Placental vascularization alterations in hypertensive disorders complicating pregnancy (HDCP) and small for gestational age with HDCP using three-dimensional power doppler in a prospective case control study

New insights into human functional ultrasound imaging

Ultrasound imaging is a vital tool for exploring in vivo the placental function which is essential to understand pathological phenomena such as preeclampsia or intrauterine growth restriction. As technology advances including ready availability of three-dimensional (3D) probes and novel software, new markers of placental function become possible. The objective of this review was to provide an overview of the new ultrasound markers of placental function with a focus on the potential clinical application of three-dimensional power Doppler (3DPD). A broad-free text literature search was undertaken based on human placental studies and sixty full-text studies were included in this review. Three-dimensional power Doppler is a promising technique to predict preeclampsia in the first trimester. However, the influence of external factors such as body mass index, parameter standardisation and machine settings still need to be addressed. Contrast-enhanced ultrasound is currently reserved for research, because the required injected contrast mediums are not currently approved for use in pregnancy, although the safety data is reassuring.

The predictive value of microRNA in early hypertensive disorder complicating pregnancy (HDCP)

OBJECTIVE

To examine the predictive value of microRNA (miRNA) in hypertensive disorder complicating pregnancy (HDCP).

METHODS

102 pregnant women with HDCP admitted to our hospital from March 2017 to June 2019 were recruited as the study cohort and randomly divided into an HDCP group, a mild preeclampsia group, and a severe preeclampsia group, with 34 patients in each group. In addition, 34 healthy pregnant women who underwent pregnancy tests in our hospital were recruited as the normal group. The relative expressions of plasma miR-19a, miR-126, and miRNA-210 in were measured. A Pearson correlation analysis was used to analyze the correlations between the miR-19a, miR-181b, and miRNA-210 expressions and the severity of HDCP. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of the miR-19a, miR-126, and miRNA-210 expressions.

RESULTS

The miR-19a and miRNA-210 expressions were higher in the HDCP group, the mild preeclampsia group, and the severe preeclampsia group than they were in the normal group, and the miR-126 expression was lower (all P<0.05). The miR-19a, miR-126, and miRNA-210 expressions were different among the four groups (P<0.05). The miR-19a and miRNA-210 expression levels in the severe preeclampsia group were higher than they were in the HDCP group, and the miR-126 expression was lower (P<0.05). A Pearson correlation analysis showed the miR-19a and miR-210 levels in the HDCP patients were positively correlated with the severity of the disease (P<0.05), and the miR-126 level is negatively correlated with disease severity (P<0.05). Our ROC curve analysis demonstrated that the miR-19a, miR-126, and miR-210 levels have a predictive value for HDCP. The areas under the curve were 0.800, 0.633, and 0.723, the sensitivities were 81.2%, 71.4%, and 80.2%, and the specificities were 73.5%, 67.5%, 81.5%. Additionally, the area under the curve of the combination of the three was 0.896, and the sensitivity and specificity were 90.5% and 93.9% respectively.

CONCLUSION

miR-19a, miR-126, and miR-210 are strongly connected to the severity of HDCP and can be used as a sensitive indicator to predict HDCP patients clinically.

Correlation analysis of levels of inflammatory cytokines and nitric oxide in peripheral blood with urine proteins and renal function in patients with gestational hypertension

