1
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Palalioglu RM, Erbiyik HI. Evaluation of maternal serum SERPINC1, E-selectin, P-selectin, RBP4 and PP13 levels in pregnancies complicated with preeclampsia. J Matern Fetal Neonatal Med 2023; 36:2183472. [PMID: 36822662 DOI: 10.1080/14767058.2023.2183472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE The aim of this study is to investigate whether Serpin clade C (SERPINC1), E-selectin, P-selectin, Placental protein 13 (PP13), and Retinol-binding protein-4 (RBP4) levels in maternal serum were associated with the presence of preeclampsia and to compare them with uncomplicated pregnancies. METHODS This prospective study included 40 women with preeclampsia and 40 healthy pregnant women. An enzyme-linked immunosorbent assay kit was used to measure serum SERPINC1, E-selectin, P-selectin, PP13, and RBP4 levels. RESULTS The preeclampsia group had significantly higher E-selectin and P-selectin levels than the control group. PP13 and SERPINC1 levels were also significantly lower than the control group. There was no significant difference in RBP4 levels. The receiver operating characteristic curve revealed the best cutoff values for the following: E-selectin >19.2 ng/mL, with 87.5% sensitivity and 95% specificity; P-selectin >5.1 ng/mL, with 97.5% sensitivity and 100% specificity; PP13 ≤ 107.03 pg/mL, with 72.5% sensitivity and 77.5% specificity; and SERPINC1 ≤ 87.76 ng/mL, with 100% sensitivity and 97.5% specificity. CONCLUSION In this study, the endothelial dysfunction parameters SERPINC1, PP13, E-selectin, and P-selectin were found to be associated with preeclampsia. Endothelial dysfunction biomarkers in maternal non-serum body fluids may differ. More research is needed, especially to determine the relationship between SERPINC1 and preeclampsia.
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Affiliation(s)
- Rabia Merve Palalioglu
- Department of Obstetrics and Gynecology, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Halil Ibrahim Erbiyik
- Operation Room Services, Uskudar University, Istanbul, Turkey.,Dr. Moral Obstetrics and Gynecology Clinic, Istanbul, Turkey
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2
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Amikam U, Hochberg A, Shenhav M, Haj L, Hochberg-Klein S, Hiersch L, Yogev Y. Anti-Phospholipid Antibodies in Women with Placenta-Mediated Complications Delivered at >34 Weeks of Gestation. J Clin Med 2023; 12:4516. [PMID: 37445549 DOI: 10.3390/jcm12134516] [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: 06/01/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To determine the prevalence of positive antiphospholipid (aPL) antibodies among pregnant women with placenta-mediated complications delivered at >340/7 weeks of gestation. METHODS This was a single-center retrospective observational study conducted between 2017 and 2022. Inclusion criteria included pregnant or post-partum women, >18 years, diagnosed with any of the following placenta-mediated complications and delivered at >340/7 weeks of gestation: small-for-gestational-age neonate (SGA ≤ 5th percentile according to local birthweight charts), preeclampsia with severe features, and placental abruption. The primary outcome was the prevalence of positive aPL antibodies: Lupus anticoagulant, Anticardiolipin, or Anti-ß2glycoprotein1. RESULTS Overall, 431 women met the inclusion criteria. Of them, 378(87.7%) had an SGA neonate, 30 had preeclampsia with severe features (7%), 23 had placental abruption (5.3%), and 21 patients had multiple diagnoses(4.9%). The prevalence of aPL antibodies in the cohort was 4.9% and was comparable between the three subgroups (SGA-3.9%; PET with severe features-3.3%; and placental abruption-13% (p = 0.17)). CONCLUSION aPL antibodies prevalence in women with placenta-mediated complications > 34 weeks of gestation was 4.9%, with comparable prevalence rates among the three subgroups. Future prospective studies are needed to delineate the need for treatment in those who tested positive for aPL antibodies and do not meet Anti-Phospholipid Antibody Syndrome clinical criteria.
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Affiliation(s)
- Uri Amikam
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Alyssa Hochberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Michael Shenhav
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Lilian Haj
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Sarit Hochberg-Klein
- Palmerston North Hospital, Te Whatu Ora Health NZ, Palmerston North 4442, New Zealand
| | - Liran Hiersch
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Yariv Yogev
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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3
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Brenner B, Papadakis E, Greer IA, Gris JC. Assessment-based management of placenta-mediated pregnancy complications: Pragmatism until a precision medicine approach evolves. Br J Haematol 2023. [PMID: 37169354 DOI: 10.1111/bjh.18856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023]
Abstract
The management of pregnant women with thrombophilia and a history of gestational vascular complications remains debatable. Treatment of the latter is often based on clinical outcome rather than disease mechanism. While the use of venous thromboembolism prophylaxis in pregnancy is recommended for those at increased risk, the ability of anticoagulant and/or antiplatelet agents to lower the risk of placenta-mediated complications in this clinical setting remains controversial. The available guidelines are inconsistent in some situations, which reflects the limited evidence base. This review critically discusses risk assessment models (RAMs) and management strategies of women with thrombophilia and pregnancy complications, using clinical vignettes. RAMs, taking into account obstetric and thrombotic history as well as thrombophilia status, could drive a precision medicine approach, based on disease mechanism, and guide individual therapeutic interventions in high-risk clinical settings.
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Affiliation(s)
- Benjamin Brenner
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emmanouil Papadakis
- Thrombosis & Hemostasis Clinic, Ob/Gyn Hematology, Genesis Hospital, Thessaloniki, Greece
| | | | - Jean-Christophe Gris
- Department of Haematology, CHU Nîmes, University of Montpellier, Nîmes, France
- UMR UA11 INSERM IDESP-Montpellier University, Montpellier, France
- Department of Obstetrics, Gynaecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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4
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Guzeltas G, Ibanoglu MC, Engin-Üstün Y. Cysteinyl Leukotriene and Systemic Inflammatory Levels in Preeclampsia. Cureus 2023; 15:e37764. [PMID: 37213986 PMCID: PMC10194035 DOI: 10.7759/cureus.37764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Background In this study, we aimed to demonstrate the efficacy of cysteinyl leukotriene levels, which play a role in inflammation, in predicting the severity of preeclampsia (PE) and to determine whether this marker can be used as a screening tool. Methods In this cross-sectional analytic study, we classified pregnant women who were normotensive (control) or PE or severe PE (SPE) between March 2019 and July 2019. Singleton pregnant 60 women who met the following criteria for the diagnosis of PE were included in the study group. We identified 30 patients with PE and 30 patients with SPE. Normotensive pregnant women (n=30) who met this criterion were included as a control group by randomly selecting them on odd days of the week. Results All pregnant women who participated in the study had a singleton pregnancy, and maternal age ranged from 18 to 40 years, with a mean age of 28.77±6.37 years. The mean gestational week of the group was 35.54±3.247 weeks. Gestational age was higher in women in the control group (p=0.018), shock index was higher in women in the control group (p < 0.001), and body mass index (BMI) value was lower in this group than in the other groups (p=0.002). The values of mean arterial pressure (MAP) were found to have a strong correlation with shock index value and a weak and negative correlation with gestational week and platelet/lymphocyte ratio (p < 0.05). The mean cysteinyl leukotriene levels of 206.15 pg/mL for the control group, 273.2 pg/mL for PE, and 211.85 pg/mL for SPE were calculated. However, no statistically significant difference was found between the groups (p=0.707). Conclusion We found that cysteinyl leukotrienes were not clinically important in assessing the risk for developing PE and predicting SPE. Alanine aminotransferase, white blood cell, lymphocyte, C-reactive protein, platelet/lymphocyte ratio, and shock index were positively correlated with the value of MAP.
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Affiliation(s)
- Gokhan Guzeltas
- Obstetrics, University of Health Sciences Ankara City Hospital, Ankara, TUR
| | | | - Yaprak Engin-Üstün
- Obstetrics and Gynecology, University of Health Sciences Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, TUR
- Obstetrics and Gynecology, Zekai Tahir Burak Womens Health Research and Education Hospital, Ankara, TUR
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5
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Palalıoğlu RM, Erbiyik HI. Assessment of maternal serum SERPINC1, E-selectin, P-selectin, and RBP4 levels in pregnancies with early- and late-onset preeclampsia. J Obstet Gynaecol Res 2023; 49:870-882. [PMID: 36604828 DOI: 10.1111/jog.15532] [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: 08/27/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION To investigate whether the SERPINC1, E-selectin, P-selectin, and RBP4 levels in first trimester maternal serum was associated with the presence of preeclampsia (PE). METHODS This cross-sectional study was conducted on 26 women with early-onset preeclampsia (EO-PE), 27 women with late-onset preeclampsia (LO-PE), and 27 women with uncomplicated pregnancies. Levels of serum SERPINC1, E-selectin, P-selectin, and RBP4 were measured with the use of an enzyme-linked immunosorbent assay (ELISA) kit. RESULTS E-Selectin levels in patients with EO-PE were higher than those with LO-PE and control patients (pE-L = 0.025; pE-C = 0.000; p < 0.05). There was no significant intergroup difference in terms of P-selectin and RBP4 levels (p > 0.05). SERPINC1 levels were lower in the patients in the with EO-PE group than in those in the LO-PE and the control groups (pE-L = 0.000; pE-C = 0.000; p < 0.05). In the PE group, there was a negative, moderate (41.7%) correlation between E-selectin level and SERPINC1 (p = 0.002; p < 0.05). The receiver operating characteristic (ROC) curve showed that the best cut-off values for E-selectin were 23.14 ng/ml > with 100% sensitivity and 100% specificity. The ROC curve showed that the best cut-off values for SERPINC1 were ≤87.76 ng/ml with 98.1% sensitivity and 96.3% specificity. DISCUSSION Of the endothelial damage parameters, E-selectin and SERPINC1 are especially associated with EO-PE. Furthermore, they can be used as potential early diagnosis markers in the prediction of PE.
