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Mlambo ZP, Sebitloane M, Naicker T. Association of angiogenic factors (placental growth factor and soluble FMS-like tyrosine kinase-1) in preeclamptic women of African ancestry comorbid with HIV infection. Arch Gynecol Obstet 2024:10.1007/s00404-024-07590-3. [PMID: 38910142 DOI: 10.1007/s00404-024-07590-3] [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: 10/06/2023] [Accepted: 06/04/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Preeclampsia is a significant cause of maternal and fetal morbidity and mortality, particularly in low- and middle-income countries like South Africa. AIM The aim of our study was to investigate the association between placental growth factor (PlGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1) in South African preeclamptic women of African ancestry, comorbid with HIV infection. METHODS The study population consisted of women attending a regional hospital in Durban, South Africa, stratified by pregnancy type (normotensive pregnant and preeclampsia) and HIV status. Preeclampsia was defined as new-onset hypertension and proteinuria. DNA was obtained from whole blood. The SNPs of interest were rs722503 in sFlt-1 and rs4903273 in PlGF. RESULTS Our findings suggest that single nucleotide polymorphisms of rs722503 analysis show no significant associations between the genotypic frequencies of rs722503 variants and preeclampsia risk in either HIV-negative or HIV-positive groups of women of African ancestry. Similarly, the rs493273 polymorphism showed no significant association with preeclampsia risk in either HIV-negative or HIV-positive pregnant women. Additionally, comparisons of dominant, recessive, and over-dominant allele models did not reveal significant associations. These findings suggest that these genetic variants may not significantly contribute to preeclampsia development in this African ancestry population. However, significant differences were observed in the rs4903273 genotype frequencies between normotensive and preeclamptic women, regardless of HIV status, over dominant alleles AA + GG vs AG showed a significant difference [OR = 2.706; 95% Cl (1.199-5.979); adjusted p = 0.0234*], also in normotensive compared to EOPE (OR = 2.804; 95% Cl (1.151-6.89) p = 0.0326* and LOPE (OR = 2.601; 95% Cl (1.0310-6.539) p = 0.0492*), suggesting that they may be the potential role of this variant in preeclampsia susceptibility. CONCLUSION The findings suggest that the rs722503 and rs493273 polymorphisms do not significantly contribute to preeclampsia susceptibility in HIV-negative or HIV-positive pregnant women. However, the rs4903273 genotype frequencies showed notable differences between normotensive and preeclamptic women, indicating a potential association with preeclampsia development in the African ancestry population irrespective of HIV status.
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Affiliation(s)
- Zinhle P Mlambo
- Optics and Imaging Centre, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Motshedisi Sebitloane
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- Optics and Imaging Centre, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Mirieri H, Nduati R, Dawa J, Okutoyi L, Osoro E, Mugo C, Wamalwa D, Jin H, Mwaengo D, Otieno N, Marwanga D, Shabibi M, Munyua P, Kinuthia J, Clancey E, Widdowson MA, Njenga MK, Verani JR, Inwani I. Risk factors of adverse birth outcomes among a cohort of pregnant women in Coastal Kenya, 2017-2019. BMC Pregnancy Childbirth 2024; 24:127. [PMID: 38347445 PMCID: PMC10860222 DOI: 10.1186/s12884-024-06320-6] [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: 04/05/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Adverse birth outcomes particularly preterm births and congenital anomalies, are the leading causes of infant mortality globally, and the burden is highest in developing countries. We set out to determine the frequency of adverse birth outcomes and the risk factors associated with such outcomes in a cohort of pregnant women in Kenya. METHODS From October 2017 to July 2019, pregnant women < 28 weeks gestation were enrolled and followed up until delivery in three hospitals in coastal Kenya. Newborns were examined at delivery. Among women with birth outcome data, we assessed the frequency of congenital anomalies defined as gastroschisis, umbilical hernia, limb abnormalities and Trisomy 21, and adverse birth outcomes, defined as either stillbirth, miscarriage, preterm birth, small for gestational age, or microcephaly. We used log-binomial regression to identify maternal characteristics associated with the presence of at least one adverse outcome. RESULTS Among the 2312 women