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Nyakio O, Cakwira H, Masimango G, Kena L, Narayan G, Naaz F, Mugenyi N, Cyubahiro VK, Amani T, Balagizi F, Suvvari TK, Oduoye MO, Akilimali A. The silent threat: investigating the incidence and clinical characteristics of pre-eclampsia and eclampsia in women from tertiary care hospitals of the Democratic Republic of Congo. Ann Med Surg (Lond) 2024; 86:3267-3272. [PMID: 38846848 PMCID: PMC11152814 DOI: 10.1097/ms9.0000000000002087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 06/09/2024] Open
Abstract
Background Pre-eclampsia and eclampsia are medical conditions that can cause severe complications, such as maternal and foetal morbidity and mortality. This study aimed to assess the incidence and characteristics of pre-eclampsia and eclampsia. Methods From July 2021 to July 2022, the authors conducted a retrospective, cross-sectional, descriptive study in the Department of Obstetrics and Gynaecology of a tertiary care hospital in the Democratic Republic of the Congo (DR Congo). Out of 1236 total deliveries, 40 patients aged 18-35 years with pre-eclampsia and/or eclampsia with complete data in medical records were studied. Results In the studied group, 3.23% of women (40 cases) experienced pre-eclampsia or eclampsia, with the majority (75%, 30 cases) occurring before childbirth. Among these, 62.5% (25 cases) were first-time mothers. The main complications observed in the mothers included HELLP syndrome and placental abruption, whereas their newborns frequently exhibited delayed in-utero growth. Caesarean delivery was the prevalent birthing method, and the treatments most often used for effective management were magnesium sulfate and nicardipine. Conclusion The research highlights the common occurrence of eclampsia among patients in the DRC and stresses the critical need for prompt detection of hypertensive complications during pregnancy, aiming to reduce negative health impacts on both mothers and their children.
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Affiliation(s)
- Olivier Nyakio
- Faculty of Medicine, Evangelic University in Africa
- Faculty of Medicine, Official University of Bukavu
| | - Hugues Cakwira
- Faculty of Medicine, Catholic University of Bukavu
- Department of research, Medical Research Circle (MedReC), Bukavu
| | - Gaston Masimango
- Faculty of Medicine, Official University of Bukavu
- Department of research, Medical Research Circle (MedReC), Bukavu
| | - Louison Kena
- Department of research, Medical Research Circle (MedReC), Bukavu
- Faculty of Medicine, Université Libre des Pays des Grands Lacs, Goma, DR Congo
| | - Gaurang Narayan
- Department of Obstetrics and Gynecology, Indira Gandhi Government Medical College, Nagpur
| | - Farheen Naaz
- Medical college, Deccan College of Medical Sciences, Hyderabad
| | - Nathan Mugenyi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Toussaint Amani
- Department of research, Medical Research Circle (MedReC), Bukavu
- Faculty of Medicine, Université Libre des Pays des Grands Lacs, Goma, DR Congo
| | - Fabien Balagizi
- Department of research, Medical Research Circle (MedReC), Bukavu
| | - Tarun Kumar Suvvari
- Department of Surgery, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
| | | | - Aymar Akilimali
- Department of research, Medical Research Circle (MedReC), Bukavu
- Society for Maternal-Fetal Medicine (SMFM), SW, Washington, DC
- Department of research, East Africa Medical Students Association, Nairobi, Kenya
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Lan R, Yu Y, Song J, Xue M, Gong H. SFRP2 suppresses trophoblast cell migration by inhibiting the Wnt/β‑catenin pathway. Mol Med Rep 2024; 29:66. [PMID: 38426532 PMCID: PMC10926097 DOI: 10.3892/mmr.2024.13190] [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: 08/10/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
The present study investigates the role of Secreted Frizzled‑Related Protein 2 (SFRP2) in trophoblast cells, a key factor in preeclampsia (PE) progression. Elevated levels of Secreted Frizzled‑Related Protein 1/3/4/5 (SFRP1/3/4/5) are associated with PE, but the role of SFRP2 is unclear. We analyzed SFRP2 expression in PE placental tissue using the GSE10588 dataset and overexpressed SFRP2 in JEG‑3 cells via lentiviral transfection. The viability, migration, apoptosis, and proliferation of SFRP2‑overexpressing JEG‑3 cells were assessed using Cell Counting Kit‑8, Transwell assays, flow cytometry, and EdU staining. Additionally, we evaluated the impact of SFRP2 overexpression on key proteins in the Wnt/β‑catenin pathway and apoptosis markers (Bax, cleaved‑caspase 3, BCL‑2, MMP9, E‑cadherin, Wnt3a, Axin2, CyclinD1, c‑Myc, p‑β‑catenin, β‑catenin, phosphorylated Glycogen Synthase Kinase 3 beta (p‑GSK3β), and GSK3β) through western blotting. Results showed high SFRP2 mRNA and protein expression in PE placenta and JEG‑3 cells post‑transfection. SFRP2 overexpression significantly reduced JEG‑3 cell viability, proliferation, and migration, while increasing apoptosis. It also altered expression levels of Wnt pathway proteins, suggesting SFRP2's potential as a therapeutic target for PE by inhibiting trophoblast cell migration through the Wnt/β‑catenin signaling cascade.
