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Gumusoglu SB, Kiel MD, Gugel A, Schickling BM, Weaver KR, Lauffer MC, Sullivan HR, Coulter KJ, Blaine BM, Kamal M, Zhang Y, Devor EJ, Santillan DA, Gantz SC, Santillan MK. Anti-angiogenic mechanisms and serotonergic dysfunction in the Rgs2 knockout model for the study of psycho-obstetric risk. Neuropsychopharmacology 2024; 49:864-875. [PMID: 37848733 PMCID: PMC10948883 DOI: 10.1038/s41386-023-01749-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
Psychiatric and obstetric diseases are growing threats to public health and share high rates of co-morbidity. G protein-coupled receptor signaling (e.g., vasopressin, serotonin) may be a convergent psycho-obstetric risk mechanism. Regulator of G Protein Signaling 2 (RGS2) mutations increase risk for both the gestational disease preeclampsia and for depression. We previously found preeclampsia-like, anti-angiogenic obstetric phenotypes with reduced placental Rgs2 expression in mice. Here, we extend this to test whether conserved cerebrovascular and serotonergic mechanisms are also associated with risk for neurobiological phenotypes in the Rgs2 KO mouse. Rgs2 KO exhibited anxiety-, depression-, and hedonic-like behaviors. Cortical vascular density and vessel length decreased in Rgs2 KO; cortical and white matter thickness and cell densities were unchanged. In Rgs2 KO, serotonergic gene expression was sex-specifically changed (e.g., cortical Htr2a, Maoa increased in females but all serotonin targets unchanged or decreased in males); redox-related expression increased in paraventricular nucleus and aorta; and angiogenic gene expression was changed in male but not female cortex. Whole-cell recordings from dorsal raphe serotonin neurons revealed altered 5-HT1A receptor-dependent inhibitory postsynaptic currents (5-HT1A-IPSCs) in female but not male KO neurons. Additionally, serotonin transporter blockade by the SSRI sertraline increased the amplitude and time-to-peak of 5-HT1A-IPSCs in KO neurons to a greater extent than in WT neurons in females only. These results demonstrate behavioral, cerebrovascular, and sertraline hypersensitivity phenotypes in Rgs2 KOs, some of which are sex-specific. Disruptions may be driven by vascular and cell stress mechanisms linking the shared pathogenesis of psychiatric and obstetric disease to reveal future targets.
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Affiliation(s)
- Serena B Gumusoglu
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
| | - Michaela D Kiel
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Aleigha Gugel
- Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Brandon M Schickling
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Kaylee R Weaver
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Marisol C Lauffer
- Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
- Neural Circuits and Behavior Core, Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
| | - Hannah R Sullivan
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Kaylie J Coulter
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Brianna M Blaine
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Mushroor Kamal
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Yuping Zhang
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Eric J Devor
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Donna A Santillan
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Stephanie C Gantz
- Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Mark K Santillan
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, USA.
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Li BJ, Zhu TT, Hu XY, He CM. Uric acid as a mediator in the correlation between white blood cells and preeclampsia severity: a retrospective cohort study. Sci Rep 2023; 13:20161. [PMID: 37978251 PMCID: PMC10656492 DOI: 10.1038/s41598-023-47625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023] Open
Abstract
This study aimed to analyze the independent risk factors for predicting preeclampsia severity and explore its underlying mechanism. Clinical data of patients with preeclampsia were collected from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Univariate and multivariate analyses were employed to assess the significant factors associated with preeclampsia severity. Additionally, we performed multivariate logistic regression analysis and mediation analysis to investigate the potential regulatory path. Based on inclusion and exclusion criteria, 731 participants were enrolled: severe preeclampsia (n = 381) and mild to moderate preeclampsia (n = 350). Age, white blood cells (WBC), platelet, creatinine, albumin, uric acid, aspartate aminotransferase, alanine aminotransferase, international normalized ratio, and prothrombin time were significantly related to preeclampsia severity. Besides, hospital length of stay was significantly higher in the severe group. Notably, age and uric acid were independent predictors for preeclampsia severity. Further, WBC and creatinine were significantly associated with uric acid. Finally, the mediation analysis showed that uric acid was a mediator of the relationship between WBC and preeclampsia severity. In conclusion, WBC might affect preeclampsia severity and progression via the mediation of uric acid. This study might provide novel insight into preventing preeclampsia development.
