Antibodies anti-CagA cross-react with trophoblast cells: a risk factor for pre-eclampsia?

Causal associations between Helicobacter pylori infection and pregnancy and neonatal outcomes: a two-sample Mendelian randomization study

Background

Observational studies have reported that Helicobacter pylori (H. pylori) infection is associated with a series of pregnancy and neonatal outcomes. However, the results have been inconsistent, and the causal effect is unknown.

Methods

A two-sample Mendelian randomization (MR) study was performed using summary-level statistics for anti-H. pylori IgG levels from the Avon Longitudinal Study of Parents and Children Cohort. Outcome data for pregnancy (miscarriage, preeclampsia-eclampsia, gestational diabetes mellitus, placental abruption, premature rupture of membranes, postpartum hemorrhage) and neonates (birthweight, gestational age, and preterm birth) were sourced from genome-wide association meta-analysis as well as the FinnGen and Early Growth Genetics Consortium. Causal estimates were calculated by five methods including inverse variance weighted (IVW). The heterogeneity of instrumental variables was quantified by Cochran's Q test, while sensitivity analyses were performed via MR-Egger, MR-PRESSO, and leave-one-out tests.

Results

IVW estimates suggested that genetically predicted anti-H. pylori IgG levels were significantly associated with increased risks of preeclampsia-eclampsia (odds ratio [OR] = 1.12, 95% confidence interval [CI] 1.01-1.24, P = 0.026) and premature rupture of membranes (OR = 1.17, 95% CI 1.05-1.30, P = 0.004). Similar results were obtained for preeclampsia-eclampsia from the MR-Egger method (OR = 1.32, 95% CI 1.06-1.64, P = 0.027) and for premature rupture of membranes from the weighted median method (OR = 1.22, 95% CI 1.06-1.41, P = 0.006). No significant causal effects were found for other outcomes. There was no obvious heterogeneity and horizontal pleiotropy across the MR analysis.

Conclusion

Our two-sample MR study demonstrated a causal relationship of H. pylori infection with preeclampsia-eclampsia and premature rupture of membranes. The findings confirm the epidemiological evidence on the adverse impact of H. pylori in pregnancy. Further studies are needed to elucidate the pathophysiological mechanisms and assess the effectiveness of pre-pregnancy screening and preventive eradication.

Update on long-term cardiovascular risk after pre-eclampsia: a systematic review and meta-analysis

BACKGROUND/INTRODUCTION

There is a need for further studies on the cardiovascular risk of women experiencing pre-eclampsia (PE).

PURPOSE

To update the literature regarding the association between a history of PE and subsequent cardiovascular diseases, including cardiovascular death, coronary heart diseases, heart failure, and stroke, focusing on the trend in the effect size (ES) estimates over time.

METHODS AND RESULTS

Following PRISMA guidelines, from inception to May 2023, we performed a systematic review of PubMed, MEDLINE, Scopus, and EMBASE. Randomized, cohort, or case-control studies in English were included if fulfiling the following criteria:(i) The association between PE and subsequent cardiovascular disease was adjusted for clinically relevant variables, (ii) the presence of a control group, and (iii) at least 1 year of follow-up. Pooled adjusted ESs and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effect model. Twenty-two studies met the inclusion criteria. PE was associated with a higher risk of cardiovascular death (ES 2.08, 95% CI 1.70-2.54, I2 56%, P < 0.00001), coronary artery diseases (ES 2.04, 95% CI 1.76-2.38, I2 87%, P < 0.00001), heart failure (ES 2.47, 95% CI 1.89-3.22, I2 83%, P < 0.00001), and stroke (ES 1.75, 95% CI 1.52-2.02, I2 72%, P < 0.00001) after adjusting for potential confounders. This risk is evident in the first 1-to-3 years of follow-up and remains significant until 39 years of follow-up.

CONCLUSIONS

Compared to women who experienced a normal pregnancy, those suffering from PE have about double the risk of lifetime cardiovascular disease.

The association between Helicobacter pylori and gastrointestinal disorders during pregnancy: A Multicenter retrospective study

BACKGROUND

Some gastrointestinal disorders may be associated with Helicobacter pylori infection, which not only affect maternal health, but may also lead to adverse pregnancy outcomes. We aim to explore the association between H. pylori and gastrointestinal disorders in pregnant women.

MATERIALS AND METHODS

In total, 503 patients were retrospectively analyzed and divided into the H. pylori-uninfected group, the H. pylori-infected group, or the H. pylori-eradicated group. We analyzed the influence of H. pylori on gastrointestinal diseases during pregnancy among the groups, as well as the severity, symptoms, laboratory tests of the H. pylori-related diseases.

RESULTS

Pregnant women with H. pylori infection had higher risk of nausea and vomiting of pregnancy (NVP) (p < 0.001), severe NVP(p = 0.012), hyperemesis gravidarum (p = 0.027), hematemesis (p = 0.018), hyponatremia (p = 0.033), as well as functional dyspepsia symptoms including epigastric pain (p = 0.004), bloating (p = 0.024), and feeling full quickly in a meal (p = 0.031) compared with those without H. pylori infection. While the prevalence of NVP (p = 0.024), severe NVP (p = 0.009), epigastric pain (p = 0.037), and bloating (p = 0.032) were lower in H. pylori-eradicated pregnant women than in H. pylori-infected women. In addition, pregnant women with H. pylori infection had higher risk of spontaneous preterm birth than whom without H. pylori infection (p = 0.033).

CONCLUSIONS

Helicobacter pylori infection was associated with higher risks of NVP, severe NVP, hyperemesis gravidarum, functional dyspepsia, and spontaneous preterm birth in pregnant women.