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Affiliation(s)
- Rabia Merve Palalıoğlu
- Department of Obstetrics and Gynecology, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Halil Ibrahim Erbiyik
- Operation Room Services, Uskudar University, Istanbul, Turkey.,Moral Obstetrics and Gynecology Clinic, Istanbul, Turkey
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6
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Pregnancy Complications Can Foreshadow Future Disease—Long-Term Outcomes of a Complicated Pregnancy. Medicina (B Aires) 2021; 57:medicina57121320. [PMID: 34946265 PMCID: PMC8704070 DOI: 10.3390/medicina57121320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 01/22/2023] Open
Abstract
During gestation, the maternal body should increase its activity to fulfil the demands of the developing fetus as pregnancy progresses. Each maternal organ adapts in a unique manner and at a different time during pregnancy. In an organ or system that was already vulnerable before pregnancy, the burden of pregnancy can trigger overt clinical manifestations. After delivery, symptoms usually reside; however, in time, because of the age-related metabolic and pro-atherogenic changes, they reappear. Therefore, it is believed that pregnancy acts as a medical stress test for mothers. Pregnancy complications such as gestational hypertension, preeclampsia and gestational diabetes mellitus foreshadow cardiovascular disease and/or diabetes later in life. Affected women are encouraged to modify their lifestyle after birth by adjusting their diet and exercise habits. Blood pressure and plasmatic glucose level checking are recommended so that early therapeutic intervention can reduce long-term morbidity. Currently, the knowledge of the long-term consequences in women who have had pregnancy-related syndromes is still incomplete. A past obstetric history may, however, be useful in determining the risk of diseases later in life and allow timely intervention.
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7
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Liew-Spilger AE, Sorg NR, Brenner TJ, Langford JH, Berquist M, Mark NM, Moore SH, Mark J, Baumgartner S, Abernathy MP. Viscoelastic Hemostatic Assays for Postpartum Hemorrhage. J Clin Med 2021; 10:3946. [PMID: 34501395 PMCID: PMC8432102 DOI: 10.3390/jcm10173946] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 12/15/2022] Open
Abstract
This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.
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Affiliation(s)
- Alyson E. Liew-Spilger
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA;
| | - Nikki R. Sorg
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA; (N.R.S.); (N.M.M.); (J.M.)
| | - Toby J. Brenner
- Division of Natural Sciences, Indiana Wesleyan University, Marion, IN 46953, USA;
| | - Jack H. Langford
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA;
| | - Margaret Berquist
- College of Science, University of Notre Dame, Notre Dame, IN 46556, USA;
| | - Natalie M. Mark
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA; (N.R.S.); (N.M.M.); (J.M.)
| | - Spencer H. Moore
- Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, USA;
| | - Julie Mark
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA; (N.R.S.); (N.M.M.); (J.M.)
| | - Sara Baumgartner
- Department of Obstetrics and Gynecology, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Mary P. Abernathy
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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8
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Izhar R, Ala SH, Husain S, Husain S. Anti-phospholipid antibodies in women presenting with preterm delivery because of preeclampsia or placental insufficiency. J Turk Ger Gynecol Assoc 2021; 22:85-90. [PMID: 33631871 PMCID: PMC8187972 DOI: 10.4274/jtgga.galenos.2021.2020.0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To assess the proportion of women presenting with preterm delivery because of preeclampsia or placental insufficiency (PREPI) with anti-phospholipid antibodies (APLA). Material and Methods: This was a prospective cohort study conducted at an obstetrics and gynecology department. Women, aged 20-40 years, with preeclampsia who delivered before 34 weeks were cases while those who delivered before 34 weeks but did not have preeclampsia acted as controls. Both groups had APLA measured at diagnosis and 12-weeks postnatally. Anti-phospholipid antibody syndrome (APS) was diagnosed according to Sapporo’s criteria. Results: The study included 98 cases and 106 controls. Both cases and controls were similar in terms of age, gestational age and parity. The frequency of APS positivity was 17.3% in cases but only 3.8% in controls (p=0.001). Cases were more likely to be of Baloch ethnicity (34.7% vs. 11.3%, p=0.001), have a history of miscarriage (25.5% vs. 13.2%, p=0.026), use aspirin (p<0.001) or low molecular weight heparin (p<0.001), and be obese (p<0.001) than controls. Cases were more likely to have lupus anticoagulant antibodies (82.4% vs. 75%). Conclusion: Our study confirms a high prevalence of APLA in women who have preterm delivery due to PREPI. An opportunity to screen these women should be made, so that proper counselling can be given and future pregnancies can be managed in an appropriate and timely manner.
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Affiliation(s)
- Rubina Izhar
- Department of Obstetrics and Gynecology, Karachi Medical and Dental College, Abbasi Shaheed Hospital, Karachi, Pakistan
| | - Syed Hasan Ala
- Department of Obstetrics and Gynecology, Dow University of Health Sciences, Karachi, Pakistan
| | - Samia Husain
- Department of Obstetrics and Gynecology, Karachi Medical and Dental College, Abbasi Shaheed Hospital, Karachi, Pakistan
| | - Sonia Husain
- Department of Obstetrics and Gynecology, Karachi Medical and Dental College, Abbasi Shaheed Hospital, Karachi, Pakistan
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9
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John-Olabode SO, Okunade KS, James A, Olorunfemi G, Ajie OI, Osuntoki AA, Akanmu AS. Prevalence of Factor V Leiden G1691A and Prothrombin G20210A Gene Mutation Among Pregnant Women: Experience from a Multi-Center Study in Nigeria. J Blood Med 2021; 12:307-312. [PMID: 34040475 PMCID: PMC8140909 DOI: 10.2147/jbm.s308997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Inherited thrombophilia and venous thromboembolism (VTE) have been closely linked to adverse pregnancy outcomes such as preeclampsia/eclampsia contributing to increased maternal and perinatal morbidity and mortality. There is, however, little genetic data from Africa including Nigeria that explores the prevalence of common VTE genetic risk markers such as factor V Leiden mutation (FVL G1691A) and prothrombin gene mutation (F2 G20210A) among pregnant women in Nigeria. Purpose To determine the prevalence and distribution of FVL G1691A and F2 G20210A in pregnant women in Lagos, Nigeria. Patients and Methods This hospital-based cross-sectional pilot study was conducted among pregnant women between 1 July 2019 and 31 August 2020. The genotype of interest was determined through amplification by polymerase chain reaction using G1691A of FV and prothrombin A20210G specific primers. Descriptive data were presented using Stata version 15 (Stata Corp) statistical software. Results Of the 400 recruited participants, 397 and 389 samples were successfully processed for FVL G1691A and F2 G20210A mutations, respectively. Three participants had FVL heterozygous mutation; thus, the prevalence of heterozygous mutation of FVL among the study participants was 0.76%, 95% CI: 0.002-0.023%, n=3/397. There was no F2 G20210A mutation detected among the study participants. Conclusion This study indicates that screening for factor V Leiden mutation and prothrombin gene mutation in pregnancy might not be of any clinical significance among Nigerian women. However, carrying out a genome-wide associated study is recommended to determine the true impact of these two common inherited thrombophilias in this population.