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Affiliation(s)
- Bai-Jia Li
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Shangcheng District, Hangzhou, 310018, Zhejiang, China
| | - Ting-Ting Zhu
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Shangcheng District, Hangzhou, 310018, Zhejiang, China
| | - Xiao-Ying Hu
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Shangcheng District, Hangzhou, 310018, Zhejiang, China
| | - Chao-Man He
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Shangcheng District, Hangzhou, 310018, Zhejiang, China.
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Kahramanoglu Ö, Schiattarella A, Demirci O, Sisti G, Ammaturo FP, Trotta C, Ferrari F, Rapisarda AMC. Preeclampsia: state of art and future perspectives. A special focus on possible preventions. J OBSTET GYNAECOL 2022; 42:766-777. [PMID: 35469530 DOI: 10.1080/01443615.2022.2048810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preeclampsia (PE) is characterised by the new onset of hypertension after the 20th week of pregnancy, with or without proteinuria or hypertension that leads to end-organ dysfunction. Since the only definitive treatment is delivery, PE still represents one of the leading causes of preterm birth and perinatal mobility and mortality. Therefore, any strategies that aim to reduce adverse outcomes are based on early primary prevention, prenatal surveillance and prophylactic interventions. In the last decade, intense research has been focussed on the study of predictive models in order to identify women at higher risk accurately. To date, the most effective screening model is based on the combination of anamnestic, demographic, biophysical and maternal biochemical factors. In this review, we provide a detailed discussion about the current and future perspectives in the field of PE. We will examine pathogenesis, risk factors and clinical features. Moreover, recent developments in screening and prevention strategies, novel therapies and healthcare management strategies will be discussed.
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Affiliation(s)
- Özge Kahramanoglu
- Department of Perinatology, Zeynep Kamil Education and Research Hospital, İstanbul, Turkey
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Education and Research Hospital, İstanbul, Turkey
| | - Giovanni Sisti
- Department of Obstetrics and Gynecology, New York Health and Hospitals/Lincoln, Bronx, NY, USA
| | - Franco Pietro Ammaturo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Trotta
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federico Ferrari
- Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Agnese Maria Chiara Rapisarda
- Department of General Surgery and Medical Surgical Specialties, Obstetrics and Gynecology Unit, University of Catania, Catania, Italy
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Liauw J, Groom K, Ganzevoort W, Gluud C, McKinlay CJD, Sharp A, Mackay L, Kariya C, Lim K, von Dadelszen P, Limpens J, Jakobsen JC. Short-term outcomes of phosphodiesterase type 5 inhibitors for fetal growth restriction: a study protocol for a systematic review with individual participant data meta-analysis, aggregate meta-analysis, and trial sequential analysis. Syst Rev 2021; 10:305. [PMID: 34861900 PMCID: PMC8643016 DOI: 10.1186/s13643-021-01849-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early onset fetal growth restriction secondary to placental insufficiency can lead to severe maternal and neonatal morbidity and mortality. Pre-clinical studies and a few small randomised clinical trials have suggested that phosphodiesterase type 5 (PDE-5) inhibitors may have protective effects against placental insufficiency in this context; however, robust evidence is lacking. The STRIDER Consortium conducted four randomised trials to investigate the use of a PDE-5 inhibitor, sildenafil, for the treatment of early onset fetal growth restriction. We present a protocol for the pre-planned systematic review with individual participant data meta-analysis, aggregate meta-analysis, and trial sequential analysis of these and other eligible trials. The main objective of this study will be to evaluate the effects of PDE-5 inhibitors on neonatal morbidity compared with placebo or no intervention among pregnancies with fetal growth restriction. METHODS We will search the following electronic databases with no language or date restrictions: OVID MEDLINE, OVID EMBASE, the Cochrane Controlled Register of Trials (CENTRAL), and the clinical trial registers Clinicaltrials.gov and World Health Organisation International Clinical Trials Registry Platform (ICTRP). We will identify randomised trials of PDE-5 inhibitors in singleton pregnancies with growth restriction. Two reviewers will independently screen all citations, full-text articles, and abstract data. Our primary outcome will be infant survival without evidence of serious adverse neonatal outcome. Secondary outcomes will include gestational age at birth and birth weight z-scores. We will assess bias using the Cochrane Risk of Bias 2 tool. We will conduct aggregate meta-analysis using fixed and random effects models, Trial Sequential Analysis, and individual participant data meta-analysis using one- and two-stage approaches. The certainty of evidence will be assessed with GRADE. DISCUSSION This pre-defined protocol will minimise bias during analysis and interpretation of results, toward the goal of providing robust evidence regarding the use of PDE-5 inhibitors for the treatment of early onset fetal growth restriction. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42017069688).