Helicobacter pylori infection in pregnant women: Gastrointestinal symptoms and pregnancy- related disorders

Helicobacter pylori (H. Pylori) is a gram-negative, flagellated and spiral-shaped bacterial pathogen that impacts approximately 46% among pregnant women globally and has been associated with various maternal-fetal complications. Iron deficiency anemia, fetal growth restriction, cardiovascular diseases, and insufficient nutrient absorption can be observed in pregnant women, as well as miscarriages and pregnancy-specific hypertensive disease, such as pre-eclampsia. Thus, the evidence supports the influence of H. pylori infection on fetal implantation/placentation failure, and positive strains of the cytotoxin-associated gene A of H. Pylori were reported as the most prevalent in these conditions. However, current knowledge indicates a relationship between this infection and the occurrence of hyperemesis gravidarum, characterized by frequent nausea and vomiting. Regarding the diagnosis of this bacterial infection, non-invasive approaches such as stool antigen test, urea breath test, and serological tests are more accepted during pregnancy, as they are easy to carry out and cost-effective. Finally, the bacteria eradication therapy should consider the risks and benefits for the pregnant woman and her child, with pharmacological intervention depending on the clinical presentation.

HLA-G alleles and their impacts on placental HSV-1 infection in women from southern Brazil

The Human Leukocyte Antigen G (HLA-G) is an immunoregulatory molecule with a critical role in pregnancy success. HLA-G alleles are associated with differential susceptibility to multiple conditions, including gestational problems, infectious diseases, and viral persistence. Of note, both herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) can impair HLA-G expression, interfering with HLA-G-associated immunoregulation. On the other hand, the impacts of HLA-G alleles on susceptibility to Herpesviridae infection is a neglected issue. Therefore, this study evaluated HLA-G allele frequencies and their associations with placental Herpesviridae infection in women from southern Brazil. Placenta samples were collected soon after delivery, and detection of viral DNA of HSV-1, HSV-2 and human cytomegalovirus (HCMV) was performed by polymerase chain reaction (PCR). A fragment of HLA-G (exons 2-4) was amplified by PCR, sequenced, and analyzed to allele determination. One hundred and seventy women had their alleles determined. Overall, 25 HLA-G alleles were found, distributed into 56 different genotypes. The most frequent alleles were G* 01:01:01 and G* 01:01:02, found in 37.9 % and 16.5 % of samples, respectively. Among the 170 women, 89 (52.4 %) tested positive for Herpesviridae DNA in the placenta, 55 (32.3 %) tested negative, 3 (1.8 %) were negative for HSV-1 and HSV-2 (with absent HCMV data), and 23 (13.5 %) were undetermined. The G* 01:01:01 allele was significantly associated with an increased risk of placental HSV-1 infection (p = 0.0151; OR=1.837; IC=1.108-3.045). This study describes new information concerning placental HLA-G alleles in women from southern Brazil and helps explain how genetic background can modify susceptibility to placental infections.

Association of Serum Hepcidin With Preeclampsia: A Systematic Review and Meta-Analysis

The objective of the present systematic review and meta-analysis was to compare the levels of serum hepcidin in women who developed pre-eclampsia with those who did not. The databases PubMed, Embase, Scopus, Cochrane, and references of retrieved articles published till September 2020 were searched with no language restriction. Mean differences in iron regulating protein (hepcidin) were compared using a random-effects model based on the level of heterogeneity. A total of 760 individuals were included in the analysis from seven studies. The pooled estimate showed that mean hepcidin levels were significantly higher in women who developed pre-eclampsia [0.3 ng/ml, 95% confidence interval (CI): 0.01-0.59, p=0.003] as compared to women who did not develop pre-eclampsia. Further research can be done to assess the levels of various iron parameters in different trimesters of pregnancy and their association with pre-eclampsia.

Adverse pregnancy outcomes and Helicobacter pylori infection: A meta-analysis

INTRODUCTION

Helicobacter pylori infection during pregnancy has some adverse effects, but its effects are still conflicting. This meta-analysis study was performed to assess the relationship between H pylori infection and adverse effects during pregnancy.

METHODS

Through a systematic literature search up to August 2020, 31 studies included 16 887 pregnant females at baseline and reported a total of 5852 H pylori infection positive and 8196 H pylori infection negative pregnant females, were found recording relationships between H pylori infection and adverse effects during pregnancy. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated between H pylori infection positive vs H pylori infection negative in adverse effects during pregnancy using the dichotomous methods with a random or fixed-effect model.

RESULTS

H pylori infection positive during pregnancy was significantly related to higher rate of preeclampsia (OR, 2.68; 95% CI, 2.02-3.56, P < .001), foetal growth restriction (OR, 1.45; 95% CI, 1.26-1.66, P < .001), gestational diabetes mellitus (OR, 2.63; 95% CI, 1.51-4.59, P < .001), and hyperemesis gravidarum (OR, 14.45; 95% CI, 10.24-20.38, P < .001) compared with H pylori infection negative. However, H pylori infection positive during pregnancy was not significantly correlated with spontaneous onset of labour (OR, 1.00; 95% CI, 0.83-1.21, P = .98) compared with H pylori infection negative.

CONCLUSIONS

H pylori infection may have an independent relationship with certain adverse effects during pregnancy. H pylori infection positive during pregnancy was significantly related to a higher rate of preeclampsia, foetal growth restriction, gestational diabetes mellitus, and hyperemesis gravidarum compared with H pylori infection negative. This relationship encouraged us to recommend screening and treating females for H pylori infection before and during pregnancy to avoid any possible complications.

Evaluating the relationship between Helicobacter pylori infection

Introduction

Helicobacter pylori is a gram-negative spiral bacterium that is frequently found in the human stomach. Significant association has been reported between Cytotoxin associated gene A (CagA)- positive Helicobacter pylori strains and coronary heart disease. The aim of the present study is to investigate the carotid intima-media thickness as an indicator of atherosclerosis in people with Helicobacter pylori infection.

Methods

This study was done on patients who underwent upper GI endoscopy and biopsy, and after obtaining conscious consent underwent ultrasound of the right and left carotid arteries for measuring carotid intima-media thickness (CIMT) and blood tests.

Results

In this study, 90 patients who underwent upper GI endoscopy were examined in three groups: negative H. pylori negative, positive cagA and negative cagA. The right, left and average of CIMT in cagA-positive group were significantly higher than the other two groups (p < 0.05). Howerver, the average of CIMT was not significantly different between men and women. Also, the hsCRP average level in positive cagA group was significantly higher than other groups (p < 0.05).