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Affiliation(s)
- Sarah O John-Olabode
- Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Kehinde S Okunade
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ayorinde James
- Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Obiefuna I Ajie
- Department of Clinical Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Akinniyi A Osuntoki
- Department of Biochemistry, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Alani S Akanmu
- Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
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10
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Lah S, Cheung NW, Lee V, Athayde N, Inglis E, Padmanabhan S. Aspirin and pre-eclampsia prevention in women with pre-existing diabetes: a retrospective study. Intern Med J 2021; 51:1673-1680. [PMID: 33650231 DOI: 10.1111/imj.15257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aspirin is routinely prescribed in high-risk pregnancies to prevent pre-eclampsia; however, there is a paucity of data in women with pre-existing diabetes. AIMS To assess the efficacy and safety of aspirin in women with pre-existing diabetes in preventing pre-eclampsia. METHODS A retrospective review of women with pre-existing diabetes who attended antenatal clinics in a tertiary referral hospital between 2013 and 2019 was conducted. Cases were those receiving aspirin prior to 16 weeks, with pre-eclampsia as the primary outcome. The relationship between early pregnancy glycaemic control and pre-eclampsia was also assessed. RESULTS Of the 164 women included in the study, 45 received aspirin. There were no differences in pre-eclampsia (odds ratio (OR) 0.9 (0.3-3.0), P = 0.924) or any other measure of placental insufficiency (OR 1.7 (0.7-4.3), P = 0.243) between the aspirin and control groups after adjusting for baseline differences. Aspirin therapy was associated with an increased risk of postpartum haemorrhage (PPH) (OR 3.1 (1.1-9.1), P = 0.041). The incidence of pre-eclampsia increased stepwise according to early pregnancy HbA1c subgroups of ≤6.0% (n = 47), 6.1-7.5% (n = 57) and > 7.5% (n = 39), with rates of 0, 12.3 and 20.5% (P = 0.007) respectively. CONCLUSIONS The aspirin group had a higher baseline risk of pre-eclampsia and placental insufficiency, therefore the absence of difference between the groups favoured the efficacy of aspirin. PPH was highlighted as a potential complication of therapy, and early pregnancy HbA1c as a novel risk stratification tool for pre-eclampsia in women with pre-existing diabetes.
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Affiliation(s)
- Siehoon Lah
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - N Wah Cheung
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Vincent Lee
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Neil Athayde
- Women's and Newborn Health, Westmead Hospital, Sydney, New South Wales, Australia
| | - Emma Inglis
- Women's and Newborn Health, Westmead Hospital, Sydney, New South Wales, Australia
| | - Suja Padmanabhan
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia
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11
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Bohiltea RE, Cirstoiu MM, Turcan N, Stoian AP, Zugravu CA, Munteanu O, Arsene LV, Oana B, Neacsu A, Furtunescu F. Inherited thrombophilia is significantly associated with severe preeclampsia. Exp Ther Med 2021; 21:261. [PMID: 33603868 DOI: 10.3892/etm.2021.9691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/26/2020] [Indexed: 12/27/2022] Open
Abstract
Methods to prevent the development of pathologies due to placental dysfunctions, such as gestational hypertension and preeclampsia, are the main approaches for obtaining the best maternal and fetal antepartum and postpartum prognosis. During 5 years of study (January, 2015 to December, 2019), the cases of pregnancy and puerperium complicated with pathology due to placental dysfunction were analyzed. The main objective was to determine the magnitude of the impact of thrombophilia on the development of an entity of gestational hypertension disorder. We compared the impact of thrombophilia and its associated complications in patients with gestational hypertension with moderate and severe preeclampsia. Thus, we found obesity, thrombophilia, and underlying cardiac pathology to be significant risk factors for severe preeclampsia. Regarding the comparative analysis of the risk factors and complications associated with patients with mild preeclampsia compared with those with severe preeclampsia, the presence in severe preeclampsia of thrombophilia, endocrine, liver, and cardiac pathology was higher and, a higher rate of complications was observed; complications included fetal death, intrauterine growth restriction (IUGR), prematurity, fetal arrhythmia with acute fetal distress, HELLP syndrome, and placental abruption. Thrombophilia has a significant effect on the development of severe preeclampsia, and oligohydramnios as specific complication of mild preeclampsia. Factors indicating an increased risk of progression from mild preeclampsia to severe preeclampsia are in addition to inherited thrombophilia the underlying pathologies, namely cardiac, hepatic, and endocrine factors.
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Affiliation(s)
- Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Monica Mihaela Cirstoiu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Natalia Turcan
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, Doctoral School, 020021 Bucharest, Romania
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, 'Carol Davila' University of Medicine and Pharmacy, 020475 Bucharest, Romania
| | - Corina-Aurelia Zugravu
- Department of Food Hygiene and Nutrition, 'Carol Davila' University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Octavian Munteanu
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania.,Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Luciana Valentina Arsene
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, Doctoral School, 020021 Bucharest, Romania
| | - Bodean Oana
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Adrian Neacsu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050463 Bucharest, Romania
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12
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Oxidative Stress and Preeclampsia-Associated Prothrombotic State. Antioxidants (Basel) 2020; 9:antiox9111139. [PMID: 33212799 PMCID: PMC7696949 DOI: 10.3390/antiox9111139] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
Preeclampsia (PE) is a common obstetric disease characterized by hypertension, proteinuria, and multi-system dysfunction. It endangers both maternal and fetal health. Although hemostasis is critical for preventing bleeding complications during pregnancy, delivery, and post-partum, PE patients often develop a severe prothrombotic state, potentially resulting in life-threatening thrombosis and thromboembolism. The cause of this thrombotic complication is multi-factorial, involving endothelial cells, platelets, adhesive ligands, coagulation, and fibrinolysis. Increasing evidence has shown that hemostatic cells and factors undergo oxidative modifications during the systemic inflammation found in PE patients. However, it is largely unknown how these oxidative modifications of hemostasis contribute to development of the PE-associated prothrombotic state. This knowledge gap has significantly hindered the development of predictive markers, preventive measures, and therapeutic agents to protect women during pregnancy. Here we summarize reports in the literature regarding the effects of oxidative stress and antioxidants on systemic hemostasis, with emphasis on the condition of PE.
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Ahmed NA, Hamdan HZ, Kamis AH, Adam I. The association of the prothrombin G20210A single-nucleotide polymorphism and the risk of preeclampsia: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 253:162-169. [PMID: 32871439 DOI: 10.1016/j.ejogrb.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/28/2020] [Accepted: 08/21/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We conducted this systematic review and meta-analysis to assess the association between the risk of preeclampsia and the prothrombin G20210A single-nucleotide polymorphism. STUDY DESIGN We followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. Relevant published studies were searched in the data base. The retrieved studies were assessed for quality by using the Modified Newcastle-Ottawa Scale for quality assessment. OpenMeta Analyst software was used for the statistics. RESULTS Twenty-eight case-control studies enrolling 3821 cases and 4808 controls were included in this systematic review and meta-analysis. We found a significantly increased preeclampsia risk associated with the G20210A polymorphism in three models: allele contrast (A vs. G), OR 2.183, 95 % CI 1.665-2.862; heterozygote (AG vs. GG), OR 2.233, 95 % CI 1.690-2.95; and the dominant model (AA + AG vs. GG) OR 2.240, 95 % CI 1.700-2.950. However, the association was not observed in the homozygote (AA vs. GG) OR 1.310, 95 % CI = 0.632-2.713 r recessive model (AA vs. AG + GG), OR 1.315, 95 % CI = 0.642-2.695. CONCLUSIONS In this meta-analysis, the prothrombin G20210A single-nucleotide polymorphism was associated with an increased risk of preeclampsia.
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Affiliation(s)
- Nadir A Ahmed
- Faculty of Medicine, Al-Neelain University, Khartoum, Sudan.
| | - Hamdan Z Hamdan
- Faculty of Medicine, Al-Neelain University, Khartoum, Sudan; Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, PO BOX 12702, Khartoum, Sudan; Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabi.
| | - Ammar H Kamis
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia.
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Schonewille NN, Abheiden CNH, Bokslag A, Thijs A, De Groot CJM, De Vries JIP, De Boer MA. Cardiovascular risk after hypertensive disorders of pregnancy in women with and without inheritable Thrombophilia. Hypertens Pregnancy 2020; 39:203-210. [PMID: 32297536 DOI: 10.1080/10641955.2020.1753767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim of this study was to compare cardiovascular risk in women with and without inheritable thrombophilia after hypertensive disorders of pregnancy (HDP). Blood pressure, anthropometrics and blood samples were measured 9-13 years after early-onset (<34 weeks) HDP. Amongst the 114 women included, no differences in hypertension (31.1% vs. 33.7%, OR 0.90 95% CI (0.29-2.79)), body mass index > 25 kg/m2 (43.8% vs. 53.1%, OR 0.69 95% CI (0.24-2.00)) or metabolic syndrome (18.8% vs. 13.3%, OR 1.51 95% CI (0.38-6.02)) were found. These data show similar cardiovascular risk profile in women with and without inheritable thrombophilia.