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Affiliation(s)
- Jessica Liauw
- Department of Obstetrics and Gynaecology, University of British Columbia, Room C420-4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada.
| | - Katie Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wessel Ganzevoort
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Andrew Sharp
- Harris-Wellbeing Preterm Birth Centre, University of Liverpool, Liverpool, UK
| | - Laura Mackay
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Ken Lim
- Department of Obstetrics and Gynaecology, University of British Columbia, Room C420-4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada
| | | | - Jacqueline Limpens
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
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Sole KB, Staff AC, Laine K. Maternal diseases and risk of hypertensive disorders of pregnancy across gestational age groups. Pregnancy Hypertens 2021; 25:25-33. [PMID: 34022624 DOI: 10.1016/j.preghy.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/27/2020] [Accepted: 05/08/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To estimate the risk of hypertensive disorders of pregnancy in nulliparous women with diabetes, chronic hypertension or obesity in three gestational age groups. STUDY DESIGN Population-based observational cohort study of 382 618 nulliparous women (94 280 with known BMI) using Medical Birth Registry of Norway and Statistics Norway. Main exposure variables were diabetes, chronic hypertension, Body Mass Index (BMI). Multiple regression analysis was performed without (model 1) and with (model 2) BMI. MAIN OUTCOME MEASURES Preeclampsia stratified by gestational age group at delivery: early (230-336 weeks), intermediate (340-366 weeks) and late (370-436 weeks), and gestational hypertension. RESULTS In model 1, Type 1 diabetes was associated with early (aOR = 5.0, 95%CI 3.8, 6.7), intermediate (aOR = 10.2, 95%CI 8.5, 12.3) and late preeclampsia (aOR = 2.7, 95%CI 2.4, 3.2), compared to no diabetes. Compared to normotensive women, women with chronic hypertension had an increased risk of preeclampsia in all groups: early (aOR = 8.68, 95%CI 6.94, 10.85), intermediate (aOR = 5.59, 95%CI 4.46, 7.02), late (aOR = 3.45, 95%CI 3.00, 3.96). The same trends persisted after adjusting for BMI (model 2). Obesity remained an independent risk factor for hypertensive disorders of pregnancy. CONCLUSIONS Maternal diabetes, chronic hypertension and obesity were associated with an increased risk of hypertensive disorders of pregnancy across all gestational age groups in nulliparous women. Adjusting for BMI did not further modify the risk in these women, although 75% of the women in the study lacked BMI data.
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Affiliation(s)
- Kristina Baker Sole
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway.
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Katariina Laine
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway; Department of Obstetrics, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
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Use of the angiogenic biomarker profile to risk stratify patients with fetal growth restriction. Am J Obstet Gynecol MFM 2021; 3:100394. [PMID: 33991706 DOI: 10.1016/j.ajogmf.2021.100394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Novel angiogenic biomarker profiles have demonstrated emerging evidence for predicting preeclampsia onset, severity, and adverse outcomes. Limited data exist in screening patients with fetal growth restriction for preeclampsia development using angiogenic biomarkers. OBJECTIVE The objective of this study was to risk stratify patients with fetal growth restriction using a soluble fms-like tyrosine kinase-1 to placental growth factor ratio. Previously published cutoff of 38 was used to predict preeclampsia development and severity as well as adverse maternal or neonatal outcomes within a 2-week time period. STUDY DESIGN This was a prospective observational cohort study performed in a single tertiary hospital. Patients with a singleton fetal growth restriction pregnancy between 24 and 37 weeks' gestation were evaluated using serial 2-week encounters from the time of enrollment to delivery. Pregnancies with proven genetic or infectious etiology of fetal growth restriction or congenital anomalies were excluded. Ultrasound growth and Doppler measurements were obtained at the start of every encounter with routine preeclampsia laboratory tests and blood pressure checks when clinically indicated. Maternal serum was collected for all serial encounters and measured for soluble fms-like tyrosine kinase-1 and placental growth factor after delivery in a double-blinded fashion. Maternal charts were reviewed for baseline demographic characteristics, pregnancy diagnoses and outcomes, and neonatal outcomes. RESULTS A total of 45 patients were enrolled for a total of 77 encounters, with the median (quartile 1, quartile 3) gestational age of the study enrolled at 31.43 (28.14-33.57) weeks. Patients were divided into low-risk (ratio of <38) and high-risk (ratio of ≥38) groups. Baseline characteristics of patients did not show any marked differences, including preeclampsia labs or ultrasound parameters, between the 2 groups. Systolic and diastolic blood pressures upon enrollment were statistically elevated when soluble fms-like tyrosine kinase-1 to placental growth factor ratio was ≥38 (P=.02 and P=.01, respectively). Compared to patients with a low ratio, patients with a high ratio had a greater proportion of preeclampsia diagnosis, higher rates of preterm delivery under 34 and 37 weeks gestation, smaller neonatal birthweight, and a shorter time to delivery from testing to delivery. CONCLUSION Among patients with fetal growth restriction, the soluble fms-like tyrosine kinase-1 to placental growth factor ratio may serve as a potential biomarker for identifying at risk patients for developing preeclampsia and subsequently preterm delivery.