Conclusion

Our findings suggest that there is an increase in CIMT values in patients with H. pylori infection, especially in cases of positive cagA. The positive cagA group showed significantly higher levels of hs-CRP, as a marker of elevated inflammatory response. Therefore, H. pylori infection, especially cagA-positive strains and its associated systemic inflammatory response can be considered as a contributing factor in atherosclerosis and cardiovascular disease.

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H.pylori infection especially in case of positive CagA⁺ caused the right/left CIMT increase.

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Higher levels of inflammation in H.pylori, CagA patients and atherosclerosis risk factors couldn’t cause the significant difference.

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H.pylori infection with positive CagA and its inflammation is an important factor in atherosclerosis and cardiovascular diseases.

Placenta-specific protein 1 promotes cell proliferation via the AKT/GSK-3β/cyclin D1 signaling pathway in gastric cancer

Gastric cancer is a malignant tumor with a poor prognosis. Therefore, it is important to search for molecules that play a vital role in the development, diagnosis, and treatment of this disease. Placenta-specific 1 (PLAC1) is one of the cancer-testis antigens; it plays an important role in both placental development and tumorigenesis. However, the role of PLAC1 in gastric cancer has not been fully investigated, and its underlying mechanism needs further study. We first explored the expression and clinical relevance of PLAC1 in gastric cancer and performed gene set enrichment analysis of PLAC1-related genes using online databases. Subsequently, we studied the function and mechanism of PLAC1 in gastric cancer cells through in vitro experiments. Our results showed that PLAC1 is highly expressed in gastric cancer, is associated with poor prognosis, and can promote gastric cancer cell proliferation through the AKT/GSK-3β/cyclin D1 signaling pathway. Moreover, we discovered that AKTi attenuates the effect of PLAC1. Our study further revealed the role and mechanism of PLAC1 in gastric cancer and suggested that this antigen might be a useful molecular marker for gastric cancer diagnosis, prognosis, and treatment.

The effects of Helicobacter pylori infection on pregnancy-related diseases and fetal development in diabetes in pregnancy

Background

This study aimed to determine the association of Helicobacter pylori (H. pylori) infection with pregnancy-related diseases and fetal development in women with diabetes in pregnancy (DIP).

Methods

All the participants were recruited before 16 weeks of gestation. According to their medical history and the results of a 75-g oral glucose tolerance test at the 24^th week of pregnancy, the participants were divided into a normal control group (NC group), a gestational diabetes mellitus group (GDM group), and a pre-pregnancy diabetes mellitus group (PGDM group). According to the results of an H. pylori serum antibody detection test, each group was further divided into two subgroups: an H. pylori positive subgroup (HP+ subgroup) and an H. pylori negative group (HP- subgroup). The incidences of pregnancy-related diseases, the fetal developmental status, and the newborn status were compared among the groups.

Results

This study recruited 356 pregnant women. The infection rates of type I H. pylori were significantly higher in the GDM group and the PGDM group than in the NC group (χ²=6.949, P=0.031). With the exception of the NC-HP+ subgroup, there were higher incidences of pregnancy-related diseases in the HP+ subgroups than in the HP− subgroups (P<0.05). Furthermore, the incidences of pregnancy-induced hypertension (PIH), preeclampsia, and premature delivery were significantly higher in the GDM-HP+ subgroup and the PGDM-HP+ subgroup than in the NC-HP+ subgroup (P<0.05). At the end of pregnancy, all 3 HP− subgroups showed better fetal development than the HP+ subgroups (P<0.05), and the NC-HP+ subgroup showed better fetal development than the GDM-HP+ and PGDM-HP+ subgroups (P<0.05). Meanwhile, the PGDM-HP+ subgroup showed poor fetal development, even in the 2^nd trimester of pregnancy.

Conclusions

H. pylori infection is extremely common in DIP. For women with DIP, infection with H. pylori can increase the risks of pregnancy-related diseases and poor fetal development. H. pylori screening and eradication therapy before pregnancy may aid in preventing pregnancy-related diseases and improve fetal development.

Relationship Between Helicobacter pylori Infection, Serum Vitamin D3 Level and Spontaneous Abortion

Background

The effects of vitamin D3 (VD3) on pregnancy outcomes remain obscure. Thus, this study aims to investigate the relationship between maternal H. pylori infection, low VD3 level, and spontaneous abortion.

Methods

This research is conducted in Shahid Ali Qader Consultant Clinic in Sulaimaniyah city in which 100 women with a history of abortion and 100 women with no history of miscarriage were included. Serum detection of anti-H. pyloriIgG, IgA, and VD3 were done using enzyme-linked immunosorbent assay (ELISA) technique.

Results

The mean of VD3, H. pylori IgG, and IgAin patients and control group cases was determined and analyzed statistically.

Conclusion

H. pylori infection and VD3 play a significant role in early pregnancy loss. Blood group A and O are more prone to spontaneous abortion.

Helicobacter pylori infection selectively increases the risk for carotid atherosclerosis in young males

BACKGROUND AND AIMS

Atherosclerosis is an important contributing factor to cardiovascular mortality. The role of Helicobacter pylori (H. pylori) infection in atherosclerosis is inconsistent and sometimes controversial. The present study aimed to determine if H. pylori infection is associated with carotid atherosclerosis.

METHODS

17,613 males and females with both carotid ultrasonic examination and ¹³C-urea breath test for H. pylori infection were screened by a major Chinese university hospital from March 2012 to March 2017 for the study. Baseline demographics, cardiac risk factors, and laboratory studies were obtained. After exclusion for pre-specified conditions, 12,836 individuals were included in the analysis, including 8157 men (63.5%) and 4679 women (36.5%). Analysis was also made for 5-year follow-up data of 1216 subjects (869 males and 347 females) with and without H. pylori infection for development and progression of carotid atherosclerosis.

RESULTS

After adjusting for age, sex, body mass index, lipid profile, hypertension, renal function, diabetes mellitus, and smoking, H. pylori infection was found as an independent risk factor for carotid atherosclerosis in males under 50 years, but not in older males or females (odds ratio 1.229, 95% CI 1.054-1.434, p = 0.009). Follow-up data analysis showed that the incidence of carotid atherosclerosis from no atherosclerosis to detectable lesions was significantly higher in young males with persistent H. pylori infection than those without H. pylori infection (p = 0.028) after 3 years.