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Affiliation(s)
- Ruihong Lan
- Department of Obstetrics, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, P.R. China
| | - Yihong Yu
- School of Clinical Medicine, Hainan Medical University, Haikou, Hainan 571199, P.R. China
| | - Jie Song
- Department of Obstetrics, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, P.R. China
| | - Mengdi Xue
- School of Clinical Medicine, Hainan Medical University, Haikou, Hainan 571199, P.R. China
| | - Humin Gong
- Department of Obstetrics, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, P.R. China
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Tadese M, Damesa WA, Solomon GS, Wakie GE, Tessema SD, Endale A. Maternal outcomes of pre-eclampsia with severe features and its determinants at Abebech Gobena Mothers and Childrens Health and Saint Peter's Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study. BMJ Open 2024; 14:e081901. [PMID: 38553084 PMCID: PMC10982730 DOI: 10.1136/bmjopen-2023-081901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE The main objective of this study was to determine the prevalence and factors associated with unfavourable maternal outcomes among pregnant women with pre-eclampsia with severity features (PEWSF) at Abebech Gobena Maternal and Children's Health and St. Peter's Hospital, Addis Ababa, Ethiopia, 2023. DESIGN A hospital-based cross-sectional study was conducted from 1 January 2023 to July 2023. The data was collected using a structured and pre-tested questionnaire through face-to-face interviews and a review clinical chart. Data was entered using EpiData V.4.6 and analysed using SPSS V.26.0 statistical software. Binary logistic regression analysis was run to identify predictors of maternal outcome. SETTING Two hospitals in Addis Ababa, Ethiopia. PARTICIPANTS 348 pregnant women with PEWSF were included. OUTCOME MEASURES Unfavourable maternal outcome was defined as mothers with PEWSF that develop at least one complication, that is, eclampsia, abruption placenta, Haemolysis, Elevated Liver Enzymes and Low Platelet Count (HELLP) syndrome, acute renal failure, disseminated intravascular coagulation, cardiac failure, stroke, postpartum haemorrhage, pulmonary oedema and death. RESULTS The overall prevalence of unfavourable maternal outcomes was 33.9% (N=118) (95% CI=28.7 to 38.8). Abruptio placenta (17.2%), HELLP syndrome (15.5%) and postpartum haemorrhage (13.8%) were common complications that occurred among mothers with PEWSF. Age above 35 years (adjusted OR (AOR) (95% CI)=2.70 (1.31 to 5.59)), rural residence (AOR (95% CI)=1.94 (1.07 to 3.53)), unemployment (AOR (95% CI)=0.35 (0.20 to 0.62)), severe blood pressure on admission (AOR (95% CI)=2.32 (1.03 to 5.19)) and complain of severe headache (AOR (95% CI)=1.91 (1.16 to 3.16)) were significant associates of unfavourable maternal outcomes. CONCLUSIONS The prevalence of unfavourable maternal outcomes was high compared with other studies in Ethiopia. Maternal age, residence, occupation, blood pressure on admission and severe headache have shown a statistically significant association with unfavourable maternal outcomes. Socioeconomic development and early identification of severe signs and symptoms of pre-eclampsia are needed to reduce unfavourable outcomes.
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Affiliation(s)
- Mesfin Tadese
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Amhara, Ethiopia
| | - Wogene Asefa Damesa
- Department of Medicine, Obstetrics and Gynecology, Abebech Gobena Mothers and Childrens Health Hospital, Addis Ababa, Ethiopia
| | | | - Getu Engida Wakie
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Amhara, Ethiopia
| | - Saba Desta Tessema
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Amhara, Ethiopia
| | - Agizew Endale
- Department of Nursing, Debre Berhan Health Science College, Debre Berhan, Amhara, Ethiopia
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Deeksha HS, Pajai S, Reddy Eleti M, Navalihiremath VU. A Comprehensive Review on Serum Lactate Dehydrogenase (LDH) and Uric Acid in Preeclampsia: Implications for Maternal Health and Disease Severity. Cureus 2024; 16:e56928. [PMID: 38665764 PMCID: PMC11044092 DOI: 10.7759/cureus.56928] [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] [Received: 02/08/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Preeclampsia, a hypertensive disorder unique to pregnancy, remains a significant cause of maternal and fetal morbidity and mortality worldwide. Serum lactate dehydrogenase (LDH) and uric acid have garnered attention as potential biomarkers in understanding preeclampsia's pathophysiology and clinical management. Elevated LDH and uric acid levels have been associated with disease severity and adverse outcomes, highlighting their potential utility in risk stratification and guiding management strategies. This comprehensive review explores the roles of LDH and uric acid in preeclampsia, summarizing current evidence regarding their diagnostic, prognostic, and therapeutic implications. Future research directions are also discussed, including understanding and validation studies. Integrating LDH and uric acid measurements into routine clinical practice may facilitate early detection and intervention, ultimately improving outcomes for preeclamptic pregnancies. This review underscores the importance of serum biomarkers in enhancing our understanding and managing preeclampsia, aiming to optimize maternal and fetal health.
