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to examine the association between discontinued and continued use of antidepressants and risk for gestational hypertension (GH) and preeclampsia (PE). METHODS Data from the MotherToBaby pregnancy studies from 2004 to 2014 were analyzed to compare women who discontinued antidepressant use ˂20 weeks of gestation (discontinuers) and women who continued antidepressant use ≥20 weeks of gestation (continuers) to non-users for risk of GH (blood pressure ≥140/90 mmHg on two or more occasions at ≥20 weeks of gestation) and PE (GH with proteinuria). Maternal data, including exposures and study outcomes, were collected through multiple phone interviews. Medical records were used to validate outcomes. Odds ratios (ORs) and 95 % confidence intervals were estimated using logistic regression. Risk for GH and PE were also assessed within antidepressant drug classes. RESULTS Data from 3471 women were analyzed. Continuers were significantly at risk for GH (adjusted odds ratios (aOR) 1.83; 95 % CI 1.05, 3.21) after adjustment. Analyses by drug class showed that continued use of serotonin-norepinephrine reuptake inhibitors (SNRI) increased risk for GH; however, of the 21 women who continued to use SNRI, only 3 developed GH. Continuers who used two or more antidepressant drug classes had increased risk for PE. Selective serotonin reuptake inhibitors or other antidepressant use was not associated with increased risk for GH or PE. No significant associations with PE or GH were found for discontinuers. CONCLUSIONS Results suggest that women who continued to use antidepressants in the second half of pregnancy are at risk for GH and PE. No significant association was found among discontinuers.
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Eslami B, Malekafzali H, Rastkari N, Rashidi BH, Djazayeri A, Naddafi K. Association of serum concentrations of persistent organic pollutants (POPs) and risk of pre-eclampsia: a case-control study. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2016; 14:17. [PMID: 27904751 PMCID: PMC5121940 DOI: 10.1186/s40201-016-0256-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/03/2016] [Indexed: 05/05/2023]
Abstract
BACKGROUND There is increasing evidence that persistent organic pollutants (POPs) may contribute to pre-eclampsia. The objective of this study was to evaluate the association between Polychlorinated Biphenyls (PCBs) and Polybrominated Diphenyl Ethers (PBDEs) as POPs with pre-eclampsia. METHODS This case-control study was performed in the three general university hospitals of Tehran University of Medical Sciences. Serum samples were collected from cases (n = 45) who had diagnosed with preeclampsia and from control samples (n = 70) with normal pregnancy and attended the same hospital for a routine prenatal visit at the third trimester of pregnancy. Pollutants levels were analyzed by Gas Chromatography Mass Spectrometry (GC/MS). RESULTS Mean participant age was 27.3 ± 5.39 with median 27. As the main independent variable, total POPs manifested with adjusted OR equal to 1.54 (95 % CI: 1.26-1.87, p-value <0.0001), which was significantly associated with pre-eclampsia. The adjusted OR proved a statistically significant association between total PCBs 1.77 (95 % CI: 1.34-2.32) and total PBDEs (OR = 2.19; 95 % CI: 1.39-3.45, p-value = 0.001) with pre-eclampsia considering confounding variables (maternal age, pre-pregnancy body mass index (BMI), gestational age, weight gain during pregnancy and total lipids in maternal serum). Finally, pre-pregnancy BMI and weight gain during pregnancy had a positive association with pre-eclampsia and gestational age yielded a negative association with pre-eclampsia in all analysis. CONCLUSION Our data indicate the association between total POPs, total PBDEs, and total PCBs with pre-eclampsia, even after controlling for the effects of a number of potentially confounding factors. Further investigation about route of exposure and the trend of POPs especially in pregnant women is needed.
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Affiliation(s)
- Bita Eslami
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Malekafzali
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Rastkari
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, 8th Floor, No. 1547, North Kargar Ave., Enghelab Square, Tehran, I.R. Iran
| | - Batool Hossein Rashidi
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Djazayeri
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, 8th Floor, No. 1547, North Kargar Ave., Enghelab Square, Tehran, I.R. Iran
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Fierro G, Silveira F, Armentano R. Central blood pressure monitoring method oriented to wearable devices. HEALTH AND TECHNOLOGY 2016. [DOI: 10.1007/s12553-016-0149-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Miliku K, Bergen NE, Bakker H, Hofman A, Steegers EAP, Gaillard R, Jaddoe VWV. Associations of Maternal and Paternal Blood Pressure Patterns and Hypertensive Disorders during Pregnancy with Childhood Blood Pressure. J Am Heart Assoc 2016; 5:JAHA.116.003884. [PMID: 27742617 PMCID: PMC5121490 DOI: 10.1161/jaha.116.003884] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypertensive disorders in pregnancy may affect the cardiovascular risk of offspring. We examined the associations of maternal blood pressure throughout pregnancy and hypertensive disorders in pregnancy with childhood blood pressure of offspring. Specific focus was on the comparison with paternal blood pressure effects, the identification of critical periods, and the role of birth outcomes and childhood body mass index in the observed associations. METHODS AND RESULTS This study was embedded in a population-based prospective cohort study among 5310 mothers and fathers and their children. We measured maternal blood pressure in each trimester of pregnancy and paternal blood pressure once. Information about hypertensive disorders in pregnancy was obtained from medical records. We measured childhood blood pressure at the median age of 6.0 years (95% range 5.7-8.0 years). Both maternal and paternal blood pressure were positively associated with childhood blood pressure (all P<0.05), with similar effect estimates. Conditional regression analyses showed that early, mid-, and late-pregnancy maternal blood pressure levels were all independent and positively associated with childhood blood pressure, with the strongest effect estimates for early pregnancy. Compared with children of mothers without hypertensive disorders in pregnancy, children of mothers with hypertensive disorders in pregnancy had higher diastolic blood pressure by a standard deviation score of 0.13 (95% CI 0.05-0.21). The observed associations were not materially affected by birth outcomes and childhood body mass index. CONCLUSIONS Both maternal and paternal blood pressure affects childhood blood pressure, independent of fetal and childhood growth measures, with the strongest effect of maternal blood pressure in early pregnancy.