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Pekkola M, Tikkanen M, Loukovaara M, Lohi J, Paavonen J, Stefanovic V. Postmortem examination protocol and systematic re-evaluation reduce the proportion of unexplained stillbirths. J Perinat Med 2020; 48:771-777. [PMID: 31990664 DOI: 10.1515/jpm-2019-0426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 12/22/2019] [Indexed: 11/15/2022]
Abstract
Background Stillbirth often remains unexplained, mostly due to a lack of any postmortem examination or one that is incomplete and misinterpreted. Methods This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland, and comprised 214 antepartum singleton stillbirths from 2003 to 2015. Maternal and fetal characteristics and the results of the systematic postmortem examination protocol were collected from medical records. Causes of death were divided into 10 specific categories. Re-evaluation of the postmortem examination results followed. Results Based on our systematic protocol, the cause of death was originally defined and reported as such to parents in 133 (62.1%) cases. Re-evaluation of the postmortem examination results revealed the cause of death in an additional 43 (20.1%) cases, with only 23 (10.7%) cases remaining truly unexplained. The most common cause of stillbirth was placental insufficiency in 56 (26.2%) cases. A higher proportion of stillbirths that occurred at ≥39 gestational weeks remained unexplained compared to those that occurred earlier (24.1% vs. 8.6%) (P = 0.02). Conclusion A standardized postmortem examination and a re-evaluation of the results reduced the rate of unexplained stillbirth. Better knowledge of causes of death may have a major impact on the follow-up and outcome of subsequent pregnancies. Also, closer examination and better interpretation of postmortem findings is time-consuming but well worth the effort in order to provide better counseling for the grieving parents.
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Affiliation(s)
- Maria Pekkola
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Loukovaara
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Latino JO, Udry S, Aranda F, Wingeyer SP, Romero DSF, Belizna C, Larrañaga GD. Risk factors for early severe preeclampsia in obstetric antiphospholipid syndrome with conventional treatment. The impact of hydroxychloroquine. Lupus 2020; 29:1736-1742. [PMID: 32838621 DOI: 10.1177/0961203320952850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The first aim was to retrospectively identify risk factors for the development of early severe preeclampsia (sPE) in patients with obstetric antiphospholipid syndrome (OAPS) who received conventional treatment (CT). The second aim was to evaluate the impact of hydroxychloroquine (HCQ) in preventing early sPE among a subgroup of patients considered at high risk. METHODS A total of 102 women diagnosed with OAPS and treated with CT since the diagnosis of pregnancy were selected. At the end of pregnancy, we identified risk factors associated with early sPE. According to these risk factors, we collected a new cohort of 42 patients who presented high-risk factors for developing early sPE and split them into two groups according to the treatment received: group A, CT (30 patients); and group B, CT+HCQ (12 patients). We evaluated and compared pregnancy outcomes in both groups. RESULTS According to the multivariate analysis, risk factors associated with early sPE and CT were triple positivity for antiphospholipid antibodies (aPL) (OR = 24.70, [4.27-142.92], p < 0.001) and a history of early sPE (OR = 7.11, [1.13-44.64], p = 0.036). A low-risk aPL profile was associated with a good response to CT in preventing early sPE (OR = 0.073, [0.014-0.382], p = 0.002). High-risk patients treated with CT+HCQ had a significantly lower early sPE rate than those treated with CT only (8.3% vs 40.0%; p = 0.03). CONCLUSION Triple positivity for aPL and a history of early sPE are potential strong risk factors for the development of early sPE. HCQ might be an interesting therapeutic option for patients with high-risk factors for early sPE.