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Affiliation(s)
- H S Deeksha
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manila Reddy Eleti
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Tadese M, Damesa WA, Solomon GS, Fitie GW, Mitiku YM, Tessema SD, Endale A. Prevalence and determinants of adverse perinatal outcomes of preeclampsia with severe features at two selected public hospitals in Addis Ababa, Ethiopia. Front Pediatr 2024; 12:1345055. [PMID: 38390276 PMCID: PMC10881656 DOI: 10.3389/fped.2024.1345055] [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] [Received: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Background Preeclampsia is a new onset of hypertension and either proteinuria or end-organ failure after 20 weeks of gestation. It is a prevalent cause of perinatal mortality, morbidity, and neonatal complications in developing nations including Ethiopia. Thus, the aimed to assess the prevalence and determinants of adverse perinatal outcomes among women with preeclampsia with severity features (PEWSF) at two selected public hospitals in Addis Ababa, Ethiopia, 2023. Method A cross-sectional study was carried out among 348 mothers between January 1, 2023, and July 1, 2023. A structured, pre-tested questionnaire was used to gather data from in-person interviews and a review of the patient's medical record. The statistical program Epi-Data version 4.6 was used to enter the data, and SPSS version 26.0 was used for analysis. Binary logistic regression analysis was used to find factors that were associated with unfavorable perinatal outcomes. A p-value of less than 0.05 was used to declare the significance level. Result The overall prevalence of unfavorable perinatal outcomes was 59.2% (95% CI: 54.0-63.8). Among the complications, low birth weight, prematurity, NICU admission, and a low fifth-minute APGAR score, encompass 48.9%, 39.4%, 20.4%, and 14.7%, respectively. No formal education [OR = 5.14, 95% CI: (1.93-13.63)], unemployment [OR = 0.42, 95% CI: (0.24-0.73)], referral cases [OR = 2.03, 95% CI: (1.08-4.06), inadequate antenatal care (ANC) contact [OR = 3.63, 95% CI: (1.22-10.71)], and family history of hypertension [OR = 1.99, 95% CI: (1.03-3.85)] have shown a statistically significant association with unfavorable perinatal outcomes. Conclusion In this study, the prevalence of unfavorable perinatal outcomes was high compared to other studies in Ethiopia. Level of education, occupation, mode of admission, ANC contact, and family history of hypertension were significant predictors of unfavorable perinatal outcomes. Socio-economic development, improving referral systems, and adequate antenatal care contact are needed to improve unfavorable outcomes. Additionally, antenatal screening and specialized care for high-risk mothers, e.g., those with a family history of hypertension are recommended.
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Affiliation(s)
- Mesfin Tadese
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Wogene Asefa Damesa
- Department of Medicine, Obstetrician and Gynecologist, Abebech Gobena Mothers and Childrens Health Hospital, Addis Ababa, Ethiopia
| | | | - Girma Wogie Fitie
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yohannes Moges Mitiku
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Saba Desta Tessema
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Agizew Endale
- Department of Nursing, Debre Berhan Health Science College, Debre Berhan, Ethiopia
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6
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Jikamo B, Adefris M, Azale T, Alemu K. The effect of preeclampsia on adverse maternal outcomes in Sidama region, Ethiopia: a prospective open cohort study. Sci Rep 2022; 12:19300. [PMID: 36369533 PMCID: PMC9652349 DOI: 10.1038/s41598-022-24034-7] [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] [Received: 06/23/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
Ethiopia has made improvements in the reduction of maternal mortality; the high burden of preeclampsia remains a concern in the Sidama region. This study aimed to measure the effect of preeclampsia on adverse maternal outcomes and identify risk factors among women with preeclampsia in Sidama region. A prospective open cohort study was conducted from August 8, 2019, to October 1, 2020. We enrolled a total of 1015 the pregnant women who had preeclampsia and normotensive women at ≥ 20 weeks of gestation and followed them until 42 days after delivery. A log-binomial logistic regression model was used to estimate the incidence of adverse maternal outcomes and its risk factors. There were 276 adverse maternal outcomes observed in the preeclampsia group compared to 154 adverse maternal outcomes in the normotensive group (P < 0.001). Women with severe features of preeclampsia had a 43% (aRR = 1.43, 95% CI 1.3-1.58) higher risk for adverse maternal outcomes compared to women without severe features of preeclampsia. Women without severe features of preeclampsia had a 39% (aRR = 1.39, 95% CI 1.2-1.76) higher risk for adverse maternal outcomes compared to women in the normotensive group. More adverse maternal outcomes occurred among women with preeclampsia after controlling for confounders.