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Affiliation(s)
- N N Schonewille
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - C N H Abheiden
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - A Bokslag
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - A Thijs
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - C J M De Groot
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - J I P De Vries
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - M A De Boer
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
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15
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Antiphospholipid syndrome: Diagnosis and management in the obstetric patient. Best Pract Res Clin Obstet Gynaecol 2020; 64:31-40. [DOI: 10.1016/j.bpobgyn.2019.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 12/13/2022]
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16
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Ahmed SF, Ali MM, Kheiri S, Elzaki SEG, Adam I. Association of methylenetetrahydrofolate reductase C677T and reduced-f carrier-1 G80A gene polymorphism with preeclampsia in Sudanese women. Hypertens Pregnancy 2020; 39:77-81. [DOI: 10.1080/10641955.2020.1725037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | | | - Sumeya Kheiri
- Faculty of Medicine, Bahri University, Khartoum, Sudan
| | | | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine, Qassim University, Unaizah, Kingdom of Saudi Arabia
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Abstract
Perinatal stroke is a heterogeneous syndrome resulting from brain injury of vascular origin that occurs between 20 weeks of gestation and 28 days of postnatal life. The incidence of perinatal stroke is estimated to be between 1:1600 and 1:3000 live births (approximately 2500 children per year in the United States), though its actual incidence is difficult to estimate because it is likely underdiagnosed. Perinatal arterial ischemic stroke (PAIS) accounts for approximately 70% of cases of perinatal stroke. Cerebral sinovenous thrombosis, while less common, also accounts for a large proportion of the morbidity and mortality seen with perinatal stroke. Hemorrhagic stroke leads to disruption of neurologic function due to intracerebral hemorrhage that is nontraumatic in origin. While most cases of PAIS fall into one of these three categories, other patterns of injury should also be considered perinatal stroke. In some cases, the etiology of PAIS is not known but is idiopathic. This chapter will review the classification, risk factors, pathogenesis, clinical presentation, management, and long-term sequelae of perinatal stroke.
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Affiliation(s)
- Emmett E Whitaker
- Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, VT, United States; Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States.
| | - Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States; Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States; Department of Pharmacology, University of Vermont Larner College of Medicine, Burlington, VT, United States
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18
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Khidri FF, Waryah YM, Ali FK, Shaikh H, Ujjan ID, Waryah AM. MTHFR and F5 genetic variations have association with preeclampsia in Pakistani patients: a case control study. BMC MEDICAL GENETICS 2019; 20:163. [PMID: 31646966 PMCID: PMC6813118 DOI: 10.1186/s12881-019-0905-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND To study the role of single nucleotide variants (SNVs) of genes related to preeclampsia in Pakistani pregnant women. METHODS After ethical approval and getting informed consent; 250 pregnant women were enrolled and equally divided into two groups (125 preeclamptic cases and 125 normotensive pregnant women). Demographic details and medical history were recorded, and 10 ml blood sample was obtained for DNA extraction. The tetra-primer amplification refractory mutation system (ARMS) assays were developed for assessing the variants of three preeclampsia related genes; F5, MTHFR and VEGFA. An association of six SNVs; F5:c.1601G > A (rs6025), F5:c.6665A > G (rs6027), MTHFR: c.665C > T (rs1801133), MTHFR: c.1286A > C (rs1801131), VEGFA: c.-2055A > C (rs699947) and VEGFA: c.*237C > T (rs3025039) with preeclampsia was determined by using different genetic models. RESULTS Genotyping of the SNVs revealed that patients with MTHFR:c.665C > T, have increased susceptibility to preeclampsia (CT versus CC/TT: OR = 2.79, 95% CI = 1.18-6.59; P* = 0.046 and CT/TT vs CC: OR = 2.91, 95% CI = 1.29-6.57; P* = 0.0497, in overdominant and dominant models, respectively), whereas F5:c.6665A > G, (A/G vs AA/GG: OR = 0.42, 95% CI = 0.21-0.84; P* = 0.038 in overdominant model) and MTHFR:c.1286A > C, (CC versus AA: OR = 0.36, 95% CI = 0.18-0.72; P* = 0.0392 in codominant model) have significantly decreased risk for preeclampsia. F5:c.1601G > A, VEGFA: c.-2055A > C and VEGFA: c.*237C > T variants revealed no relationship with the disease. CONCLUSION This is the first case control study describing the protective role of F5:c.6665A > G against preeclampsia in any world population. In addition, the present study confirmed the association and role of MTHFR gene variations in the development of preeclampsia in Pakistani patients. Further genetic studies may be required to better understand the complex genetic mechanism of SNVs in preeclampsia related genes in pregnant women.
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Affiliation(s)
- Feriha Fatima Khidri
- Molecular Biology and Genetics Department, Medical Research Center, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
- Department of Biochemistry, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Yar Muhammad Waryah
- Molecular Biology and Genetics Department, Medical Research Center, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
- Department of Chemistry, Shaheed Benazir Bhutto University, Shaheed Benazir Abad, Pakistan
| | - Faiza Kamran Ali
- Department of Gynaecology and Obstetrics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Hina Shaikh
- Molecular Biology and Genetics Department, Medical Research Center, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Ikram Din Ujjan
- Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Ali Muhammad Waryah
- Molecular Biology and Genetics Department, Medical Research Center, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
- Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
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Lidan H, Jianbo W, Liqin G, Jifen H, Lin L, Xiuyan W. The Diagnostic Efficacy of Thrombelastography (TEG) in Patients with Preeclampsia and its Association with Blood Coagulation. Open Life Sci 2019; 14:335-341. [PMID: 33817167 PMCID: PMC7874822 DOI: 10.1515/biol-2019-0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 05/06/2019] [Indexed: 12/22/2022] Open
Abstract
Objective The aim of this study was to investigate the diagnostic efficacy of thrombelastography (TEG) in patients with preeclampsia. Methods One hundred and seventeen pregnant women were recruited from Department of Obstetrics and Gynecology of 1st affiliated Hospital of Fujian Medical University. Of the 117 patients, 59 were normal late gestation (control group), 32 were mild preeclampsia and other 26 cases were severe preeclampsia. All the patients were received thrombelastography (including: K time, Reaction time, Clot angel, MA value, CI value) and blood coagulation examination (including: PT, APTT, Fib, TT, D-dimer and AT-III). Results The R time, K time, Coagulation Index value and Clot Angle in preeclampsia group were significant different between control and preeclampsia groups with statistical difference (p<0.05). Moreover, the R and K time value in severe preeclampsia group were significant higher than those of control groups (p<0.05); however, the Coagulation Index value and Clot Angle in severe preeclampsia group were significant higher than those of mild preeclampsia group with statistical difference (p<0.05). Coagulation Index had the highest diagnostic sensitivity [87.93 (76.70-95.01) %] and specificity [83.83 (79.17-96.18)%] compared to other parameters with the AUC of 0.94 (0.90-0.98). The K time and the Coagulation Index had the highest diagnostic sensitivity (96.15%) and specificity (0.75%) respectively with the AUC of 0.68 and 0.75 respectively in differential diagnosis of severe preeclampsia from mild preeclampsia. However, there were no statistical difference in the aspects of platelet count and parameters relevant to coagulation test for the control, mild and sever preeclampsia groups(p>0.05). Conclusion TEG provides more accurate information in monitoring the blood coagulation of preeclampsia patients and can be used as a reliable marker for assessing the severity of preeclampsia.
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Affiliation(s)
- He Lidan
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Fujian Medical University, FuzhouFuzhou Fujian Province 350005 PR China
| | - Wu Jianbo
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Fujian Medical University, FuzhouFuzhou Fujian Province 350005 PR China
- E-mail:
| | - Gao Liqin
- Department of Clinical laboratory, the First Affiliated Hospital of Fujian Medical University, FuzhouFuzhou Fujian Province 350005 PR China
| | - Hu Jifen
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Fujian Medical University, FuzhouFuzhou Fujian Province 350005 PR China
| | - Lu Lin
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Fujian Medical University, FuzhouFuzhou Fujian Province 350005 PR China
| | - Wu Xiuyan
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Fujian Medical University, FuzhouFuzhou Fujian Province 350005 PR China
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20
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Li Y, Ruan Y. Association of hypertensive disorders of pregnancy risk and factor V Leiden mutation: A meta-analysis. J Obstet Gynaecol Res 2019; 45:1303-1310. [PMID: 31037802 DOI: 10.1111/jog.13976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/06/2019] [Indexed: 12/14/2022]
Abstract
AIM To date, the conclusions of studies on a possible association between factor V Leiden (FVL, FV G1691A, rs6025) and hypertensive disorders of pregnancy (HDP) are conflicting. Here, we aimed to estimate the relationship between the risk of HDP and FVL. METHODS Eligible studies focused on FVL and HDP were searched from the PubMed and the Web of Science databases up to March 31, 2018. We used random effects model for the meta-analysis, and I2 statistic to assess the degree of heterogeneity between all included studies. To evaluate the association between FVL and the risk of HDP, we calculated the odds ratio (OR) and 95% confidence intervals (CI) comparing cases and controls of all samples and each subgroup based on different regions. RESULTS Fifty citations on FVL and HDP were identified through the literature search, and a meta-analysis on the GA + AA genotype between 6041 cases and 8364 controls was conducted. The holistic analysis found that pregnant women with GA or AA genotype of FVL have a 1.97-fold (95% CI: 1.64-2.35, P < 0.00001) increased risk of HDP compared with GG carriers. While the OR are 2.23 (95% CI: 1.76-2.84, P < 0.00001) and 1.90 (95% CI: 1.12-3.23, P = 0.02) in Europe and the Middle East subgroups, respectively. CONCLUSION Factor V Leiden mutation is associated with an increased risk of HDP, and is particularly associated with preeclampsia and eclampsia in European women. However, further high-quality studies are warranted to confirm the possible effectiveness of FVL in HDP patients.