CONCLUSIONS

These data suggest that H. pylori infection might be an important risk factor for carotid atherosclerosis in young Chinese males under 50.

The risk of Helicobacter pylori infection for adverse pregnancy outcomes: A systematic review and meta-analysis

OBJECTIVE

To estimate the current evidence regarding the association between Helicobacter pylori infection during pregnancy and adverse pregnancy outcomes.

MATERIALS AND METHODS

A systematic literature search for relevant publications was conducted using PubMed, EMBASE, Cochrane Library, and Web of science databases through November 17th, 2018. The pooled odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were selected as the effect size. Subgroup analysis and sensitivity analysis were performed.

RESULTS

Thirty-one studies with a total of 22 845 participants were identified. There was significant association of H pylori infection with preeclampsia (OR: 2.51; 95% CI: 1.88-3.34; P < 0.001), fetal growth restriction (OR: 2.28; 95% CI: 1.21-4.32; P = 0.01), gestational diabetes mellitus (OR: 2.03; 95% CI: 1.56-2.64; P < 0.001), spontaneous abortion (OR: 1.50; 95% CI: 1.05-2.14; P = 0.024), and birth defect (OR: 1.63; 95% CI: 1.05-2.54; P = 0.03). Sensitivity analysis showed the significant association between H pylori infection and low birthweight (OR: 1.59; 95% CI: 1.05-2.40; P = 0.03).

CONCLUSION

The present meta-analysis offers proof to support that H pylori infection during pregnancy can increase the risk on adverse pregnancy outcomes. Screening and treating for H pylori infection before pregnancy should be taken into account.

Helicobacter pylori and Chlamydia trachomatis in Sudanese women with preeclampsia

Background: Helicobacter pylori and Chlamydia trachomatis infections are associated with many complications of pregnancy including preeclampsia. The association between H. pylori and C. trachomatis with preeclampsia needs to be further explored.Methods: A case-control study was conducted at Saad Abualila Hospital, Khartoum, Sudan during the period of February to August 2015 to investigate the association between H. pylori or C. trachomatis with preeclampsia. The cases were women with preeclampsia and healthy pregnant women were the controls. The obstetrics and clinical history were gathered using questionnaires. Weight and height were measured and were used to compute body mass index (BMI). H. pylori and C. trachomatis antibodies (IgG) were determined by their specific enzyme-linked immunosorbent assays (ELISAs), respectively.Results: There was no significant difference in the age, parity, gestational age, BMI, and hemoglobin between the two groups (93 women in each arm). In all, 31 and 62 cases were severe and mild preeclampsia, respectively. H. pylori seropositivity (IgG) was significantly higher in the preeclamptic women compared with their respective controls (80/93 [86.0%] versus 52/93 [55.9%], p < 0.001). In binary logistic regression, H. pylori seropositivity (adjusted odds ratio [AOR] = 4.933, 95% confidence interval [CI] = 2.082-11.692) was associated with preeclampsia. No C. trachomatis seropositive women were detected in the studied subjects.Conclusion: The current study confirmed that H. pylori, but not C. trachomatis, is associated with preeclampsia.

Helicobacter pylori infection increases the risk of developing preeclampsia: A meta-analysis of observational studies

BACKGROUND

Helicobacter pylori has been previously linked with preeclampsia on the basis of altered angiogenesis and activation of inflammatory cytokines.

PURPOSE

The purpose of the present systematic review is to summarise current evidence concerning the correlation of the two diseases.

MATERIALS AND METHODS

We searched the Medline (1966-2017), Scopus (2004-2017), Clinicaltrials.gov (2008-2017) EMBASE (1980-2017), and Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases. We selected all observational studies (both prospective and retrospective) that reported the incidence of preeclampsia among women with H. Pylori infection. Statistical meta-analysis was performed with the RevMan 5.3 software.

RESULTS

Fourteen studies were finally included in this review, which included a total number of 9787 women. Nine percentage of these had preeclampsia (879 women). The evaluation of studies with the ROBINS-I tool revealed low to moderate risk of bias. H. pylori IgG seropositivity was significantly more prevalent in preeclamptic than in healthy pregnant women (9391 women, OR: 2.32, 95% CI [1.55, 3.46]). The frequency of anti-CagA antibodies was also higher in pregnancies complicated with preeclampsia (3275 women, OR: 3.97, 95% CI [1.55, 10.19]).

CONCLUSION

The findings of our study support that H. pylori infection doubles the risk of developing preeclampsia. The exact pathophysiological processes, however, remain poorly investigated and future experimental studies are needed to shed light on the underlying mechanisms.

Maternal serum levels and placental expression of hepcidin in preeclampsia

Preeclampsia (PE) is a multifactorial pregnancy-induced syndrome and infection could have a role in its etiopathogenesis. Hepcidin, central regulator of iron homeostasis, is an antimicrobial peptide induced by inflammatory/infective stimuli. Therefore, hepcidin could be a good nonspecific marker of infection in PE. In a cross-sectional study, we assessed maternal serum levels (ELISA) and placental expression (Real-Time PCR and ELISA) of hepcidin in PE and normal pregnancies. In a prospective study, hepcidin maternal serum levels were assessed in early pregnancy before PE onset and in age matched controls. Hepcidin protein and gene expressions were significantly decreased in PE placentae with normal fetal growth compared to controls and PE with Fetal Growth Restriction (FGR), respectively. In contrast, we did not find significant differences in maternal serum hepcidin levels in PE vs gestational age-matched controls. Hepcidin serum levels in the first half of pregnancy were found significantly higher in women who subsequently developed PE compared to mothers having a physiological pregnancy until term. Altered hepcidin expression in PE placentae could be explained by direct infective/inflammatory stimuli. Furthermore, high hepcidin levels in maternal serum could be an early marker of PE, further emphasizing the role of inflammatory status before symptoms onset in PE.