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Affiliation(s)
- Birhanu Jikamo
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia ,grid.192268.60000 0000 8953 2273Hawassa University College of Medicine and Health Sciences, Hawassa, Southern Nations Ethiopia
| | - Mulat Adefris
- grid.59547.3a0000 0000 8539 4635Department of Gynecology and Obstetrics Gondar University Hospital, School of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- grid.59547.3a0000 0000 8539 4635Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mousa A, Mandili RL, Aljahdali M, Gari S, Khaimi S, Alahdal S, Derar RM, Marzook S. Maternal and Fetal Outcomes of Preeclampsia With and Without Severe Features in King Abdulaziz University Hospital, Jeddah, Saudi Arabia: A Retrospective Study. Cureus 2022; 14:e31013. [DOI: 10.7759/cureus.31013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
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Leta M, Assefa N, Tefera M. Obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia; A systematic review and meta-analysis. Front Glob Womens Health 2022; 3:942668. [PMID: 36386434 PMCID: PMC9643843 DOI: 10.3389/fgwh.2022.942668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Obstetric emergencies are life-threatening medical problems that develop during pregnancy, labor, or delivery. There are a number of pregnancy-related illnesses and disorders that can endanger both the mother's and the child's health. During active labor and after delivery, obstetrical crises can arise (postpartum). While the vast majority of pregnancies and births proceed without a hitch, all pregnancies are not without risk. Pregnancy can bring joy and excitement, but it can also bring anxiety and concern. Preterm birth, stillbirth, and low birth weight are all adverse pregnancy outcomes, leading causes of infant illness, mortality, and long-term physical and psychological disorders. Purpose The purpose of this study is to assess the magnitude and association of obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia. Method We used four databases to locate the article: PUBMED, HINARI, SCIENCE DIRECT, and Google Scholar. Afterward, a search of the reference lists of the identified studies was done to retrieve additional articles. For this review, the PEO (population, exposure, and outcomes) search strategy was used. Population: women who had obstetric emergencies in Ethiopia. Exposure: predictors of obstetric emergencies. Outcome: Women who had an adverse perinatal outcome. Ethiopian women were the object of interest. The primary outcome was the prevalence of adverse maternal and perinatal outcomes among Ethiopian women. Obstetrical emergencies are life-threatening obstetrical conditions that occur during pregnancy or during or after labor and delivery. The Joanna Briggs Institute quality assessment tool was used to critically appraise the methodological quality of studies. Two authors abstracted the data by study year, study design, sample size, data collection method, and study outcome. Individual studies were synthesized using comprehensive meta-analysis software and STATA version 16. Statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using the I 2 statistics. Summary statistics (pooled effect sizes) in an odd ratio with 95% confidence intervals were calculated. Result A total of 35 studies were used for determining the pooled prevalence of adverse maternal and perinatal outcomes; twenty-seven were included in determining the odd with 95% CI in the meta-analysis, from which 14 were cross-sectional, nine were unmatched case-control studies, and 14 were conducted in the south nation and nationality Peoples' Region, and eight were from Amhara regional states, including 40,139 women who had an obstetric emergency. The magnitude of adverse maternal and perinatal outcomes following obstetric emergencies in Ethiopia was 15.9 and 37.1%, respectively. The adverse maternal outcome increased by 95% in women having obstetric emergencies (OR 2.29,95% CI 2.43-3.52), and perinatal deaths also increased by 95% in women having obstetric emergencies (OR 3.84,95% CI 3.03-4.65) as compared with normotensive women. Conclusion This review demonstrated the high prevalence of perinatal mortality among pregnant women with one of the obstetric emergencies in Ethiopia. Adverse maternal and perinatal outcomes following obstetric emergencies such as ICU admission, development of PPH, giving birth via CS, maternal death, NICU admission, LBW, and perinatal death were commonly reported in this study.
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Affiliation(s)
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Maleda Tefera
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Jikamo B, Adefris M, Azale T, Gelaye KA. Incidence of adverse perinatal outcomes and risk factors among women with pre-eclampsia, southern Ethiopia: a prospective open cohort study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001567. [PMID: 36053644 PMCID: PMC9438059 DOI: 10.1136/bmjpo-2022-001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/12/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In Ethiopia, in 2021, more than 80% of all newborn deaths were caused by preventable and treatable conditions. This study aimed to measure the incidence of adverse perinatal outcomes and risk factors among women with pre-eclampsia in the Sidama region of southern Ethiopia. METHODS A prospective open cohort study was conducted from 8 August 2019 to 1 October 2020. We enrolled 363 women with pre-eclampsia and 367 normotensive women at ≥20 weeks of gestation and followed them until the 37th week. We then followed them until the seventh day after delivery up to the last perinatal outcome status was ascertained. A log-binomial logistic regression model was used to estimate the incidence of adverse perinatal outcomes and its risk factors among women with pre-eclampsia. Relative risk (RR) with a 95% CI was reported. A p<0.05 was considered statistically significant. RESULTS There were 224 adverse perinatal outcomes observed in the 363 women with pre-eclampsia compared with 136 adverse perinatal outcomes in the 367 normotensive women (p<0.001). There were 23 early neonatal deaths in the pre-eclampsia group compared with six deaths in the normotensive group (p<0.001). There were 35 perinatal deaths in the pre-eclampsia group compared with 16 deaths in the normotensive group (p<0.05). Women with severe features of pre-eclampsia had a 46% (adjusted RR 1.46, 95% CI 1.38 to 2.77) higher risk for adverse perinatal outcomes compared with women without severe features of pre-eclampsia. CONCLUSIONS In this study, more adverse perinatal outcomes occurred among women with pre-eclampsia after controlling for confounders. A higher perinatal outcome observed among women with pre-eclampsia, especially among women with severe features of pre-eclampsia, and those admitted to hospital at <34 weeks. This paper highlights the significantly elevated perinatal risks associated with pre-eclampsia, especially when it has severe features.