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Affiliation(s)
- Yuan Li
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yan Ruan
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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21
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Ahmed NA, Adam I, Elzaki SEG, Awooda HA, Hamdan HZ. Factor-V Leiden G1691A and prothrombin G20210A polymorphisms in Sudanese women with preeclampsia, a case -control study. BMC MEDICAL GENETICS 2019; 20:2. [PMID: 30611230 PMCID: PMC6321713 DOI: 10.1186/s12881-018-0737-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/13/2018] [Indexed: 01/09/2023]
Abstract
Background Preeclampsia can lead to adverse maternal and perinatal outcomes. There are few studies on the association of preeclampsia with thrombophilia in Africa including Sudan. Methods A case –controls study was conducted at Saad Abualila Hospital in Khartoum, Sudan during the period of February through November 2017. The cases were women with preeclampsia and healthy pregnant women were the controls (180 women in each arm of the study). Genotyping for Factor-V Leiden 1691G/A and Prothrombin gene variation 20210G/A was done by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP). Results There was no significant difference in the age, parity, body mass index (BMI) and the other characteristics between the cases and the controls. Genotypes distribution of Factor V Leiden 1691G/A and prothrombin gene 20210G/A in controls was in accordance with the Hardy–Weinberg equilibrium (P > 0.05). The factor V Leiden-variation was present in 9.6% of the cases compared with 0.6% of the controls, P < 0.001 (OR = 18.60, 95% CI = 2.38–136.1). Only 4 patients with severe preeclampsia had homozygous variation A/A and it was not detected in the controls. Prothrombin G20210A variations not detected neither in the cases nor in the controls group. Conclusions High prevalence of Factor V Leiden 1691G/A variation in preeclamptic patients compared to controls suggest an involvement of this variation in predisposing to preeclampsia in this setting.
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Affiliation(s)
- Nadir A Ahmed
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, P.O. Box: 12702, Khartoum, Sudan
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Salah Eldin G Elzaki
- Department of Epidemiology, Tropical Medicine Research Institute, Khartoum, Sudan
| | - Hiba A Awooda
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, P.O. Box: 12702, Khartoum, Sudan
| | - Hamdan Z Hamdan
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, P.O. Box: 12702, Khartoum, Sudan.
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Gibbins KJ, Tebo AE, Nielsen SK, Branch DW. Antiphospholipid antibodies in women with severe preeclampsia and placental insufficiency: a case-control study. Lupus 2018; 27:1903-1910. [PMID: 30028257 PMCID: PMC6085160 DOI: 10.1177/0961203318787035] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Preterm delivery for preeclampsia or placental insufficiency (PREPI) is a clinical criterion for antiphospholipid syndrome (APS), but no prior prospective studies have used the international classification criteria for APS. Our objective is to determine the proportion of women with PREPI who test positive for aPL using international criteria for antiphospholipid antibody (aPL) assays. Methods We conducted a prospective, case-control study of 148 women delivered < 36 weeks because of PREPI compared to 148 controls. PREPI cases delivered < 36 weeks were compared to matched controls. Cases and controls were tested for aPL. Demographic variables were compared with chi-squared and Wilcoxon-rank-sum statistics. Rates of + aPL were compared using adjusted odds ratios (aORs) for maternal body mass index (BMI) and Caucasian race. Positive aPL (+aPL) was defined as lupus anticoagulant (LA), anticardiolipin (aCL) immunoglobulin G (IgG) (GPL) or immunoglobulin M (IgM) (MPL) ≥ 40, or anti-β2-glycoprotein I (aβ2GPI) IgG (SGU) or IgM (SMU) ≥ 40. Results Controls were more likely to be Caucasian (87% vs 70%, p = 0.006) and had lower BMIs (BMI 26 vs 33, p < 0.001). Positive aPL were found more commonly in cases than controls (11.5% vs 1.4%, aOR 8.9 (95% CI 1.9-41.4)). In + aPL cases, 76% had + LA, 41% had + aCL, and 24% had + aβ2GPI. Conclusion Women requiring early delivery for PREPI are more likely to have aPL (and thus APS) than controls. This is the first prospective study using both obstetric definitions and laboratory criteria in accordance with APS international criteria.
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Affiliation(s)
- K J Gibbins
- 1 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - A E Tebo
- 2 Department of Pathology, University of Utah School of Medicine, Salt Lake City; UT ARUP Laboratories, Salt Lake City, UT, USA
| | - S K Nielsen
- 1 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - D W Branch
- 3 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Intermountain Healthcare Department of Maternal Fetal Medicine, Salt Lake City, UT, USA
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Nizyaeva NV, Sukhacheva TV, Serov RA, Kulikova GV, Nagovitsyna MN, Kan NE, Tyutyunnik VL, Pavlovich SV, Poltavtseva RA, Yarotskaya EL, Shchegolev AI, Sukhikh GT. Ultrastructural and Immunohistochemical Features of Telocytes in Placental Villi in Preeclampsia. Sci Rep 2018; 8:3453. [PMID: 29472628 PMCID: PMC5823867 DOI: 10.1038/s41598-018-21492-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/06/2018] [Indexed: 11/09/2022] Open
Abstract
A new cell type, interstitial Cajal-like cell (ICLC), was recently described in different organs. The name was recently changed to telocytes (TCs), and their typical thin, long processes have been named telopodes (Tp). TCs regulate the contractile activity of smooth muscle cells and play a role in regulating vessel contractions. Although the placenta is not an innervated organ, we believe that TCs are present in the placenta. We studied placenta samples from physiological pregnancies and in different variants of preeclampsia (PE). We examined these samples using light microscopy of semi-thin sections, transmission electron microscopy, and immunohistochemistry. Immunohistochemical examination was performed with primary antibodies to CD34, CD117, SMA, and vimentin, and TMEM16a (DOG-1), the latter was used for the diagnosis of gastrointestinal stromal tumours (GIST) consisting of TCs. We have identified a heterogenetic population of ТСs in term placentas, as these cell types differed in their localization, immunophenotype and ultrastructural characteristics. We assume TMEM16a could be used as the marker for identification of TCs. In PE we have revealed telocyte-like cells with ultrastructural signs of fibrocytes (significant process thickening and the granular endoplasmic reticulum content was increased) and a loss of TMEM16a immunohistochemical staining.
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Affiliation(s)
- Natalia V Nizyaeva
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia.
| | - Tatiana V Sukhacheva
- A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, 119991, Russia
| | - Roman A Serov
- A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, 119991, Russia
| | - Galina V Kulikova
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia
| | - Marina N Nagovitsyna
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia
| | - Natalia E Kan
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, 121552, Russia
| | - Victor L Tyutyunnik
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, 121552, Russia
| | - Stanislav V Pavlovich
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, 121552, Russia
| | - Rimma A Poltavtseva
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia
| | - Ekaterina L Yarotskaya
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia
| | - Aleksandr I Shchegolev
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia
| | - Gennadiy T Sukhikh
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, 121552, Russia
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Assessment of the fetal-placental unit using clinical and ultrasound evaluation and inherited thrombophilia in pregnant patients. GINECOLOGIA.RO 2018. [DOI: 10.26416/gine.21.3.2018.1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Baptista FS, Bortolotto MRDFL, Bianchini FRM, Krebs VLJ, Zugaib M, Francisco RPV. Can thrombophilia worsen maternal and perinatal outcomes in cases of severe preeclampsia? Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2017.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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SerpinC1/Antithrombin III in kidney-related diseases. Clin Sci (Lond) 2017; 131:823-831. [PMID: 28424376 PMCID: PMC5396475 DOI: 10.1042/cs20160669] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 01/11/2023]
Abstract
The gene SerpinC1 encodes a serine protease inhibitor named antithrombin III (ATIII). This protease demonstrates both anticoagulant and anti-inflammatory action. ATIII is the most important coagulation factor inhibitor, and even minor changes in ATIII can significantly alter the risk of thromboembolism. ATIII can also suppress inflammation via a coagulation-dependent or -independent effect. Moreover, apart from ATIII deficiency, ATIII and its gene SerpinC1 may also be related to many diseases (e.g. hypertension, kidney diseases). The present review summarizes how ATIII affects the progress of kidney disease and its mechanism. Further studies are required to investigate how ATIII affects renal function and the treatment.