enrolled, 1916 (82.9%) had birth outcome data. Overall, 402/1916 (20.9%; 95% confidence interval (CI): 19.1-22.8) pregnancies had adverse birth outcomes. Specifically, 66/1916 (3.4%; 95% CI: 2.7-4.4) were stillbirths, 34/1916 (1.8%; 95% CI: 1.2-2.4) were miscarriages and 23/1816 (1.2%; 95% CI: 0.8-1.9) had congenital anomalies. Among the participants with anthropometric measurements data, 142/1200 (11.8%; 95% CI: 10.1 - 13.8) were small for gestational age and among the participants with ultrasound records, 143/1711 (8.4%; 95% CI: 7.1-9.8) were preterm. Febrile illnesses in current pregnancy (adjusted risk ratio (aRR): 1.7; 95% CI: 1.1-2.8), a history of poor birth outcomes in prior pregnancy (aRR: 1.8; 95% CI: 1.3-2.4) and high blood pressure in pregnancy (aRR: 3.9, 95% CI: (1.7-9.2) were independently associated with adverse birth outcomes in a model that included age, education, human immunodeficiency virus status and high blood pressure at enrolment. CONCLUSION We found similar rates of overall adverse birth outcomes, congenital anomalies, and small for gestational age but higher rates of stillbirths and lower rates of prematurity compared to the rates that have been reported in the sub-Saharan Africa region. However, the rates of adverse birth outcomes in this study were comparable to other studies conducted in Kenya. Febrile illnesses during the current pregnancy, previous history of poor birth outcomes and high blood pressure in pregnancy are predictive of an increased risk of adverse birth outcomes.
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Affiliation(s)
- Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya.
| | - Ruth Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Lydia Okutoyi
- Department of Health Care Quality, Kenyatta National Hospital, Nairobi, Kenya
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Hafsa Jin
- Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Dufton Mwaengo
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Nancy Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Doris Marwanga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | | | - Peninah Munyua
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Erin Clancey
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - M Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Irene Inwani
- Department of Paediatrics, Kenyatta National Hospital, Nairobi, Kenya
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Wang D, Xiao C, Li H, Fan J. Serum ferritin and 25-hydroxyvitamin D levels as predictors for premature birth in pregnant women with preeclampsia. Medicine (Baltimore) 2023; 102:e35741. [PMID: 37933037 PMCID: PMC10627698 DOI: 10.1097/md.0000000000035741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/29/2023] [Indexed: 11/08/2023] Open
Abstract
This study aimed to investigate the expression levels of serum ferritin (SF) and 25-hydroxyvitamin D (25-[OH]-D) and analyze their predictive value for premature birth in pregnant women with preeclampsia. Between December 2018 and December 2021, 104 pregnant women with preeclampsia were selected as the observation group and 52 pregnant women with normal blood pressure as the control group. The observation group were divided into occurrence and nonoccurrence groups according to gestational age at birth. Relevant laboratory indicators were examined in both the occurrence and nonoccurrence groups, and the predictive value of SF and 25-(OH)-D levels for premature births in pregnant women with preeclampsia was analyzed. The incidence of premature delivery in the 104 pregnant women with preeclampsia was 20.19% (21/104). Pre-pregnancy body mass index (BMI), systolic blood pressure, diastolic blood pressure, 24 hours urinary protein, triglycerides, and SF levels of the pregnant women in the observation group were significantly higher, and the 25-(OH)-D levels were significantly lower, than those in the control group (P < .05). Furthermore, the pre-pregnancy BMI, systolic blood pressure, diastolic blood pressure, 24 hours urinary protein, and SF levels of pregnant women in the occurrence group were significantly higher, and the 25-(OH)-D levels were significantly lower, than those in the nonoccurrence group (P < .05). Logistic regression analysis showed that high pre-pregnancy BMI, systolic blood pressure, diastolic blood pressure, 24 hours urinary protein, and SF levels were risk factors for premature birth in pregnant women with preeclampsia (OR > 1, P < .05) and that high serum 25-(OH)-D was a protective factor (OR < 1, P < .05). In conclusion, SF and 25-(OH)-D levels are abnormally expressed in pregnant women with preeclampsia and are associated with premature birth in these women.