Human infectious diseases and risk of preeclampsia: an updated review of the literature

BACKGROUND

Preeclampsia (PE) is one of the major causes of maternal and perinatal morbidity and mortality, especially in low- and middle-income countries. In recent years, a growing body of literatures suggests that infections by bacteria, viruses, and parasites and their related inflammations play an important role in the pathogenesis of PE.

METHODS

We searched PubMed, Google scholar, and Cochrane databases using the following search words: "infection and preeclampsia," "bacterial infection and preeclampsia," "viral infection and preeclampsia" and "parasitic infection and preeclampsia."

RESULTS

The literature review revealed that many bacteria including Helicobacter pylori, Chlamydia pneumonia, and those are involved in periodontal disease or urinary tract infections (UTIs) and some viral agents such as Cytomegalovirus, herpes simplex virus type-2, human immunodeficiency virus, and some parasites especially Plasmodium spp. and Toxoplasma gondii can be effective in development of PE. Inflammation responses against infections has major role in the inducement of PE. The shift of immunological cytokine profile of Th2 toward Th1 and high levels of pro-inflammatory cytokines (TNF-ɑ, IL-12, IFN-γ, etc.), increase of oxidative stress, increase of anti-angiogenic proteins, increase of vascular endothelial growth factor receptor 1 (sVEGFR1), and complement C5a are the main potential mechanisms related to infections and enhanced development of PE.

CONCLUSION

Thus, early diagnosis and treatment of bacterial, viral, and parasitic infections could be an effective strategy to reduce the incidence of PE.

Helicobacter pylori infection: a predictor of vomiting severity in pregnancy and adverse birth outcome

BACKGROUND

Nausea and occasional vomiting in early pregnancy is common. Why some women experience severe nausea and occasional vomiting in early pregnancy is unknown. Causes are multifactorial and only symptomatic treatment options are available, although adverse birth outcomes have been described. Helicobacter pylori infection has been implicated in the cause of nausea and occasional vomiting in early pregnancy.

OBJECTIVE

The purpose of this study was to investigate the association of H pylori with vomiting severity in pregnancy and its effect on birth outcome.

STUDY DESIGN

We assembled a population-based prospective cohort of pregnant women in The Netherlands. Enrolment took place between 2002 and 2006. H pylori serology was determined in mid gestation. Women reported whether they experienced vomiting in early, mid, and late gestation. Maternal weight was measured in the same time periods. Birth outcomes were obtained from medical records. Main outcome measures were vomiting frequency (no, occasional, daily) and duration (early, mid, late gestation), maternal weight gain, birthweight, small for gestational age, and prematurity. Data were analyzed with the use of multivariate regression.

RESULTS

We included 5549 Women, of whom 1932 (34.8%) reported occasional vomiting and 601 (10.8%) reported daily vomiting. Women who were H pylori-positive (n=2363) were more likely to report daily vomiting (adjusted odds ratio, 1.44; 95% confidence interval, 1.16-1.78). H pylori-positivity was associated with a reduction of total weight gain in women with daily vomiting (adjusted difference, -2.1 kg; 95% confidence interval, -2.7 to -1.5); infants born to women with H pylori and daily vomiting had slightly reduced birthweight (addjusted difference -60g; 95% confidence interval, -109 - -12) and an increased risk of being small for gestational age (adjusted odds ratio, 1.49; 95% confidence interval, 1.04-2.14). H pylori and daily vomiting did not significantly affect prematurity rate.

CONCLUSION

This study suggests that H pylori is an independent risk factor for vomiting in pregnancy. In women with daily vomiting, H pylori is also associated with low maternal weight gain, reduced birth weight, and small for gestational age. Because effective treatments for severe nausea and occasional vomiting in early pregnancy are currently lacking, the effect of H pylori eradication therapy on nausea and occasional vomiting in early pregnancy symptom severity should be the target of future studies.

Helicobacter pylori colonization and pregnancies complicated by preeclampsia, spontaneous prematurity, and small for gestational age birth

BACKGROUND

Preeclampsia (PE), small for gestational age (SGA), and spontaneous preterm birth (PTB) each may be complications of impaired placental function in pregnancy. Although their exact pathogenesis is still unknown, certain infectious agents seem to play a role. Helicobacter pylori (H. pylori) colonization has been associated with increased risk for PE. Our aim was to assess the association between H. pylori colonization and PE, SGA, and PTB.

MATERIAL AND METHODS

We measured IgG anti-H. pylori and CagA antibodies in serum of pregnant women (median 20.5 weeks, range 16.5-29.4) who participated in a population-based prospective cohort study. Delivery and medical records were assessed. Information on demographics, education, and maternal risk factors was collected by questionnaire. We used multivariate logistic regression analyses to assess associations between H. pylori colonization and PE, SGA, and PTB.

RESULTS

In total, 6348 pregnant women were assessed. H. pylori positivity was found in 2915 (46%) women, of whom 1023 (35%) also were CagA-positive. Pregnancy was complicated by PE, SGA, or PTB in 927 (15%) women. H. pylori colonization was associated with PE (aOR 1.51; 95%CI 1.03-2.25). Differentiation according to CagA status revealed the same risk. H. pylori was positively related with SGA, mainly explained by CagA-positive strains (aOR 1.34; 1.04-1.71). No association was observed between H. pylori and PTB.

CONCLUSIONS

Our data suggest that H. pylori colonization may be a risk factor for PE and SGA. If these associations are confirmed by future studies and shown to be causal, H. pylori eradication may reduce related perinatal morbidity and mortality.

Helicobacter pylori infection contributes to placental impairment in preeclampsia: basic and clinical evidences

BACKGROUND

Preeclampsia (PE) is a major cause of maternal and neonatal morbidity and mortality. Epidemiological association between Helicobacter pylori (Hp) infection and PE onset has been widely shown. The aim of this study was to analyze a possible correlation between Hp infection and the severity of clinical presentation of PE and to identify an immunologic mechanism triggered by Hp infection potentially contributing to the pathogenesis of PE.

MATERIALS AND METHODS

Sera from 93 preeclamptic women and 87 healthy pregnant women were tested for Hp infection by immunoassay and for anti-CagA antibodies by Western blot assay. The serologic results were correlated with the clinical features of PE. The functional effect of serum IgG fractions, positive or negative for Hp, from preeclamptic women or controls were tested on trophoblast and endothelial cell cultures and in a murine model of angiogenesis.