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Affiliation(s)
- Birhanu Jikamo
- Hawassa University College of Medicine and Health Sciences, Hawassa, Southern Nations, Ethiopia
| | - Mulat Adefris
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Telake Azale
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Zheng J, Zhang L, Zhou Y, Xu L, Zhang Z, Luo Y. Development and evaluation of a nomogram for adverse outcomes of preeclampsia in Chinese pregnant women. BMC Pregnancy Childbirth 2022; 22:504. [PMID: 35725446 PMCID: PMC9210655 DOI: 10.1186/s12884-022-04820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Preeclampsia, the main cause of maternal and perinatal deaths, is associated with several maternal complications and adverse perinatal outcomes. Some prediction models are uesd to evaluate adverse pregnancy outcomes. However, some of the current prediction models are mainly carried out in developed countries, and many problems are still exist. We, thus, developed and validated a nomogram to predict the risk of adverse pregnancy outcomes of preeclampsia in Chinese pregnant women. Methods The clinical data of 720 pregnant women with preeclampsia in seven medical institutions in Chongqing from January 1, 2010, to December 31, 2020, were analyzed retrospectively. The patients were divided into two groups: 180 cases (25%) with adverse outcomes and 540 cases (75%) without adverse outcomes. The indicators were identified via univariate analysis. Logistic regression analysis was used to establish the prediction model, which was displayed by a nomogram. The performance of the nomogram was evaluated in terms of the area under the receiver operating characteristic (ROC) curve, calibration, and clinical utility. Results Univariate analysis showed that 24 indicators were significantly different (P < 0.05). Logistic regression analysis showed that gestational age, 24 h urine protein qualitative, and TT were significantly different (P < 0.05). The area under the ROC curve was 0.781 (95% CI 0.737–0.825) in training set and 0.777 (95% CI 0.689–0.865) in test set. The calibration curve of the nomogram showed good agreement between prediction and observation. The analysis of the clinical decision curve showed that the nomogram is of practical significance. Conclusion Our study identified gestational age, 24 h urine protein qualitative, and TT as risk factors for adverse outcomes of preeclampsia in pregnant women, and constructed a nomogram that can easily predict and evaluate the risk of adverse pregnancy outcomes in women with preeclampsia.
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Affiliation(s)
- Jiangyuan Zheng
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Li Zhang
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Yang Zhou
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - Lin Xu
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Zuyue Zhang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Yaling Luo
- College of Medical Informatics, Chongqing Medical University, Chongqing, China.
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Madaan S, Jaiswal A, Acharya N, Tayade S, Dhok A, Kumar S, Acharya S, Dewani D, Talwar D, Halani D, Reddy Eleti M. Role of Salivary Uric Acid Versus Serum Uric Acid in Predicting Maternal Complications of Pre-Eclampsia in a Rural Hospital in Central India: A Two-Year, Cross-Sectional Study. Cureus 2022; 14:e23360. [PMID: 35475103 PMCID: PMC9020463 DOI: 10.7759/cureus.23360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Hypertensive disorders during pregnancy are an important topic of concern, specifically in rural and remote areas of India where there is a lack of awareness and it is difficult to maintain proper follow-up of pregnant females to screen them for complications developed during pregnancy. Gestational hypertension and pre-eclampsia result in the abruption of the placenta, hemolysis, elevated liver enzymes, low platelet count syndrome, eclampsia, and disseminated intravascular coagulation, which can be a serious threat to the health of the mother and the fetus. Therefore, it is important to identify biomarkers for diagnosing and predicting the complications of pre-eclampsia that may aid the obstetric high-dependency units based in rural areas to tackle this important health hazard during pregnancy. Methodology A total of 180 singleton pregnant women of more than 34 weeks of gestational age were enrolled in this study. All women were divided into three groups (control group, severe pre-eclampsia, and non-severe pre-eclampsia) based on the severity of blood pressure and the presence of proteinuria (≥+1 by the dipstick method). Salivary and serum uric acid levels were measured through morning samples, and all patients were monitored for the development of complications and outcomes. Salivary uric acid and serum uric acid levels were correlated with each other and with maternal complications of pre-eclampsia. Results Mean salivary uric acid (mg/dL) in severe pre-eclampsia was (6.72 ± 0.49) significantly higher compared to non-severe pre-eclampsia (4.75 ± 0.94) and control (3.13 ± 0.43). Mean serum uric acid (mg/dL) in severe pre-eclampsia was (8.13 ± 0.87) significantly higher compared to non-severe pre-eclampsia (6.23 ± 0.76) and control (3.85 ± 0.46).The lowest best cut-off value of maternal salivary uric acid was 5.06 mg/dL, above which one can predict maternal complications with a diagnostic accuracy of 78.33%. Conclusions Salivary uric acid and serum uric acid levels are significantly raised in cases of pre-eclampsia in comparison to normal pregnancy. Salivary uric acid and serum uric acid are correlated significantly indicating that salivary uric acid can function as a cost-effective, novel marker to provide an idea about serum uric acid levels. The prognostic accuracy of salivary uric acid was good in predicting maternal complications among cases of pre-eclampsia (severe and non-servere) and early-onset maternal complications. Therefore, it may be utilized as a helpful marker to identify high-risk patients.