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Affiliation(s)
- Dandan Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
| | - Chenwei Xiao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
| | - Hongyu Li
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
| | - Jing Fan
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
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Ma S, Wu L, Yu Q, Chen D, Geng C, Peng H, Yu L, Zhang M. Associations Between Trajectory of Different Blood Pressure Components in Pregnancy and Risk of Adverse Birth Outcomes - A Real World Study. Risk Manag Healthc Policy 2021; 14:3255-3263. [PMID: 34393532 PMCID: PMC8360358 DOI: 10.2147/rmhp.s318956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background High blood pressure during pregnancy has been suggested to be associated with adverse birth outcomes (ABO), but it is unclear how different blood pressure changes and the extent of the effect. Therefore, we aimed to investigate the association between blood pressure trajectories (systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP)) of pregnant women and ABO in a real-world study. Material and Methods Leveraging 28,679 pregnant women and their fetuses from a register-based cohort from January 1, 2010, to December 31, 2019. Blood pressure trajectories were estimated by package “traj” in R software using real-world blood pressure data of routine antenatal care examinations. Logistic regression models were applied to examine the association between trajectories of different blood pressure components (SBP, DBP, MAP, and PP) during pregnancy and the risk of ABO. Results Trajectories of all blood pressure components were identically labeled as low-stable, moderate-increasing, moderate-decreasing and high-stable. After adjusting for confounding factors, compared with pregnant women with the low-stable pattern, pregnant women with a high-stable or moderate-increasing pattern had a significantly increased risk of developing adverse birth outcomes. Pregnant women with a moderate-decreasing pattern had no significant increased risk of ABO but had a lower risk of adverse birth outcomes than those with a moderate-increasing pattern. The trajectories crossed at 17–20 weeks of gestation for all blood pressure components. Conclusion Our study results indicated that reduction and maintenance of blood pressure to a low level of less than 110 mmHg for SBP and 65 mmHg for DBP after 20 weeks of gestation would benefit prevention of adverse birth outcomes, regardless of the level of blood pressure at early pregnancy.
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Affiliation(s)
- Shengqi Ma
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Lei Wu
- Department of Maternal and Child Health, Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, Jiangsu, People's Republic of China
| | - Qing Yu
- Department of Gynecology and Obstetrics, Suzhou Kowloon Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Donghui Chen
- Department of Maternal and Child Health, Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, Jiangsu, People's Republic of China
| | - Chunsong Geng
- Department of Gynecology and Obstetrics, Suzhou Kowloon Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Hao Peng
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Lugang Yu
- Department of Maternal and Child Health, Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, Jiangsu, People's Republic of China
| | - Mingzhi Zhang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
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Nabweyambo S, Sande OJ, McGovern N, Bwanga F, Ssekagiri A, Keesiga A, Adroma M, Wasswa R, Atuheirwe M, Namugenyi J, Castelnuovo B, Nakimuli A. Circulating levels of angiogenic factors and their association with preeclampsia among pregnant women at Mulago National Referral Hospital in Uganda. PLoS One 2021; 16:e0251227. [PMID: 34010327 PMCID: PMC8133410 DOI: 10.1371/journal.pone.0251227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
Preeclampsia (PE) is a major cause of maternal and new-born morbidity and mortality. Angiogenic factors contribute a major role in the vascular dysfunction associated with PE. We investigated the circulating levels of vascular endothelial growth factor (VEGF), placental growth factor (PlGF) and soluble Feline McDonough Sarcoma (fms)-like tyrosine kinase-1 (sFlt1), their association with PE and diagnostic performance of disease among pregnant women in Uganda. Using a case-control study design, 106 women with PE and 106 with normal pregnancy were enrolled. Demographic and clinical characteristics, and anticoagulated blood samples were collected from participants. Plasma VEGF, PlGF and sFlt1 levels were measured using Luminex and enzyme linked immunosorbent assays (ELISA). Conditional logistic regression was used to explore association of angiogenic factors with PE and receiver operating characteristic analysis was performed to investigate PE diagnostic performance. Levels of VEGF and PIGF were significantly lower in cases compared to controls (VEGF: median = 0.71 pg/ml (IQR = 0.38-1.11) Vs 1.20 pg/ml (0.64-1.91), p-value<0.001 and PlGF: 2.20 pg/ml (1.08-5.86) Vs 84.62 pg/ml (34.00-154.45), p-value<0.001). Plasma levels of sFlt1 were significantly higher in cases than controls (median = 141.13 (71.76-227.10) x103 pg/ml Vs 19.86 (14.20-29.37) x103 pg/ml). Increasing sFlt1 levels were associated with increased likelihood of PE (aOR = 4.73; 95% CI, 1.18-19.01; p-value = 0.0287). The sFlt1/PlGF ratio and sFlt1 had a better performance for diagnosis of PE, with AUC = 0.95 (95% CI, 0.93-0.98) followed by PlGF with AUC = 0.94 (95% CI, 0.91-0.97). Therefore, sFlt1, sFlt1/PlGF ratio and PlGF are potential candidates for incorporation into algorithms for PE diagnosis in the Ugandan population.