RESULTS

Preeclamptic women showed higher seroprevalence of Hp infection (57.0%) compared to controls (33.3%) (P<.001). The seropositivity for CagA-positive strains of Hp was 45.2% in preeclamptic women vs 13.7% in controls (P<.001). In PE women, Hp infection was associated with abnormality of uterine arteries Doppler (P<.001). Hp+ IgG fractions from preeclamptic women bound to trophoblast and endometrial endothelial cell cultures, reducing in vitro invasiveness and angiogenesis, respectively, and inhibited angiogenesis in mice.

CONCLUSIONS

Our data show, for the first time, an association between Hp infection and PE with abnormal uterine arteries Doppler velocimetry, suggesting a role for Hp infection in impairing placental development and increasing the risk to develop PE. This study opens the new perspective of a potential screening and treatment for Hp infection in pregnancy.

Effect of maternal Helicobacter Pylori infection on birth weight in an urban community in Uganda

BACKGROUND

Helicobacter pylori, a widespread infection particularly in developing countries has been associated with many adverse effects during pregnancy including hyperemesis gravidarum, neural tube defects in newborns, intrauterine fetal growth restriction and miscarriage. We sought to document the effects of H. pylori infection on birth weight in a low-income setting in Kampala, Uganda.

METHODS

This was a prospective cohort study conducted in Kampala between May 2012 and May 2013. The participants were H. pylori positive and H. pylori negative HIV negative primigravidae and secundigravidae. Recruitment was at ≤18 gestation weeks and follow up assessments were carried out at 26 and 36 gestation weeks and soon after delivery. H. pylori infection was determined using H. pylori stool antigen test. Maternal weight and height were measured, and body mass index (BMI) and gestational weight gain were calculated. Only term and live babies were considered. Low birth weight (LBW) was defined as a birth weight of <2500 gram.

RESULTS

A total of 221 participants were enrolled with mean ± standard deviation (SD) age of 20.9 ± 2.7 years. The mean ± SD gestation age at delivery was 39.4 ± 1.0 weeks. Primigravidae were 61.5 % (n = 188) and 52.9 % (n = 117) of the participants were positive for H. pylori infection. Low pre-pregnancy BMI (<18.5 kg/m(2)) was recorded in 14.6 % (n = 28) while 38 % (n = 73) had a height <156 cm at recruitment. Of the infants born to the participants, 13.6 % (n = 26) had low birth weight (<2500 gram). Independent predictors for LBW were the mother being positive for H. pylori infection (odds ratio, OR, 3.6, 95 % CI 1.1 - 11.5; P = 0.031) maternal height at recruitment <156 cm (OR 3.4, 95 % CI 1.4-8.2; P = 0.008) and maternal weight gain rates <0.3 kg/week during the 2(nd) and 3(rd) trimesters (OR 3.8, 95 % CI 1.0-14.1; P = 0.044).

CONCLUSION

H. pylori infection is associated with LBW among primigravidae and secundigravidae in Kampala, Uganda.

Barriers and Challenges in Hyperemesis Gravidarum Research

Nausea and occasional vomiting in early pregnancy (NVP) are common. When vomiting is severe or protracted, it is referred to as hyperemesis gravidarum (HG). HG affects up to 3% of pregnancies and is characterized by weight loss, dehydration, electrolyte imbalance, and the need for hospital admission. HG has significant consequences for maternal well-being, is associated with adverse birth outcomes, and leads to major health care costs. Treatment options are symptomatic, hampered by the lack of evidence-based options including studies on nutritional interventions. One of the reasons for this lack of evidence is the use of a broad range of definitions and outcome measures. An internationally accepted definition and the formulation of core outcomes would facilitate meta-analysis of trial results and implementation of evidence in guidelines to ultimately improve patient care.

A Dormant Microbial Component in the Development of Preeclampsia

Preeclampsia (PE) is a complex, multisystem disorder that remains a leading cause of morbidity and mortality in pregnancy. Four main classes of dysregulation accompany PE and are widely considered to contribute to its severity. These are abnormal trophoblast invasion of the placenta, anti-angiogenic responses, oxidative stress, and inflammation. What is lacking, however, is an explanation of how these themselves are caused. We here develop the unifying idea, and the considerable evidence for it, that the originating cause of PE (and of the four classes of dysregulation) is, in fact, microbial infection, that most such microbes are dormant and hence resist detection by conventional (replication-dependent) microbiology, and that by occasional resuscitation and growth it is they that are responsible for all the observable sequelae, including the continuing, chronic inflammation. In particular, bacterial products such as lipopolysaccharide (LPS), also known as endotoxin, are well known as highly inflammagenic and stimulate an innate (and possibly trained) immune response that exacerbates the inflammation further. The known need of microbes for free iron can explain the iron dysregulation that accompanies PE. We describe the main routes of infection (gut, oral, and urinary tract infection) and the regularly observed presence of microbes in placental and other tissues in PE. Every known proteomic biomarker of "preeclampsia" that we assessed has, in fact, also been shown to be raised in response to infection. An infectious component to PE fulfills the Bradford Hill criteria for ascribing a disease to an environmental cause and suggests a number of treatments, some of which have, in fact, been shown to be successful. PE was classically referred to as endotoxemia or toxemia of pregnancy, and it is ironic that it seems that LPS and other microbial endotoxins really are involved. Overall, the recognition of an infectious component in the etiology of PE mirrors that for ulcers and other diseases that were previously considered to lack one.

Helicobacter pylori, Chlamydiae pneumoniae and trachomatis as probable etiological agents of preeclampsia

OBJECTIVES

The aim of this study was to evaluate the evidence for Helicobacter pylori, Chlamydiae pneumoniae and trachomatis to act as a probable etiology for preeclampsia (PE), together with estimating the prevalence of such infections in pregnant women with PE.

METHODS

We performed a prospective study in Mansoura University Hospitals, Egypt, for detecting H. pylori infection by estimating H. pylori IgG and IgM, in addition to detection of Chlamydiae infections by PCR in 90 pregnant women with PE and 90 normotensive pregnant women of the same age and body mass index who were studied as control.