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Affiliation(s)
- José Omar Latino
- Autoimmune, Thrombophilic Diseases and Pregnancy Section, Acute Hospital "Dr. Carlos G. Durand", City of Buenos Aires, Argentina
| | - Sebastián Udry
- Hemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr. Francisco J. Muñiz", City of Buenos Aires, Argentina
| | - Federico Aranda
- Hemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr. Francisco J. Muñiz", City of Buenos Aires, Argentina
| | - Silvia Perés Wingeyer
- Hemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr. Francisco J. Muñiz", City of Buenos Aires, Argentina
| | - Diego Santiago Fernández Romero
- Autoimmune, Thrombophilic Diseases and Pregnancy Section, Acute Hospital "Dr. Carlos G. Durand", City of Buenos Aires, Argentina
| | - Cristina Belizna
- Vascular and Coagulation Department, University Hospital Angers, Angers, France
| | - Gabriela de Larrañaga
- Hemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr. Francisco J. Muñiz", City of Buenos Aires, Argentina
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Tskhay V, Schindler A, Shestakova M, Klimova O, Narkevich А. The role of progestogen supplementation (dydrogesterone) in the prevention of preeclampsia. Gynecol Endocrinol 2020; 36:698-701. [PMID: 31876197 DOI: 10.1080/09513590.2019.1706085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Our goal was determine the effects of dydrogesterone supplementation to reduce the incidence of preeclampsia (PE) in early pregnancy (from 6 to 20 weeks of gestation). A total of 406 pregnant women were involved into the study. The Study group enrolled 169 women, supplemented with dydrogesterone at a dose of 30 mg/d 6-20 weeks of gestation compared with the control group (237 subjects) - without dydrogesterone supplementation. The women were randomized by age, race, obstetrics complications, and their somatic history. The use of dydrogesterone in early pregnancy - before 20 weeks of gestation (at a dose of 30 mg/d) with high-risk factors of PE contributed to a statistically significant reduction in the frequency of this complication (13.1% and 71.4%, p < .001). It was seen, that women who took dydrogesterone developed significantly less such disorders like hypertension (3.2% and 71.2%, p < .001), proteinuria (0.0% and 66.18%, p < .001), fetal growth retardation syndrome (2.2% and 21.58%, p < .001), destroy of uteri-placenta velocity (3.2% and 21.58%, p < .001), preterm labor (8.6% and 53.95%, p < .001). Dydrogesterone supplementation in the first and second period of pregnancy (from 6 to 20 weeks of gestation) significantly reduced the incidence of PE in women with higher risk pregnancy.
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Affiliation(s)
- V Tskhay
- Perinatology, Obstetrics and Gynecology Department, Krasnoyarsk State Medical University named after Voino-Yasenetsky, Krasnoyarsk, Russia
| | - A Schindler
- Perinatology, Obstetrics and Gynecology Department, Krasnoyarsk State Medical University named after Voino-Yasenetsky, Krasnoyarsk, Russia
- Institute for Medical Research and Education, Essen, Germany
| | - M Shestakova
- Perinatology, Obstetrics and Gynecology Department, Krasnoyarsk State Medical University named after Voino-Yasenetsky, Krasnoyarsk, Russia
| | - O Klimova
- Perinatology, Obstetrics and Gynecology Department, Krasnoyarsk State Medical University named after Voino-Yasenetsky, Krasnoyarsk, Russia
| | - А Narkevich
- Perinatology, Obstetrics and Gynecology Department, Krasnoyarsk State Medical University named after Voino-Yasenetsky, Krasnoyarsk, Russia
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Gárate-Escamilla AK, Garza-Padilla E, Carvajal Rivera A, Salas-Castro C, Andrès E, Hajjam El Hassani A. Cluster Analysis: A New Approach for Identification of Underlying Risk Factors and Demographic Features of First Trimester Pregnancy Women. J Clin Med 2020; 9:E2247. [PMID: 32679845 PMCID: PMC7408845 DOI: 10.3390/jcm9072247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/31/2022] Open
Abstract
Thyroid pathology is reported internationally in 5-10% of all pregnancies. The overall aim of this research was to determine the prevalence of hypothyroidism and risk factors during the first trimester screening in a Mexican patients sample. We included the records of 306 patients who attended a prenatal control consultation between January 2016 and December 2017 at the Women's Institute in Monterrey, Mexico. The studied sample had homogeneous demographic characteristics in terms of age, weight, height, BMI (body mass index) and number of pregnancies. The presence of at least one of the risk factors for thyroid disease was observed in 39.2% of the sample. Two and three clusters were identified, in which patients varied considerably among risk factors, symptoms and pregnancy complications. Compared to Cluster 0, one or more symptoms or signs of hypothyroidism occurred, while Cluster 1 was characterized by healthier patients. When three clusters were used, Cluster 2 had a higher TSH (thyroid stimulating hormone) value and pregnancy complications. There were no significant differences in perinatal variables. In addition, high TSH levels in first trimester pregnancy are characterized by pregnancy complications and decreased newborn weight. Our findings underline the high degree of disease heterogeneity with existing pregnant hypothyroid patients and the need to improve the phenotyping of the syndrome in the Mexican population.