The aim of the study was to investigate correlations among inflammatory cytokines, nitric oxide (NO) level, urine protein, renal function and blood pressure in peripheral blood of patients with hypertensive disorder complicating pregnancy (HDCP). A total of 60 patients diagnosed with HDCP in the Obstetrics Department of Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology from May 2016 to April 2017 were selected. The patients were divided into the HDCP (n=20), mild pre-eclampsia (n=20) and severe pre-eclampsia (n=20) groups. Additionally, 20 healthy pregnant women were selected as the control group. General data of the patients were collected. NO, renal function and 24-h urine protein were measured. The systolic and diastolic blood pressure, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the HDCP group was significantly higher than that in the control group. The CRP, TNF-α and IL-6 levels in the pre-eclampsia groups were higher than those in the gestational hypertension group (P<0.05). The NO level in peripheral blood of patients in the pre-eclampsia groups was lower than that in the gestational hypertension group (P<0.05). The levels of 24-h urine protein, homocysteine (Hcy), cystatin-C (Cys-C), serum creatinine (SCr), urea and β2 microglobulin in the pre-eclampsia groups were higher than those in the gestational hypertension group (P<0.05). Gestational age and the levels of baseline blood pressure, inflammatory cytokines, 24-h urine protein and renal function have independent predictive value for the occurrence of HDCP (P<0.05). The results show that, 24-h urine protein, renal function and inflammatory cytokines are closely correlated with the occurrence of HDCP, which can reflect the severity and prognosis of the disease to a certain extent. In addition, it has important reference value for the assessment and treatment of the disease.

Influence of maternal obesity on the association between common pregnancy complications and risk of childhood obesity: an individual participant data meta-analysis

BACKGROUND

Gestational diabetes and gestational hypertensive disorders are associated with offspring obesity, but the role of maternal adiposity in these associations remains unclear. We aimed to investigate whether these pregnancy complications affect the odds of offspring obesity independently of maternal obesity.

METHODS

We did an individual participant data (IPD) meta-analysis of mother-offspring pairs from prospective birth cohort studies that had IPD on mothers with singleton liveborn children born from 1989 onwards and had information available about maternal gestational diabetes, gestational hypertension or pre-eclampsia, and childhood body-mass index (BMI). We applied multilevel mixed-effects models to assess associations of gestational diabetes, gestational hypertension, and pre-eclampsia with BMI SD scores and the odds of overweight and obesity throughout childhood, adjusting for lifestyle characteristics (offspring's sex, maternal age, educational level, ethnicity, parity, and smoking during pregnancy). We then explored the extent to which any association was explained by maternal pre-pregnancy or early-pregnancy BMI.

FINDINGS

160 757 mother-offspring pairs from 34 European or North American cohorts were analysed. Compared with uncomplicated pregnancies, gestational diabetes was associated with increased odds of overweight or obesity throughout childhood (odds ratio [OR] 1·59 [95% CI 1·36 to 1·86] for early childhood [age 2·0-4·9 years], 1·41 [1·26 to 1·57] for mid childhood [5·0-9·9 years], and 1·32 [0·97 to 1·78] for late childhood [10·0-17·9 years]); however, these associations attenuated towards the null following adjustment for maternal BMI (OR 1·35 [95% CI 1·15 to 1·58] for early childhood, 1·12 [1·00 to 1·25] for mid childhood, and 0·96 [0·71 to 1·31] for late childhood). Likewise, gestational hypertension was associated with increased odds of overweight throughout childhood (OR 1·19 [95% CI 1·01 to 1·39] for early childhood, 1·23 [1·15 to 1·32] for mid childhood, and 1·49 [1·30 to 1·70] for late childhood), but additional adjustment for maternal BMI largely explained these associations (1·01 [95% CI 0·86 to 1·19] for early childhood, 1·02 [0·95 to 1·10] for mid childhood, and 1·18 [1·03 to 1·36] for late childhood). Pre-eclampsia was associated with decreased BMI in early childhood only (difference in BMI SD score -0·05 SD score [95% CI -0·09 to -0·01]), and this association strengthened following additional adjustment for maternal BMI.

INTERPRETATION

Although lowering maternal risk of gestational diabetes, gestational hypertension, and pre-eclampsia is important in relation to maternal and fetal pregnancy outcomes, such interventions are unlikely to have a direct impact on childhood obesity. Preventive strategies for reducing childhood obesity should focus on maternal BMI rather than on pregnancy complications.

FUNDING

EU's Horizon 2020 research and innovation programme (LifeCycle Project).