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Okoye HC, Eweputanna LI, Okpani AOU, Ejele OA. Associations between pre-eclampsia and protein C and protein S levels among pregnant Nigerian women. Int J Gynaecol Obstet 2017; 137:26-30. [PMID: 28092096 DOI: 10.1002/ijgo.12085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/01/2016] [Accepted: 12/13/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate levels of protein C and free protein S among women with pre-eclampsia, and determine whether there is a relationship between deficiencies and pre-eclampsia. METHODS A cross-sectional study was conducted at a hospital in Nigeria from July 2013 to March 2014 among 90 pregnant women with pre-eclampsia (blood pressure ≥140/90 mm Hg, proteinuria ≥300 mg in 24 hours) and 90 normotensive pregnant women (control group). Plasma levels of protein C and free protein S were analyzed by enzyme-linked immunosorbent assay, and protein C activity by a chromogenic method. RESULTS Mean protein C antigen and activity levels did not differ between groups (P=0.639 and P=0.444, respectively). The incidence of protein C antigen and activity deficiency also did not differ (P=0.288 and P>0.99, respectively). The mean free protein S antigen level was higher among women with pre-eclampsia (54.48%±19.58%) than in the control group (47.23%±10.27%; P=0.004). No woman in the control group had protein S deficiency, as compared with 2 (2%) of the women with pre-eclampsia (P=0.497). No association was found between deficiencies of these proteins and pre-eclampsia. CONCLUSION Deficiencies of protein C and free protein S are unlikely to be etiopathogenetic for pre-eclampsia; therefore, therapeutic intervention should focus on other potential pathogenetic pathways.
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Affiliation(s)
- Helen C Okoye
- Department of Hematology and Immunology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Lisa I Eweputanna
- Department of Radiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Anthony O U Okpani
- Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Oseikhuemen A Ejele
- Department of Hematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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Abheiden CNH, Thijs A, de Vries JIP, de Boer MA. Cardiovascular risk factors in women with inheritable thrombophilia a decade after single or recurrent hypertensive disorder of pregnancy. Hypertens Pregnancy 2016; 35:461-469. [PMID: 27322349 DOI: 10.1080/10641955.2016.1183674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To described cardiovascular risk factors in women with inheritable thrombophilia 8-19 years after early-onset hypertensive disorders of pregnancy (HD) with or without recurrent HD. METHODS Women with recurrent HD were compared with women with single HD, for physical examination and cardiovascular parameters in serum. RESULTS Systolic blood pressure, diastolic blood pressure, and albumin: creatinine ratio were higher in women with recurrent HD compared with women with single HD (p = 0.046, p = 0.029, and p = 0.008, respectively). In both groups 72.7% had an increased cardiovascular risk. CONCLUSION Women with inheritable thrombophilia after single or recurrent HD have a high cardiovascular risk.
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Affiliation(s)
- Carolien N H Abheiden
- a Department of Obstetrics and Gynaecology , Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center , Amsterdam , The Netherlands
| | - Abel Thijs
- b Department of Internal Medicine , Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center , Amsterdam , The Netherlands
| | - Johanna I P de Vries
- a Department of Obstetrics and Gynaecology , Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center , Amsterdam , The Netherlands
| | - Marjon A de Boer
- a Department of Obstetrics and Gynaecology , Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center , Amsterdam , The Netherlands
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Liatsikos SA, Tsikouras P, Manav B, Csorba R, von Tempelhoff GF, Galazios G. Inherited thrombophilia and reproductive disorders. J Turk Ger Gynecol Assoc 2016; 17:45-50. [PMID: 27026779 DOI: 10.5152/jtgga.2016.15212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/16/2016] [Indexed: 12/13/2022] Open
Abstract
Apart from its established role in the pathogenesis of venous thromboembolism (VTE), inherited thrombophilia has been proposed as a possible cause of pregnancy loss and vascular gestational complications. There is a lot of controversy in the literature on the relationship between inherited prothrombotic defects and these obstetric complications. This is a review of the literature on inherited thrombophilia and reproductive disorders. Factor V Leiden, prothrombin G20210A mutation, and protein S deficiency seem to be associated with late and recurrent early pregnancy loss, while their impact on other pregnancy complications is conflicting. No definite association has been established between protein C and antithrombin deficiency and adverse pregnancy outcome, primarily due to their low prevalence. Screening is suggested only for women with early recurrent loss or late pregnancy loss. Anticoagulant treatment during pregnancy should be considered for women with complications who were tested positive for thrombophilia.
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Affiliation(s)
- Spyros A Liatsikos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
| | - Bachar Manav
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
| | - Roland Csorba
- Department of Obstetrics and Gynecology, Clinicum Aschaffenburg, Teaching Hospital University of Würzburg, Germany
| | | | - Georgios Galazios
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
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Berks D, Duvekot JJ, Basalan H, De Maat MPM, Steegers EAP, Visser W. Associations between phenotypes of preeclampsia and thrombophilia. Eur J Obstet Gynecol Reprod Biol 2015; 194:199-205. [PMID: 26444331 DOI: 10.1016/j.ejogrb.2015.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/04/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Preeclampsia complicates 2-8% of all pregnancies. Studies on the association of preeclampsia with thrombophilia are conflicting. Clinical heterogeneity of the disease may be one of the explanations. The present study addresses the question whether different phenotypes of preeclampsia are associated with thrombophilia factors. Study design We planned a retrospective cohort study. From 1985 until 2010 women with preeclampsia were offered postpartum screening for the following thrombophilia factors: anti-phospholipid antibodies, APC-resistance, protein C deficiency and protein S deficiency, hyperhomocysteineamia, factor V Leiden and Prothrombin gene mutation. Hospital records were used to obtain information on phenotypes of the preeclampsia and placental histology. RESULTS We identified 844 women with singleton pregnancies who were screened for thrombophilia factors. HELLP complicated 49% of pregnancies; Fetal growth restriction complicated 61% of pregnancies. Early delivery (<34th week) occurred in 71% of pregnancies. Any thrombophilia factor was present in 29% of the women. Severe preeclampsia was associated with protein S deficiency (p=0.01). Fetal growth restriction was associated with anti-phospholipid antibodies (p<0.01). Early onset preeclampsia was associated with anti-phospholipid antibodies (p=0.01). Extensive placental infarction (>10%) was associated with anti-phospholipid antibodies (p<0.01). Low placental weight (<5th percentile) was associated with hyperhomocysteineamia (p=0.03). No other associations were observed. CONCLUSIONS Early onset preeclampsia, especially if complicated by fetal growth restriction, are associated with anti-phospholipid antibodies. Other phenotypes of preeclampsia, especially HELLP syndrome, were not associated with thrombophilia. We advise only to test for anti-phospholipid antibodies after early onset preeclampsia, especially if complicated by fetal growth restriction. We suggest enough evidence is presented to justify no further studies are needed.
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Affiliation(s)
- Durk Berks
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Hillal Basalan
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Moniek P M De Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Willy Visser
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Brock CO, Brohl AS, Običan SG. Incidence, pathophysiology, and clinical manifestations of antiphospholipid syndrome. ACTA ACUST UNITED AC 2015; 105:201-8. [DOI: 10.1002/bdrc.21107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Clifton O'neill Brock
- Department of Obstetrics and Gynecology; Columbia University College of Physicians and Surgeons; New York New York
| | - Andrew Scott Brohl
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai; Egypt
| | - Sarah Gloria Običan
- Department of Obstetrics and Gynecology; Columbia University College of Physicians and Surgeons; New York New York
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Aberrant maternal inflammation as a cause of pregnancy complications: A potential therapeutic target? Placenta 2015; 36:960-6. [DOI: 10.1016/j.placenta.2015.05.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/12/2015] [Accepted: 05/25/2015] [Indexed: 12/17/2022]
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Wu X, Yang K, Tang X, Sa Y, Zhou R, Liu J, Luo Y, Tang W. Folate metabolism gene polymorphisms MTHFR C677T and A1298C and risk for preeclampsia: a meta-analysis. J Assist Reprod Genet 2015; 32:797-805. [PMID: 25758986 DOI: 10.1007/s10815-014-0408-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 12/11/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES MTHFR C677T and A1298C have been associated with the risk of preeclampsia (PE), but with conflicting results. We performed this meta-analysis to derive a more precise estimation of the association between MTHFR polymorphisms and PE. STUDY DESIGN An electronic search of PubMed and Chinese Biomedicine database was conducted to select studies for meta-analysis. 54 case controlled studies containing MTHFR C677T and A1298C gene polymorphisms were chosen, and odds ratio (OR) with confidence interval (CI) was used to assess the strength of this association. RESULT These studies evaluated 7398 cases and 11230 controls for MTHFR C677T. The overall results suggested that MTHFR C677T was associated with the risk of PE. (T vs. C: OR = 1.157, 95% CI: 1.057-1.266, p = 0.002; TT + CT vs. CC: OR = 1.165, 95% CI : 1.049-1.293, P = 0.004; TT vs. CT + CC: OR = 1.371, 95% CI: 1.153-1.63, p < 0.001). We also evaluated 1103 cases and 988 controls for MTHFR A1298C but could not demonstrate an increased risk of PE for this polymorphism (p = 0.667). A symmetric funnel plot, the Egger's test (p = 0.819) suggested a lack of publication bias. CONCLUSION This meta-analysis supports the idea that MTHFR C677T genotype is associated with increased risk for PE, especially in the case of Asians and Caucasians.