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Affiliation(s)
| | - Edelmiro Garza-Padilla
- Monterrey Institute of Technology and Higher Education, Monterrey 64700, Mexico; (E.G.-P.); (A.C.R.); (C.S.-C.)
| | - Agustín Carvajal Rivera
- Monterrey Institute of Technology and Higher Education, Monterrey 64700, Mexico; (E.G.-P.); (A.C.R.); (C.S.-C.)
| | - Celina Salas-Castro
- Monterrey Institute of Technology and Higher Education, Monterrey 64700, Mexico; (E.G.-P.); (A.C.R.); (C.S.-C.)
| | - Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, CHRU de Strasbourg, 67091 Strasbourg, France;
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11
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Morikawa M, Kato-Hirayama E, Mayama M, Saito Y, Nakagawa K, Umazume T, Chiba K, Kawaguchi S, Okuyama K, Watari H. Glycemic control and fetal growth of women with diabetes mellitus and subsequent hypertensive disorders of pregnancy. PLoS One 2020; 15:e0230488. [PMID: 32176740 PMCID: PMC7075561 DOI: 10.1371/journal.pone.0230488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/02/2020] [Indexed: 11/25/2022] Open
Abstract
Pregnant women with diabetes mellitus (DM) are at high risk for hypertensive disorder of pregnancy (HDP). Women with poor control DM sometimes have heavy-for-dates infants. However, women with HDP sometimes have light-for-dates infants. We aim to clarify the relationship between glycemic control and fetal growth in women with DM and/or subsequent HDP. Of 7893 women gave singleton birth at or after 22 gestational weeks, we enrolled 154 women with type 1 DM (T1DM) or type 2 DM (T2DM) whose infants did not have fetal abnormalities. Among women with T1DM or T2DM, characteristics of the three groups (with HDP, without HDP, and with chronic hypertension [CH]) were compared. No women with T1DM had CH, but 19 (17.4%) of 109 with T2DM did. HDP incidence was similar between women with T1DM (22.2%) and T2DM without CH (16.7%). Among women with T1DM, the incidences of fetal growth restriction (FGR) with and without HDP were similar. However, among women with T2DM without CH, this incidence was significantly higher among those with HDP (33.3%) than among those without HDP (5.3%), was significantly more common with HbA1c levels at first trimester ≥ 7.2% (33.3%) than with those < 7.2% (5.6%), and significantly more numerous without pre-pregnancy therapies for DM (23.3%) than with them (3.3%). Among women with T2DM and HDP, those with FGR had smaller placenta SDs and higher insulin dosages at delivery than those without light-for-dates. In multivariate analysis, the presence of diabetic nephropathy was a predictor of T1DM and HDP (P = 0.0105), whereas HbA1c levels ≥ 7.2% before pregnancy was a predictor of T2DM and HDP (P = 0.0009). Insulin dosage ≥ 50U/day at delivery (P = 0.0297) and the presence of HDP (P = 0.0116) independently predicted T2DM, HDP, and FGR development. Insufficient pre-pregnancy treatment of DM increased the risk of HDP.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- * E-mail:
| | - Emi Kato-Hirayama
- Department of Obstetrics and Gynecology, Sapporo City Hospital, Sapporo, Japan
| | - Michinori Mayama
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshihiro Saito
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kinuko Nakagawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Chiba
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kawaguchi
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhiko Okuyama
- Department of Obstetrics and Gynecology, Sapporo City Hospital, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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12
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Hendrix MLE, Palm KCM, Van Kuijk SMJ, Bekers O, Spaanderman MEA, Bons JAP, Al-Nasiry S. Longitudinal changes in placental biomarkers in women with early versus late placental dysfunction. Hypertens Pregnancy 2019; 38:268-277. [PMID: 31559879 DOI: 10.1080/10641955.2019.1668948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: To evaluate longitudinal changes of angiogenic biomarkers in early- (EO-PD) versus late-onset (LO-PD) placental dysfunction. Methods: Serum PlGF and sFlt-1 measured at different intervals in EO-PD (n= 43), LO-PD (n= 31) and controls (n = 133). Results: sFlt-1/PlGF ratio was higher at 16 weeks (30.6 vs 17.5), 20 weeks (29.3 vs 8.9) and 30 weeks (16.6 vs 6.7) in EO-PD vs controls (all p< 0.05), but not in LO-PD. Longitudinal changes for all intervals had higher AUC than single measurements. Conclusion: Longitudinal biomarker change between 12 and 30 weeks could improve prediction of EO-PD compared to single measurements.