Combined use of serum gamma glutamyl transferase level and ultrasonography improves prediction of perinatal outcomes associated with preeclamptic pregnancy

INTRODUCTION

Serum gamma glutamyl transferase (GGT), produced and released mostly from the liver and bile duct, is an enzyme involved in response to oxidative stress, and has been used as a maker for prediction of cardiovascular events. Umbilical artery blood flow resistance index, e.g., the systolic/diastolic ratio (S/D ratio) as determined by ultrasound, has been used to assess the fetal intrauterine conditions. While changes of GGT and S/D ratio in preeclampsia are found to be associated with the risk for adverse perinatal outcome, the potential value of combined use of the two measurements for the prediction of adverse perinatal outcome has not been determined.

MATERIALS AND METHODS

This study included severe preeclampsia patients in late pregnancy and determined their serum GGT levels and ultrasonic flow resistance index of umbilical artery within a week before delivery. Demographic data and perinatal outcomes including perinatal death, five-minute Apgar score, admission to neonatal intensive care unit, respiratory distress syndrome, and intrauterine growth restriction, are documented and analyzed.

RESULTS

It was found that serum GGT combined with umbilical artery S/D ratio predicted perinatal adverse outcomes in severe preeclampsia patients with a sensitivity of 94.30% and a specificity of 80.00%. Moreover, absent or reversed UA diastolic blood flow was found to be an independent risk factor for intrauterine growth restriction.

CONCLUSION

GGT in combination with umbilical artery S/D ratio is a potentially useful marker for the prediction of adverse outcome in severe preeclampsia patients. Future studies in a larger cohort of patients should be performed to verify the efficacy of the strategy. Early and accurate prediction of adverse perinatal events can facilitate the efforts to improve the perinatal outcomes of neonates associated with preeclamptic pregnancies.

Three dimensional power Doppler of the placenta and its clinical applications

The aim of this review is to discuss three dimensional (3D) power Doppler of the placenta and its clinical applications. There is a strong clinical need to develop noninvasive, simple and widely available methods of evaluating in vivo placental function to assess fetal wellbeing. While conventional ultrasound is a proven tool in the evaluation of fetal structural anomalies and health, its ability to assess placental function, especially prior to the onset of fetal compromise, is the subject of ongoing investigation. Three dimensional power Doppler has the ability to detect vascularity and blood flow with greater detail than conventional ultrasound, which has led to its investigation in preeclampsia, fetal growth restriction, and other placental vascular abnormalities. While more data are needed on the optimal imaging protocol and its predictive ability for clinical outcomes, 3D power Doppler is emerging as a promising new technology that will improve the evaluation of placental function.

Molecular mechanism of miR-181b in heart disease due to pregnancy-induced hypertension syndrome

The present study aimed to investigate the molecular mechanisms of microRNA (miR)-181b in heart disease due to hypertensive disorders complicating pregnancy (HDCP) through regulating the expression of metallopeptidase inhibitor 3 (TIMP3). miR-181b expression was detected by reverse transcription-quantitative polymerase chain reaction in peripheral blood samples from patients with HDCP. These samples were analyzed for clinical pathological characteristics. The primary cardiomyocytes of rats were cultured in hypoxic conditions for 24 h, in which miR-181b expression was detected at different time points. The expression of TIMP3 was assessed in normal rat cardiomyocytes following transfection with miR-181b mimics by western blot analysis. The TIMP3 protein was also detected in cardiomyocytes following transfection with TIMP3 short interfering-RNA. The apoptosis rate of transfected cardiomyocytes was detected by flow cytometry following 24 h of culture in a hypoxic environment. Luciferase assay was applied to validate whether miR-181b binds to the 3' untranslated region of TIMP3 mRNA. miR-181b expression was significantly downregulated in the peripheral blood of patients with HDCP and the miR-181b expression was negatively associated with the grades of hypertension (P<0.05). The results of luciferase assay indicated that miR-181b directly targets TIMP3. The apoptosis rates of rat cardiomyocytes in the group transfected with miR-181b or TIMP3 siRNA was significantly lower than the normal control group (P<0.05). miR-181b may inhibit apoptosis of cardiomyocytes to protect myocardial cells through directly targeting TIMP3 genes, which serve important roles in HDCP.