RESULTS

The prevalence of H. pylori infection in preeclamptic pregnant women was 54.4% with a statistically significant association to PE. The prevalence of C. pneumonia was 27.8% whereas that of C. trachomatis was 4.44%. The infected preeclamptic cases showed high levels of leucocytes besides elevated C-reactive protein concentrations.

CONCLUSION

Helicobacter pylori was found to act as a cofactor in the development of PE. Occurrence of C. trachomatis was low in pregnant women in our community; however, it showed that it may act as a cofactor in PE, whereas C. pneumoniae was attributed to have no role in PE pathogenesis until supported by further studies.

Helicobacter pylori seropositivity and pregnancy-related diseases: a prospective cohort study

The relationship between Helicobacter pylori infection and extragastric disease is well established. This study prospectively investigated whether maternal H. pylori seropositivity, detected during the first half of pregnancy, could be associated with the development of the major pregnancy-related pathological conditions during the late second or third trimester in a general population. Our hypothesis was that H. pylori infection might negatively influence pregnancy development and outcome. A total of 2820 consecutive pregnant women were recruited before 20 weeks' gestation, from October 2008 to August 2010, and blood samples were collected from each subject. IgG antibodies against H. pylori were assayed in maternal serum by a commercial immunoassay. Logistic regression analyses were performed to assess any association between H. pylori seropositivity and adverse pregnancy outcomes. Gestational diabetes mellitus (GDM) was the most common maternal complication (5.7%) and the only pregnancy-related disorder with a significantly higher rate of H. pylori-positive women (41.3%) compared with subjects who did not develop the disease (27.7%; P < 0.001; OR = 1.829, 95% CI = 1.320-2.533). The difference observed remained statistically significant after adjusting for potential confounding variables. The presence of antibodies against H. pylori antigens in maternal serum was independently associated with the development of GDM. These findings suggest that H. pylori eradication might play a role in the prevention of gestational diabetes mellitus.

[Helicobacter pylori infection and extragastroduodenal diseases]

At present, the clinical significance of Helicobacter pylori infection has been validly determined within the development of a diversity of gastroduodenal diseases, including chronic gastritis, gastroduodenal ulcer, MALT lymphoma, and gastric adenocarcinoma. The Expert Council's Maastricht IV consensus (2010) determining international standards for the diagnosis and treatment of H. pylori infection is that there is evidence that the latter may be associated with the development of a number of extragastroduodenal diseases (EGDDs) presented by iron-deficiency anemia of unspecified etiology, idiopathic thrombocytopenic purpura, and vitamin B12 deficiency. In these diseases, it is recommended that infection with H. pylori be diagnosed and, if the test is positive, this microorganism be eradicated. A large number of investigations have been recently conducted to examine the association of H. pylori infection with other EGDDs. This paper reviews theoretical and epidemiological data on the association of H. pylori with diseases of the cardiovascular (atherosclerosis, myocardial infarction) and central nervous (Alzheimer's disease, Parkinson's disease) systems, pancreas (autoimmune pancreatitis, pancreatic cancer), oncological (colonic adenomas, colorectal cancer, hepatocellular carcinoma), dermatological (chronic spontaneous urticaria), and other EGDDs. The review highlights the potential protective role of H. pylori in diseases with the atopic element of genesis and a complicated course of gastroesophageal reflux disease (Barrett's esophagus, esophageal adenocarcinoma).

Insights into the Role of Helicobacter pylori Infection in Preeclampsia: From the Bench to the Bedside

Preeclampsia (PE) is defined as a hypertensive and coagulative disorder affecting about 2–8% of all pregnancies and is one of the main causes of maternal and fetal morbidity and mortality. Despite the great amount of studies run in this field, little is known about the precise pathogenic mechanisms behind PE. While endothelial and trophoblast dysfunctions, exaggerated inflammatory response, and hypercoagulative state have been shown to play a key role in the occurrence of PE, the primary trigger is still unknown. One of the hypotheses is that some infectious agents may represent a trigger for PE onset. Consistently, higher seroprevalence of Helicobacter pylori (HP) infection, a Gram-negative bacterium with a specific tropism for human gastric mucosa, has been shown in women with PE. Even tighter association has been found between PE and infection with cytotoxin-associated gene-A (CagA)-positive strains of HP. Recent in vitro studies have shown that anti-CagA antibodies cross-react with human trophoblast cells and determine a functional impairment in terms of cell invasiveness, thus, providing the first pathogenic model of HP infection-mediated placental damage. Since in the early process of implantation and placental development, trophoblast invasion of maternal decidua is a crucial step, the proposed autoimmune mechanism induced by HP infection, negatively interfering with the fetal side of the early developing placenta, may represent a mechanism explaining the higher seropositivity for HP infection among PE women. However, the contribution of HP infection to the pathogenesis of PE or to the worsening of its clinical presentation need to be further investigated as well as the possible impact of pre-pregnancy screening and eradication of HP infection on the incidence of the syndrome.

Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment

Helicobacter pylori (H. pylori) is an extremely common, yet underappreciated, pathogen that is able to alter host physiology and subvert the host immune response, allowing it to persist for the life of the host. H. pylori is the primary cause of peptic ulcers and gastric cancer. In the United States, the annual cost associated with peptic ulcer disease is estimated to be $6 billion and gastric cancer kills over 700000 people per year globally. The prevalence of H. pylori infection remains high (> 50%) in much of the world, although the infection rates are dropping in some developed nations. The drop in H. pylori prevalence could be a double-edged sword, reducing the incidence of gastric diseases while increasing the risk of allergies and esophageal diseases. The list of diseases potentially caused by H. pylori continues to grow; however, mechanistic explanations of how H. pylori could contribute to extragastric diseases lag far behind clinical studies. A number of host factors and H. pylori virulence factors act in concert to determine which individuals are at the highest risk of disease. These include bacterial cytotoxins and polymorphisms in host genes responsible for directing the immune response. This review discusses the latest advances in H. pylori pathogenesis, diagnosis, and treatment. Up-to-date information on correlations between H. pylori and extragastric diseases is also provided.