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Affiliation(s)
- Manouk L E Hendrix
- Department of Obstetrics & Gynecology, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Kirsten C M Palm
- Department of Obstetrics & Gynecology, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Sander M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre(MUMC+) , Maastricht , The Netherlands
| | - Otto Bekers
- Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics & Gynecology, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Judith A P Bons
- Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Salwan Al-Nasiry
- Department of Obstetrics & Gynecology, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
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13
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Härkin P, Marttila R, Pokka T, Saarela T, Hallman M. Survival analysis of a cohort of extremely preterm infants born in Finland during 2005-2013. J Matern Fetal Neonatal Med 2019; 34:2506-2512. [PMID: 31522587 DOI: 10.1080/14767058.2019.1668925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to analyze the mortality of extremely preterm infants (ELGA born alive before 28 weeks) until the postconceptional age of 42 weeks, death, or home discharge, whichever came first. It was focused especially on studying the relationship between antenatal risk factors, the time of death, and the postnatal morbidities associated with mortality. STUDY DESIGN The original data obtained from the nationwide Finnish medical birth register of extremely preterm and low birthweight infants born during 2005-2013 were analyzed. The total population consisted of 1353 ELGA infants after the exclusion of 18 infants born with lethal congenital anomalies or genetic defects. Mortality risks were adjusted according to the length of gestation, the administration of antenatal steroids, and the delivery hospital. RESULTS During the first 48 hours, extreme immaturity was seen to be the prominent cause of death, and intrauterine growth did not influence mortality. The ELGA population surviving for at least 48 hours (N = 1135) was submitted for mortality risk analysis. After the adjustments, small-for-gestational-age (SGA) (birth weight below -2 SD) was found to be the factor with the highest risk for demise [OR 6.2; 95% CI (3.9-10.0) p < .001]. Multiple deliveries were associated with increased risk for death [OR 1.5; 95% CI (1.0-2.1), p = .048] to a lesser extent. The main neonatal morbidities associated with the risk of mortality after 48 postnatal hours of life were severe intraventricular hemorrhage (IVH) [OR 4.4; 95% CI (3.0-6.7), p < .001], respiratory distress syndrome (RDS) [OR 2.6; 95% CI (1.3-5.0), p = .006], and necrotizing enterocolitis (NEC) [OR 2.3; 95% CI (1.5-3.4), p < .001]. The major morbidities associated with deaths among non-SGA infants were severe IVH (32.1% of all deaths), NEC (19.1%), and sepsis (8.4%). In SGA infants, severe respiratory disease (RDS, severe bronchopulmonary dysplasia, pulmonary hemorrhage, or pulmonary hypertension) was the main cause of death (60.9% of all deaths). Medical or surgical PDA treatment was not found to be associated with increased risk of death [OR 0.4; 95% CI (0.2-0.5), p < .001] compared to infants who had survived for more than 2 days. Severe preeclampsia was found to be associated with 42% of all ELGA-SGA births. After the adjustments, ELGA infants from pregnancies complicated by preeclampsia of the mother exhibited a significantly lower risk of severe IVH [OR 0.3; 95% CI (0.2-0.5), p < .001] compared to the non-preeclamptic mothers' infants. The low incidence of severe IVH was evident regardless of fetal growth in this patient group. CONCLUSIONS SGA infants with less than 28 gestational weeks, who had survived for at least 2 days, had excessively high mortality due to severe pulmonary disease. Intrauterine growth had no influence on the risk of death, other than pulmonary causes. The infants of preeclamptic mothers exhibited an increased risk of intrauterine growth retardation; however, despite this serious complication, these infants exhibited a significant decrease in the risk for severe IVH.