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Meazaw MW, Chojenta C, Taddele T, Loxton D. Audit of Clinical Care for Women with Preeclampsia or Eclampsia and Perinatal Outcome in Ethiopia: Second National EmONC Survey. Int J Womens Health 2022; 14:297-310. [PMID: 35250315 PMCID: PMC8896042 DOI: 10.2147/ijwh.s350656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Preeclampsia and eclampsia contribute to maternal and perinatal morbidity and mortality, especially in developing countries. However, the evidence on clinical practice in the management of preeclampsia/eclampsia and perinatal outcomes is limited. Therefore, the aim of this study was to assess clinical care and perinatal outcomes for women with preeclampsia/eclampsia admitted to health facilities in Ethiopia. Methods This study used the 2016 Emergency Obstetric and Newborn Care survey, which included 3804 health facilities. The last two cases of women with preeclampsia/eclampsia who were admitted for birth in each participating health facility were selected and their medical records were reviewed. Descriptive analyses by health facility type, location and management authority were conducted. A chi-squared test was used to test for differences. Results Out of the 3804 health-care facilities across the country, we could review a total of 959 medical records of women with preeclampsia or eclampsia. Of all cases, 90% (863) were hospitalised in public health facilities, 542 (56.6%) were admitted at health centre/clinics and 638 (66.3%) were in urban health facilities. A substantial proportion of maternal and newborn information was missing from their medical records. Of the 553 records that recorded perinatal outcomes, the proportion of perinatal mortality prior to discharge was 16.3% (95% CI: 13.4%, 19.6%). A significant perinatal death was recorded among mothers admitted to hospitals (P < 0.01), maternal age 15–24 (P < 0.04), facilities in urban areas (P < 0.01), referred cases (P < 0.007), high systolic and diastolic blood pressure (P < 0.001), unconscious and experience seizure (P < 0.001), newborn with morbidity (P < 0.001), and women who spent more hours before giving birth (P < 0.002). Conclusions and Recommendations High perinatal mortality in health facilities was reported and care toward mothers with preeclampsia/eclampsia was limited. Strengthening the health facility readiness to respond for management with data registration and reporting system needs to be improved for evidence-based decision-making on perinatal and maternal health.
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Affiliation(s)
- Maereg Wagnew Meazaw
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia.,Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Catherine Chojenta
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Tefera Taddele
- Health System and Reproductive Health Directorate, The Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Deborah Loxton
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
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Scher MS. Neurologic Sequelae Associated with Hypertensive Disorders of Pregnancy. CHILDREN (BASEL, SWITZERLAND) 2021; 8:945. [PMID: 34828658 PMCID: PMC8617864 DOI: 10.3390/children8110945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
Hypertensive disorders of pregnancy (HDP) contribute to adverse gene-environment interactions prior to conception and continue throughout pregnancy. Embryonic/fetal brain disorders occur from interactions between genetic susceptibilities interacting with acquired diseases or conditions affecting the maternal/placental fetal (MPF) triad. Trimester-specific pathophysiological mechanisms, such as maternal immune activation and ischemic placental syndrome, contribute to adverse peripartum, neonatal and childhood outcomes. Two diagnostic approaches provide timelier diagnoses over the first 1000 days from conception until two years of age. Horizontal analyses assess the maturation of the triad, neonate and child. Vertical analyses consider systems-biology from genetic, molecular, cellular, tissue through organ networks during each developmental niche. Disease expressions associated with HDP have cumulative adverse effects across the lifespan when subjected to subsequent adverse events. Critical/sensitive periods of developmental neuroplasticity over the first 1000 days are more likely to result in permanent sequelae. Novel diagnostic approaches, beginning during pre-conception, will facilitate the development of effective preventive, rescue and reparative neurotherapeutic strategies in response to HDP-related trimester-specific disease pathways. Public health policies require the inclusion of women's health advocacy during and beyond their reproductive years to reduce sequelae experienced by mothers and their offspring. A lower global burden of neurologic disease from HDP will benefit future generations.