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Affiliation(s)
- Kozeta Miliku
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Nienke E Bergen
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hanneke Bakker
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Santiago-Font JA, Amaral LM, Faulkner J, Ibrahim T, Vaka VR, Cunningham MW, LaMarca B. Serelaxin improves the pathophysiology of placental ischemia in the reduced uterine perfusion pressure rat model of preeclampsia. Am J Physiol Regul Integr Comp Physiol 2016; 311:R1158-R1163. [PMID: 27629886 DOI: 10.1152/ajpregu.00192.2016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 01/22/2023]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy that has limited therapeutic options. In healthy pregnancy, relaxin plays an important vasodilatory role to maintain vascular compliance; however, currently, there is no preclinical evidence to support the use of relaxin during preeclampsia. Therefore, the goal of this study was to test the hypothesis that recombinant human relaxin-2 (Serelaxin, Novartis; RLX) could reduce mean arterial pressure (MAP) and improve uterine artery resistance index (UARI) and nitric oxide bioavailability, and/or decrease prepro-endothelin-1 (PPET-1), soluble fms-like tyrosine kinase-1 (sFlt-1), and TNF-α) in the reduced uterine perfusion pressure (RUPP) model of preeclampsia. On day 14 of gestation (GD14), pregnant rats were assigned to normal pregnant (NP), RUPP, RUPP+RLX, or NP+RLX groups. Treated rats received RLX at 0.4 μg/h or RLX2 4 μg/h RLX via minipump implanted on GD14. On GD18, carotid arterial catheters were inserted, and on GD19, MAP and tissues were collected. MAP was increased in RUPP rats compared with NP but was lowered with either dose of RLX. UARI and sFlt-1 were significantly improved in both treated RUPP groups. Total circulating nitrate-nitrite improved and placental PPET-1 and TNF-α were significantly decreased with the higher dose of RLX. Renal cortex PPET-1 was reduced with both doses of RLX. In conclusion, Serelaxin improved blood pressure, sFlt-1, TNF-α, UARI, and nitric oxide bioavailability and PPET-1 in a rat model of preeclampsia, thereby suggesting a potential therapeutic role for RLX in maintaining maternal health and prolonging pregnancy in the face of placental ischemia.
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Affiliation(s)
- Jose A Santiago-Font
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Lorena M Amaral
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jessica Faulkner
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Tarek Ibrahim
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Venkata Ramana Vaka
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Mark W Cunningham
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Babbette LaMarca
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
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Chen Q, Yin YX, Wei J, Tong M, Shen F, Zhao M, Chamley L. Increased expression of high mobility group box 1 (HMGB1) in the cytoplasm of placental syncytiotrophoblast from preeclamptic placentae. Cytokine 2016; 85:30-6. [PMID: 27285673 DOI: 10.1016/j.cyto.2016.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preeclampsia is a pregnancy-specific disorder characterised by an inappropriate maternal inflammatory response during pregnancy. High mobility group box 1 (HMGB1) was originally characterised as a nuclear protein but when released into the extracellular environment following necrotic cell death, it is proinflammatory. HMGB1 is expressed in the syncytiotrophoblast of human placenta. Higher levels of uric acid are reported in preeclampsia. The aim of this study was to investigate whether the expression of HMGB1differed between early onset and late onset preeclampsia or severe and mild preeclampsia and whether its expression correlated with the levels of uric acid. METHODS 74 preeclamptic placentae and 110 normotensive placentae were included in this study. The levels of uric acid in women with preeclampsia were measured. The expression of HMGB1 in preeclamptic placentae or in first trimester and term placentae that had been treated with uric acid was measured. RESULTS HMGB1 was expressed predominantly in the syncytiotrophoblast of the placenta and the expression of HMGB1 in the cytoplasm of the syncytiotrophoblast was significantly increased in both severe preeclampsia and early onset preeclampsia compared to normotensive pregnancies. The circulating levels of uric acid were significantly increased in preeclampsia and correlated with the expression of HMGB1. Increased levels of HMGB1 were significantly correlated with the severity and the time of onset of preeclampsia, but pathologic levels of uric acid did not increase the expression of HMGB1. CONCLUSION Our data provides a better understanding of the function of HMGB1, a danger molecule in the pathogenesis of preeclampsia.
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Affiliation(s)
- Q Chen
- The Hospital of Obstetrics & Gynaecology, Fudan University, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand.
| | - Y X Yin
- Wuxi maternity and Children Hospital, Nanjing Medical University, China
| | - J Wei
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - M Tong
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - F Shen
- The Hospital of Obstetrics & Gynaecology, Fudan University, China
| | - M Zhao
- Wuxi maternity and Children Hospital, Nanjing Medical University, China
| | - L Chamley
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
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