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Affiliation(s)
- Pia Härkin
- Medical Research Centre Oulu, PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Riitta Marttila
- Medical Research Centre Oulu, PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- Medical Research Centre Oulu, PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Timo Saarela
- Medical Research Centre Oulu, PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Mikko Hallman
- Medical Research Centre Oulu, PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
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14
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Sun X, Qu T, He X, Yang X, Guo N, Mao Y, Xu X, Sun X, Zhang X, Wang W. Screening of differentially expressed proteins from syncytiotrophoblast for severe early-onset preeclampsia in women with gestational diabetes mellitus using tandem mass tag quantitative proteomics. BMC Pregnancy Childbirth 2018; 18:437. [PMID: 30404616 PMCID: PMC6223002 DOI: 10.1186/s12884-018-2066-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/19/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Previous studies have revealed that women with gestational diabetes mellitus (GDM) have an increased risk of developing preeclampsia (PE). The possible reason is the abnormal lipid metabolism caused by GDM that leads to dysfunction of vascular endothelial cells and atherosclerosis, resulting in the onset of PE. However, studies focusing on the pathogenesis of PE in syncytiotrophoblast of GDM patients are lacking. This study aimed to compare differentially expressed proteins from syncytiotrophoblast between women with GDM and women with GDM with subsequently developed PE. METHODS Syncytiotrophoblast samples were obtained from pregnant women immediately after delivery. To explore the protein expression changes of syncytiotrophoblast that might explain the pathogenesis of PE in women with GDM, quantitative proteomics was performed using tandem mass tag (TMT) isobaric tags and liquid chromatography-tandem mass spectrometry. Bioinformatics analysis was performed to enrich the biological processes that these differentially expressed proteins were involved in. RESULTS A total of 28,234 unique peptides and 4140 proteins were identified in all samples. Among them, 23 differentially expressed proteins were identified between patients with GDM and patients with GDM with subsequently developed PE. Therein, 11 proteins were upregulated and 12 proteins were downregulated. Two relative proteins (FLT1 and PABPC4) were independently verified using immunoblotting analysis. Bioinformatic results indicated that the onset of PE in patients with GDM is a multifactorial disorder, involving factors such as apoptosis, transcriptional misregulation, oxidative stress, lipid metabolism, cell infiltration and migration, and angiogenesis. CONCLUSION These results indicated that the inadequacy of endometrium infiltration, angiogenic disorder, and oxidative stress in syncytiotrophoblast are more likely to occur in patients with GDM and may be the potential mechanisms leading to such patients secondarily developing severe early-onset PE.
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Affiliation(s)
- Xiaotong Sun
- 0000 0000 8571 0482grid.32566.34The First Clinical Medical College, Lanzhou University, Lanzhou, China
- grid.417234.7Department of Obstetrics, Gansu Provincial Hospital, Lanzhou, China
| | - Tao Qu
- grid.417234.7Department of Biotherapy Center, Gansu Provincial Hospital, Lanzhou, China
| | - Xiyan He
- grid.417234.7Department of Obstetrics, Gansu Provincial Hospital, Lanzhou, China
| | - Xueping Yang
- grid.417234.7Department of Obstetrics, Gansu Provincial Hospital, Lanzhou, China
| | - Nan Guo
- grid.417234.7Department of Obstetrics, Gansu Provincial Hospital, Lanzhou, China
| | - Yan Mao
- grid.417234.7Department of Obstetrics, Gansu Provincial Hospital, Lanzhou, China
| | - Xianghong Xu
- grid.417234.7Department of Biotherapy Center, Gansu Provincial Hospital, Lanzhou, China
| | - Xiaodong Sun
- 0000 0004 1790 6079grid.268079.2Department of Endocrinology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xuehong Zhang
- 0000 0000 8571 0482grid.32566.34The First Clinical Medical College, Lanzhou University, Lanzhou, China
- grid.412643.6The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo of Gansu, Lanzhou, China
| | - Weihua Wang
- Houston Fertility Laboratory, Houston, TX USA
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15
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Abstract
Preeclampsia is characterized by blood pressure greater than 140/90 mmHg in the second half of pregnancy. This disease is a major contributor to preterm and low birth weight babies. The early delivery of the baby, which becomes necessary for maintaining maternal well-being, makes preeclampsia the leading cause for preterm labor and infant mortality and morbidity. Currently, there is no cure for this pregnancy disorder. The current clinical management of PE is hydralazine with labetalol and magnesium sulfate to slow disease progression and prevent maternal seizure, and hopefully prolong the pregnancy. This review will highlight factors implicated in the pathophysiology of preeclampsia and current treatments for the management of this disease.
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