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Affiliation(s)
- Xiaoming Wu
- Laboratory of Molecular Genetics of Aging & Tumor, Medical Faculty, Kunming University of Science and Technology, Chenggong Campus, 727 South Jingming Road, Kunming, Yunnan, 650500, China
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Wang X, Bai T, Liu S, Pan H, Wang B. Association between thrombophilia gene polymorphisms and preeclampsia: a meta-analysis. PLoS One 2014; 9:e100789. [PMID: 24967675 PMCID: PMC4072713 DOI: 10.1371/journal.pone.0100789] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/29/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To estimate the relationship between the risk of preeclampsia and two thrombophilia gene single-nucleotide polymorphisms (SNPs), the factor V G1691A SNP and the prothrombin G20210A SNP. DATE SOURCES A systematic search of the English-language literature up to November 2012 was performed using Medline and EMBASE. Search terms included "preeclampsia," "thrombophilia," "factor V Leiden," "prothrombin gene 20210," and their combinations. RESULT(S) Thirty-seven studies with 5048 preeclampsia patients and 6796 controls were included in the meta-analysis. We found that the prothrombin G20210A polymorphism was associated with an increased risk of all preeclampsia (pooled odds ratio (OR) = 1.81, 95% confidence interval (CI) 1.25-2.63) and severe preeclampsia (pooled OR = 3.02, 95%CI 2.06-4.45). Meanwhile, the pooled OR for the association between factor V Leiden and all preeclampsia was 1.60 (95%CI 1.28-2.00) and 2.45 (95%CI 1.63-3.69) for the cases of severe preeclampsia. CONCLUSION(S) This meta-analysis supports that the factor V G1691A SNP and the prothrombin G20210A SNP are associated with an increased risk for both preeclampsia overall and severe preeclampsia.
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Affiliation(s)
- Xi Wang
- Graduate School of Peking Union Medical College, Beijing, China
- National Research Institute for Family Planning, Beijing, China
| | - Tingting Bai
- Graduate School of Peking Union Medical College, Beijing, China
- National Research Institute for Family Planning, Beijing, China
| | - Shengnan Liu
- Graduate School of Peking Union Medical College, Beijing, China
- National Research Institute for Family Planning, Beijing, China
| | - Hong Pan
- National Research Institute for Family Planning, Beijing, China
| | - Binbin Wang
- Graduate School of Peking Union Medical College, Beijing, China
- National Research Institute for Family Planning, Beijing, China
- * E-mail:
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Yang B, Fan S, Zhi X, Li Y, Liu Y, Wang D, He M, Hou Y, Zheng Q, Sun G. Associations of MTHFR gene polymorphisms with hypertension and hypertension in pregnancy: a meta-analysis from 114 studies with 15411 cases and 21970 controls. PLoS One 2014; 9:e87497. [PMID: 24505291 PMCID: PMC3914818 DOI: 10.1371/journal.pone.0087497] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 12/24/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Several epidemiological studies have investigated the associations of methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms with hypertension (H) or hypertension in pregnancy (HIP). However, the results were controversial. We therefore performed a comprehensive meta-analysis to provide empirical evidences on the associations. METHODOLOGIES The English and Chinese databases were systematically searched to identify relevant studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the strength of the associations. Meta-regression, subgroup analysis, sensitivity analysis, cumulative meta-analysis and assessment of publication bias were performed in our study. PRINCIPAL FINDINGS A total of 114 studies with 15411 cases and 21970 controls were included, 111 studies with 15094 cases and 21633 controls for the C677T polymorphism and 21 with 2533 cases and 2976 controls for the A1298C polymorphism. Overall, the C677T polymorphism was significantly associated with H and HIP (H & HIP: OR = 1.26, 95% CI = 1.17-1.34; H: OR = 1.36, 95% CI = 1.20-1.53; HIP: OR = 1.21, 95% CI = 1.08-1.32). Stratified analysis by ethnicity revealed a significant association among East Asians and Caucasians, but not among Latinos, Black Africans, and Indians and Sri Lankans. In the stratified analyses according to source of controls, genotyping method, sample size and study quality, significant associations were observed in all the subgroups, with the exception of population based subgroup in H studies and large sample size and "others" genotyping method subgroups in HIP studies. For the A1298C polymorphism, no significant association was observed either in overall or subgroup analysis under all genetic models. CONCLUSIONS This meta-analysis suggests that the MTHFR C677T rather than A1298C polymorphism may be associated with H & HIP, especially among East Asians and Caucasians.
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Affiliation(s)
- Boyi Yang
- Environment and Non-Communicable Diseases Research Center, School of Public Health, China Medical University, Shenyang, China
| | - Shujun Fan
- Environment and Non-Communicable Diseases Research Center, School of Public Health, China Medical University, Shenyang, China
| | - Xueyuan Zhi
- Environment and Non-Communicable Diseases Research Center, School of Public Health, China Medical University, Shenyang, China
| | - Yongfang Li
- Environment and Non-Communicable Diseases Research Center, School of Public Health, China Medical University, Shenyang, China
| | - Yuyan Liu
- Environment and Non-Communicable Diseases Research Center, School of Public Health, China Medical University, Shenyang, China
| | - Da Wang
- Environment and Non-Communicable Diseases Research Center, School of Public Health, China Medical University, Shenyang, China
| | - Miao He
- Environment and Non-Communicable Diseases Research Center, School of Public Health, China Medical University, Shenyang, China
| | - Yongyong Hou
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Quanmei Zheng
- Environment and Non-Communicable Diseases Research Center, School of Public Health, China Medical University, Shenyang, China
| | - Guifan Sun
- Environment and Non-Communicable Diseases Research Center, School of Public Health, China Medical University, Shenyang, China
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Weintraub AY, Press F, Wiznitzer A, Sheiner E. Maternal thrombophilia and adverse pregnancy outcomes. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.2.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rosser ML, Katz NT. Preeclampsia: an obstetrician's perspective. Adv Chronic Kidney Dis 2013; 20:287-96. [PMID: 23928395 DOI: 10.1053/j.ackd.2013.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 02/15/2013] [Indexed: 01/23/2023]
Abstract
Preeclampsia is a pregnancy-specific syndrome that usually develops after 20 weeks gestation. The exact pathogenic mechanisms remain uncertain and are likely multifactorial. Preeclampsia is a heterogeneous condition with potentially maternal and fetal consequences. As part of the spectrum of hypertensive disorders of pregnancy, preeclampsia may progress rapidly and is a leading cause of maternal and perinatal morbidity and mortality worldwide. In the United States, the incidence of preeclampsia has increased. Clinical manifestations are highly variable and may occur antepartum, intrapartum, or postpartum. Hypertension and proteinuria are the traditional hallmarks for the diagnosis of preeclampsia. These signs may occur with or without multisystem dysfunction and fetal involvement. Risk factors have been identified for the development of preeclampsia; however, ideal methods for prevention, screening, and treatment remain elusive. Preeclampsia resolves after delivery of the fetus, but patients may still have hypertension postpartum. Women and fetuses affected by preeclampsia are at higher risk of developing long-term health issues. There appear to be risk factors common to hypertensive disorders of pregnancy and cardiovascular disease seen later in adulthood. Physicians providing healthcare to women are urged to recognize potential risk factors that arise from patient obstetric histories so that optimal long-term health surveillance is provided.