Can Helicobacter pylori infection influence human reproduction?

Helicobacter pylori (H. pylori) infection could be associated with extra-digestive diseases. Here, we report the evidences concerning the decrease in reproductive potential occurring in individuals infected by H. pylori, especially by strains expressing CagA. This infection is more prevalent in individuals with fertility disorders. Infected women have anti-H. pylori antibodies in cervical mucus and follicular fluid that may decrease sperm motility and cross react immunologically with spermatozoa, conceivably hampering the oocyte/sperm fusion. Infection by CagA positive organisms enhances the risk of preeclampsia, which is a main cause of foetus death. These findings are supported by the results of experimental infections of pregnant mice, which may cause reabsorption of a high number of foetuses and alter the balance between Th1 and Th2 cell response. Infected men have decreased sperm motility, viability and numbers of normally shaped sperm and augmented systemic levels of inflammatory cytokines, such as tumor necrosis factor-α, which may damage spermatozoa. In countries where parasitic infestation is endemic, detrimental effects of infection upon spermatozoa may not occur, because the immune response to parasites could determine a switch from a predominant Th1 type to Th2 type lymphocytes, with production of anti-inflammatory cytokines. In conclusion, the evidences gathered until now should be taken into consideration for future studies aiming to explore the possible role of H. pylori infection on human reproduction.

A novel association between cytotoxin-associated gene A (CagA) positive strain of Helicobacter pylori and unexplained recurrent early pregnancy loss

OBJECTIVE

To assess whether or not there is an association between the cytotoxin-associated gene A (CagA)-positive strain of Helicobacter (H.) pylori and unexplained recurrent early pregnancy loss (REPL).

METHODS

A case control study was conducted in a tertiary care maternity centre during a one-year period. Ninety-six women with first trimester unexplained REPL admitted for surgical or medical termination of pregnancy were included in the study group (group 1), along with 96 women who suffered a first trimester missed abortion but had no history of REPL and who were included in the control group (group 2). Sera from all these women were collected for detection of the CagA line of IgG type of H. pylori using an immunoblotting assay. The main outcome measure was the association between the CagA-positive strain of H. pylori and unexplained REPL.

RESULTS

A significantly greater proportion of women were seropositive for the CagA- H. pylori strain in group 1 than in group 2 (71 [74%] vs. 51 [53%], respectively; p = 0.003).

CONCLUSION

The CagA-positive strain of H. pylori seems to be significantly more prevalent among women with unexplained REPL when compared to women with a single missed abortion.

Clinical effects of Helicobacter pylori outside the stomach

The discovery of Helicobacter pylori infection in the stomach could be considered as one of the most important events of modern gastroenterology. Understanding of the natural history of many disorders of the upper gastrointestinal tract, including chronic gastritis, peptic ulcer disease, gastric cancer and MALT lymphoma, was altered by this discovery. Interestingly, epidemiological studies have also revealed a correlation between H. pylori infection and some diseases localized outside the stomach, especially those characterized by persistent and low-grade systemic inflammation. Of note, H. pylori has an important role in iron deficiency anaemia, idiopathic thrombocytopenic purpura and vitamin B12 deficiency. Moreover, the association of this bacterial pathogen with many other diseases, including hepatobiliary, pancreatic, cardiovascular and neurodegenerative disorders is currently under investigation. In this Review, we summarize the results of the most important studies performed to date surrounding the association of H. pylori infection with extragastric diseases, as well as the strength of the evidence. We also provide information concerning bacterial-host interactions and the mechanisms implicated in the pathogenesis of each of these extragastric diseases.

Helicobacter pylori and pregnancy-related disorders

Helicobacter pylori (H. pylori) infection is investigated in gastric diseases even during pregnancy. In particular, this Gram-negative bacterium seems to be associated with hyperemesis gravidarum, a severe form of nausea and vomiting during pregnancy. During the last decade, the relationship among H. pylori and several extra-gastric diseases strongly emerged in literature. The correlation among H. pylori infection and pregnancy-related disorders was mainly focused on iron deficiency anemia, thrombocytopenia, fetal malformations, miscarriage, pre-eclampsia and fetal growth restriction. H. pylori infection may have a role in the pathogenesis of various pregnancy-related disorders through different mechanisms: depletion of micronutrients (iron and vitamin B₁₂) in maternal anemia and fetal neural tube defects; local or systemic induction of pro-inflammatory cytokines release and oxidative stress in gastrointestinal disorders and pre-eclampsia; cross-reaction between specific anti-H. pylori antibodies and antigens localized in placental tissue and endothelial cells (pre-eclampsia, fetal growth restriction, miscarriage). Since H. pylori infection is most likely acquired before pregnancy, it is widely believed that hormonal and immunological changes occurring during pregnancy could activate latent H. pylori with a negative impact not only on maternal health (nutritional deficiency, organ injury, death), but also on the fetus (insufficient growth, malformation, death) and sometime consequences can be observed later in life. Another important issue addressed by investigators was to determine whether it is possible to transmit H. pylori infection from mother to child and whether maternal anti-H. pylori antibodies could prevent infant’s infection. Studies on novel diagnostic and therapeutic methods for H. pylori are no less important, since these are particularly sensitive topics in pregnancy conditions. It could be interesting to study the possible correlation between H. pylori infection and other pregnancy-related diseases of unknown etiology, such as gestational diabetes mellitus, obstetric cholestasis and spontaneous preterm delivery. Since H. pylori infection is treatable, the demonstration of its causative role in pregnancy-related disorders will have important social-economic implications.

Extragastric diseases and Helicobacter pylori

In the last year, several diseases from outside of the gastrointestinal tract have been associated with Helicobacter pylori infection. Indeed, this bacterium produces a low-grade inflammatory state, induces molecular mimicry mechanisms, and interferes with the absorbance of nutrients and drugs possibly influencing the occurrence or the evolution of many diseases. In addition to its role in some hematologic conditions, such as immune thrombocytopenic purpura, idiopathic sideropenic anemia, and vitamin B12 deficiency, which were included in the current guidelines, several other conditions such as cardiovascular diseases, diabetes mellitus, hepatobiliary diseases, and neurologic disorders have also shown promising results.