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Affiliation(s)
- Mark S. Scher
- Pediatrics and Neurology, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Department of Pediatrics, Division of Pediatric Neurology Fetal/Neonatal Neurology Program, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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Chang L, Liu Y, Zhang X, Shi Z, Ren D, Li X, Li Y. The clinical effect of aspirin combined with low-molecular-weight heparin in the treatment of severe preeclampsia and the combination's effect on pregnancy outcomes. Am J Transl Res 2021; 13:9113-9121. [PMID: 34540025 PMCID: PMC8430098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the clinical effects of aspirin combined with low-molecular-weight heparin (LMWH) in the treatment of patients with severe preeclampsia and the combination's influence on pregnancy outcomes. METHODS From October 2018 to June 2020, 104 patients with severe preeclampsia who underwent treatment in our hospital were recruited as the study cohort and divided into two groups according to different treatment scheme each patient underwent. In the research group (RG), the 54 patients were administered aspirin combined with LMWH, and the other 50 patients in the control group (CG) were administered routine treatment. The total effective rates were compared between the two groups. The blood pressure, coagulation function, hemorheology, and renal function indexes were compared before and after the therapy. The Apgar scores of the newborns and the incidences of adverse pregnancy outcomes were measured at 1 and 5 minutes after the births. RESULTS After the therapy, the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) in the RG were lower than they were in the CG. The PT and APTT in the RG were significantly higher than they were in the CG, and the FIB and D-D were significantly lower than they were in the CG. After the treatment, the hematocrit, the erythrocyte sedimentation rate, and the plasma viscosity in the RG were significantly lower than they were in the CG. The 24 h UP, BUN, UA, and Scr levels in the RG were significantly lower than they were in the CG. The Apgar scores of the newborns in the RG were significantly higher than they were in the CG at 1 min and 5 min after the births. After the therapy, the incidence of adverse pregnancy outcomes in the RG was significantly lower than it was in the CG, and the total effective rate in the RG was significantly higher than it was in the CG. CONCLUSION Aspirin combined with LMWH can effectively improve the clinical efficacy, the coagulation function, the renal function, and the blood pressure levels, and the combination can reduce adverse pregnancy outcomes in severe preeclampsia patients.
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Affiliation(s)
- Lihua Chang
- Obstetrics, The Second Affiliated Hospital of Xi’an Medical UniversityXi’an 710038, Shaanxi Province, China
| | - Yanfeng Liu
- General Surgery, The Second Affiliated Hospital of Xi’an Medical UniversityXi’an 710038, Shaanxi Province, China
| | - Xingxing Zhang
- Clinical Laboratory, The Second Affiliated Hospital of Xi’an Medical UniversityXi’an 710038, Shaanxi Province, China
| | - Ziyun Shi
- Obstetrics, Shanxi Provincial People’s HospitalXi’an 710068, Shaanxi Province, China
| | - Duomei Ren
- Obstetrics, Shanxi Provincial People’s HospitalXi’an 710068, Shaanxi Province, China
| | - Xiujuan Li
- Obstetrics, The Second Affiliated Hospital of Xi’an Medical UniversityXi’an 710038, Shaanxi Province, China
| | - Yanchuan Li
- Obstetrics, Shanxi Provincial People’s HospitalXi’an 710068, Shaanxi Province, China
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Zhou T, Wang W, Qi T, Ma S, Lu W. Expression and significance of let-7a and tumor necrosis factor-alpha in placenta of severe preeclampsia. J Matern Fetal Neonatal Med 2021; 35:7363-7367. [PMID: 34284684 DOI: 10.1080/14767058.2021.1949276] [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: 10/20/2022]
Abstract
OBJECTIVE To investigate the expression and clinical significance of let-7a and tumor necrosis factor-alpha (TNF-α) in placental tissue of patients with severe preeclampsia (SPE). METHODS From January 2018 to October 2019, 64 cases of puerperal delivery at the First People's Hospital of Lianyungang City, 44 cases of SPE (SPE group), and 20 cases of healthy pregnant women (NC group) were selected. QRT-PCR and Western-blot were used to detect the expression levels of let-7a, TNF-αmRNA, and protein in the two groups of placental tissues. The correlation and the clinical significance of the two were statistically analyzed. RESULTS The relative expression of let-7a in the SPE group was significantly lower than that in the control group (0.06 ± 0.02 versus 0.25 ± 0.04, p < .05); the expression of TNF-αmRNA in the SPE group was significantly higher than that in the control group (0.48 ± 0.04 versus 0.17 ± 0.03, p < .05); TNF-α protein expression was significantly increased in the SPE group (1.09 ± 0.12 versus 0.56 ± 0.03, p < .05); let-7a and TNF-α were significantly negatively correlated (r = -0.41, p < .05); the blood pressure and birth weight of the pregnant women in the SPE group and the control group were significantly different [systolic blood pressure (164.27 ± 4.62) mmHg versus (125.01 ± 2.23)] mmHg, diastolic blood pressure (109.24 ± 2.97) mmHg versus (75.94 ± 2.74) mmHg, neonatal birth weight (2507.02 ± 161.46) g versus (3592.12 ± 153.05) g, p < .05]; the expression of TNF-α in placental tissue of SPE group was significantly positively correlated with systolic and diastolic blood pressure (r = 0.93 and 0.89, p < .05). CONCLUSION let-7a may participate in the occurrence and development of SPE by negatively regulating the expression of TNF-α.