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Affiliation(s)
- Sheila Nabweyambo
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Obondo James Sande
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Naomi McGovern
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Freddie Bwanga
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alfred Ssekagiri
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
| | - Annette Keesiga
- Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda
| | - Moses Adroma
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Wasswa
- Department of Immunology, Global Health Uganda, Kampala, Uganda
| | - Maxine Atuheirwe
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Namugenyi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Lewandowska M, Więckowska B. The Influence of Various Smoking Categories on The Risk of Gestational Hypertension and Pre-Eclampsia. J Clin Med 2020; 9:jcm9061743. [PMID: 32512866 PMCID: PMC7356904 DOI: 10.3390/jcm9061743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022] Open
Abstract
The relationship between smoking and the risk of pregnancy-induced hypertension (PIH) is not clearly established. Therefore, we conducted an analysis of cigarette smoking in a Polish cohort of women, recruited in the first trimester of a single pregnancy in 2015–2016. We evaluated the women who subsequently developed PIH (n = 137) (gestational hypertension—GH (n = 113) and pre-eclampsia—PE (n = 24)), and the women who remained normotensive (n = 775). The diseases odds ratios (and 95% CI—confidence intervals) were calculated in a multivariate logistic regression. In the PIH cases (vs. normotensive women) we found more smokers (25.6% vs. 17.2%, p = 0.020) including smokers in the first trimester (14.6% vs. 4.8%, p < 0.001). The average number of cigarettes smoked daily per smokers in the first trimester was 11.2 (range 2–30), and the average number of years of smoking was 11.6 (range 2–25). The number of years of smoking was a stronger risk factor for GH and PE than the number of cigarettes/day. Compared to the women who have never smoked, smoking ever before pregnancy was associated with a higher GH risk (AOR = 1.68; p = 0.043), and with no effect on PE risk (OR = 0.97; p = 0.950). Smokers in the first trimester had a higher odds ratio of GH (AOR = 4.75; p < 0.001) and PE (OR = 2.60; p = 0.136). Quitting smoking before pregnancy (ex-smokers) was associated with a lower odds ratio of GH (AOR = 0.83; p = 0.596) and PE (OR = 0.33; p = 0.288). However, quitting smoking during pregnancy was associated with a higher risk of GH (AOR = 11.63; p < 0.0001) and PE (OR = 3.57; p = 0.238). After dissection of the cohort into pre-pregnancy body–mass index (BMI) categories, smoking in the first trimester was associated with the higher hypertension risk in underweight women (OR = 22.00, p = 0.024). Conclusions: The factors that increased the risk of GH and PE were smoking in the first trimester and (paradoxically and more strongly) smoking cessation during pregnancy. Our results suggest that women of childbearing potential should be encouraged to quit smoking before pregnancy.
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Affiliation(s)
- Małgorzata Lewandowska
- Medical Faculty, Lazarski University, 02-662 Warsaw, Poland
- Division of Gynecological Surgery, University Hospital, 33 Polna Str., 60-535 Poznan, Poland
- Correspondence:
| | - Barbara Więckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
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