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Response to Xuan. Hypertens Res 2013; 36:465-6. [PMID: 23466626 DOI: 10.1038/hr.2012.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rath W, Thaler CJ. [Hereditary thrombophilias and placental-mediated pregnancy complications in the II./III. trimester]. Hamostaseologie 2013; 33:21-36. [PMID: 23392307 DOI: 10.5482/hamo-12-11-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/18/2013] [Indexed: 11/05/2022] Open
Abstract
UNLABELLED Placental-mediated pregnancy complications (PmC) like preeclampsia, intrauterine growth restriction and placental abruption are common causes of fetal and maternal morbidity and mortality. The high prevalence of hereditary thrombophilias in case-control studies associated with pathological morphological findings of the placenta in these cases gave evidence for the association between hereditary thrombophilias and PmC. However, data from the literature are inconsistent, since subsequent prospective cohort studies could not demonstrate significant associations between inherited thrombophilia and PmC. Because of the multifactorial aetiology of PmC it may be difficult to prove, that hereditary thrombophilias are independent risk factors for PmC. Current guidelines do not recommend screening for inherited thrombophilias in patients with previous PmC. Evidence from current in vitro studies have shown, that heparin has beneficial non-anticoagulatory effects on trophoblast invasion. Retrospective case-control studies and recently published randomised controlled cohort studies have shown, that prophylactic administration of low-molecular-weight heparin (LWH), started in early pregnancy, may lead to a significant reduction in the incidence of PmC in subsequent pregnancies in patients with and without hereditary thrombophilias and previous PmC. CONCLUSION Large, well-designed multicenter studies are needed to elucidate the role of hereditary thrombophilias in cases of PmC and to confirm the benefit of LWH for subsequent pregnancy outcomes.
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Affiliation(s)
- W Rath
- Gynäkologie und Geburtshilfe, Medizinische Fakultät, Universitätsklinikum, Wendlingweg 2, 52074 Aachen.
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Wang XM, Wu HY, Qiu XJ. Methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism and risk of preeclampsia: an updated meta-analysis based on 51 studies. Arch Med Res 2013; 44:159-68. [PMID: 23395424 DOI: 10.1016/j.arcmed.2013.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS The methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism has been considered to be associated with preeclampsia (PE), but the results from previous studies were conflicting. The present study aimed at investigating the frequency of preeclampsia according to the distribution polymorphism using a meta-analysis on the published studies. METHODS The English and Chinese databases were searched to identify eligible studies published in English before August 2012. Data were extracted using standardized methods. The association was assessed by odds ratio (OR) with 95% confidence intervals (CI). Begg's test was used to measure publication bias. RESULTS A total of 51 case-control studies containing 6,403 patients and 11,346 controls were involved in this meta-analysis. Significant associations were detected between MTHFR C677T polymorphism and risk of PE in the overall population for TT vs. CC (OR = 1.280, 95% CI: 1.074-1.525), recessive model (OR = 1.264, 95% CI: 1.067-1.303), and dominant genetic model (OR = 1.174, 95% CI: 1.057-1.303); in Caucasian population for dominant model (OR = 1.136, 95% CI: 1.022-1.263), and in East Asia population for TT vs. CC (OR = 2.199, 95% CI: 1.366-3.924) CT vs. CC (OR = 1.453, 95% CI: 1.001-2.109), recessive model (OR = 1.742, 95% CI: 1.202-2.525), and dominant model (OR = 1.783, 95% CI: 1.271-2.501). Conversely, no associations were detected in Latin America, South Asia, and Africa populations. CONCLUSIONS Results of the meta-analysis suggest that the MTHFR C677T polymorphism was associated with risk of PE in overall, Caucasian, and East Asia populations. Nevertheless, the results for Latino, East Asians, South Asians and Africans should be interpreted with caution due to the small sample size.
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Affiliation(s)
- Xi-mei Wang
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Jiangnan University, Wuxi 214062, China.
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Association between the methylenetetrahydrofolate reductase C677T polymorphism and susceptibility to preeclampsia: the need for data clarification in a recent meta-analysis. Hypertens Res 2013; 36:463-4. [DOI: 10.1038/hr.2012.211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Buurma A, Turner R, Driessen J, Mooyaart A, Schoones J, Bruijn J, Bloemenkamp K, Dekkers O, Baelde H. Genetic variants in pre-eclampsia: a meta-analysis. Hum Reprod Update 2013; 19:289-303. [DOI: 10.1093/humupd/dms060] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Rahimi Z, Malek-Khosravi S, Rahimi Z, Jalilvand F, Parsian A. MTHFR C677T and eNOS G894T variants in preeclamptic women: Contribution to lipid peroxidation and oxidative stress. Clin Biochem 2013; 46:143-7. [DOI: 10.1016/j.clinbiochem.2012.10.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 09/27/2012] [Accepted: 10/15/2012] [Indexed: 01/15/2023]
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Co-occurrence of Cardiovascular and Prothrombotic Risk Factors in Women With a History of Preeclampsia. Obstet Gynecol 2013; 121:97-105. [DOI: 10.1097/aog.0b013e318273764b] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hawfield AT, Freedman BI. Preeclampsia and risk for subsequent ESRD in populations of European ancestry. Clin J Am Soc Nephrol 2012; 7:1743-5. [PMID: 23065495 DOI: 10.2215/cjn.09910912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Tranquilli AL, Landi B, Giannubilo SR, Sibai BM. Preeclampsia: No longer solely a pregnancy disease. Pregnancy Hypertens 2012; 2:350-7. [DOI: 10.1016/j.preghy.2012.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 05/19/2012] [Accepted: 05/29/2012] [Indexed: 11/16/2022]
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Abstract
Pre-eclampsia is a syndrome of pregnancy, defined by the gestational-onset of hypertension and proteinuria, which resolves postpartum. This definition does not consider the variable multiorgan involvement of a syndrome that can include seizures, fulminating hepatic necrosis and a consumptive coagulopathy. These disparate clinical features are a consequence of an accelerated but transient metabolic syndrome with widespread maternal endothelial dysfunction and inflammation. A trigger to this maternal state is the relatively ischaemic placenta. As pregnancy progresses, the concentration of vaso-toxic factors released by the relatively ischaemic placenta gradually builds up in the maternal circulation. Those predisposed to endothelial dysfunction, e.g. women with risk factors for cardiovascular disease, are more sensitive to these placental derived factors and will develop pre-eclampsia before natural onset of labour. A woman's vulnerability to pre-eclampsia is therefore composed of a unique balance between her pre-existing maternal endothelial and metabolic health and the concentration of placental derived factors toxic to maternal endothelium. Delivery of the placenta remains the only cure. Years later, women who had pre-eclampsia are at increased risk of chronic hypertension, ischaemic heart disease, cerebrovascular disease, kidney disease, diabetes mellitus, thromboembolism, hypothyroidism and even impaired memory. This article describes how a brief, usually single episode of this acute pregnancy syndrome might both identify those vulnerable to chronic disease in later life and in some cases initiate chronic disease.
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Affiliation(s)
- David Williams
- Consultant Obstetric Physician, Department of Maternal Medicine, Institute for Women's Health, University College London Hospital, London, UK
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Lykke JA, Bare LA, Olsen J, Lagier R, Arellano AR, Tong C, Paidas MJ, Langhoff-Roos J. Thrombophilias and adverse pregnancy outcomes: results from the Danish National Birth Cohort. J Thromb Haemost 2012; 10:1320-5. [PMID: 22578003 DOI: 10.1111/j.1538-7836.2012.04773.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inherited thrombophilias have inconsistently been linked to adverse pregnancy outcomes. Differences in study design, size and population could explain this heterogeneity. OBJECTIVE The aim of the present study was to evaluate if factor (F)V Leiden G1691A, prothrombin mutation G20210A (PTM) and methylenetetrahydrofolate reductase C677T (MTHFR) increased the risk of severe preeclampsia, fetal growth restriction, very preterm delivery, placental abruption and a composite of these outcomes also including stillbirth. PATIENTS AND METHODS In a nested case-cohort study of pregnant women in Denmark, we genotyped 2032 cases and 1851 random controls. Each of the medical records of the cases was validated. We calculated both genomic and allelic models, and present both models. We also performed sensitivity analyses adjusting for parity, age, smoking, body mass index and socioeconomic status. RESULTS In the allelic models, FV Leiden increased the risk of the composite outcome (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.1-1.8), severe preeclampsia (OR 1.6, 95% CI 1.1-2.4), fetal growth restriction (OR 1.4, 95% CI 1.1-1.8) and placental abruption (OR = 1.7 (95% CI 1.2-2.4). In the sensitivity analyses, adjustment diminished these estimates slightly. PTM was not significantly associated with any of the outcomes, and MTHFR was only significantly associated with severe preeclampsia (OR 1.3, 95% CI 1.1-1.6). CONCLUSION FV Leiden predisposes to adverse pregnancy outcomes in a setting of Scandinavian women.
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Affiliation(s)
- J A Lykke
- Department of Obstetrics and Gynecology, Roskilde Hospital, Roskilde, Denmark.
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Ibrahim ZM, Metawie MAE, El-Baz AM, El-Bahie MA. Methylenetetrahydrofolate C677T polymorphism and pre-eclamptic Egyptian women. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2012. [DOI: 10.1016/j.mefs.2011.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Is thrombophilia a risk factor for placenta-mediated pregnancy complications? Arch Gynecol Obstet 2012; 286:585-9. [DOI: 10.1007/s00404-012-2342-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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