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Affiliation(s)
- Tiantian Zhou
- Department of Obstetrics, Lianyungang First People's Hospital, Lianyungang, China
| | - Weijun Wang
- Department of Obstetrics, Lianyungang First People's Hospital, Lianyungang, China
| | - Ting Qi
- Department of Obstetrics, Lianyungang First People's Hospital, Lianyungang, China
| | - Shanduo Ma
- Department of Obstetrics, Lianyungang First People's Hospital, Lianyungang, China
| | - Wei Lu
- Department of Obstetrics, Lianyungang First People's Hospital, Lianyungang, China
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Zhao Y, Zong F. Inhibiting USP14 ameliorates inflammatory responses in trophoblast cells by suppressing MAPK/NF-κB signaling. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:1016-1024. [PMID: 34089575 PMCID: PMC8342211 DOI: 10.1002/iid3.465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022]
Abstract
Background Preeclampsia can cause severe consequences for pregnant women and infants, and developing effective medicine or methods to prevent or treat patients with preeclampsia is urgently needed. Ubiquitin‐specific protease 14 (USP14) has emerged as a critical regulator in the development of human cancers and neurodegenerative diseases. However, its role in preeclampsia remains elusive. Methods The expression of USP14 in placental tissues from healthy donors and preeclampsia patients were determined by quantitative reverse transcription PCR assay. The protein levels of targeted genes were evaluated by Western blotting assay. Small interfering RNA‐mediated gene knockdown was used to reduce USP14 expression in trophoblast cell lines. Results The expression levels of USP14 and proinflammatory cytokine were substantially upregulated in placental tissues from preeclampsia patients. Knockdown or inhibition of USP14 significantly abrogated hypoxia/reoxygenation‐induced upregulation of nuclear factor kappa B (NF‐κB) activation and proinflammatory cytokine production. Conclusion Our results suggested that USP14 promotes proinflammatory cytokine production through activation of NF‐κB. Developing drugs targeting USP14 may be beneficial for the prevention or treatment of patients with preeclampsia.
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Affiliation(s)
- Yingzi Zhao
- Department 3 of Obstetrics, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Fang Zong
- Department 3 of Obstetrics, Cangzhou Central Hospital, Cangzhou, Hebei, China
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Liu H, Wang F, Zhang Y, Xing Y, Wang Q. Exosomal microRNA-139-5p from mesenchymal stem cells accelerates trophoblast cell invasion and migration by motivation of the ERK/MMP-2 pathway via downregulation of protein tyrosine phosphatase. J Obstet Gynaecol Res 2020; 46:2561-2572. [PMID: 32945060 PMCID: PMC7756315 DOI: 10.1111/jog.14495] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/19/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023]
Abstract
AIM Exosomes present essential roles for intercellular interaction via extracellular pathways during systemic dysfunctions, including preeclampsia (PE). Here, we assessed the specific mechanism of mesenchymal stem cells (MSC)-originated exosomes in PE. METHODS The effects of exosomes on trophoblasts were studied by EdU, wound healing, Transwell and TUNEL assays. By microarray analysis, we found that exosomes enhanced the microRNA-139-5p (miR-139-5p) in trophoblasts, and confirmed the target gene of miR-139-5p by bioinformatics prediction and dual-luciferase reporter gene assay. At the same time, ERK/MMP-2 pathway-related biomolecules were assessed through Western blot analysis. The pathway inhibitor was used for rescue experiments. Finally, the effect of exosomes on the pathology of PE rats was verified by in vivo experiments. RESULTS The exosomes originated from hucMSC fostered the trophoblast cell migration, invasion and proliferation and obstructed apoptosis. Moreover, miR-139-5p could be transmitted to trophoblasts through hucMSC-secreted exosomes. miR-139-5p targeted protein tyrosine phosphatase (PTEN), which regulated the ERK/MMP-2 pathway. Inhibition of the ERK/MMP-2 pathway significantly reduced the promoting effect of exosomes on trophoblasts. Treatment with exosomes significantly lowered blood pressure values and reduced 24-h proteinuria in PE rats. CONCLUSION hucMSC-originated exosomes overexpressing miR-139-5p activated the ERK/MMP-2 pathway via PTEN downregulation, thus accelerating trophoblast cell invasion and migration, and blocking apoptosis. These results demonstrated that hucMSC-derived exosomes overexpressing miR-139-5p might be an innovative direction for therapeutic approaches against PE.
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Affiliation(s)
- Huijie Liu
- Department of ObstetricsLiaocheng Second People's HospitalLiaochengShandongChina
| | - Fang Wang
- Department of Obstetrics and GynecologyJinxiang People's HospitalJiningShandongChina
| | - Ying Zhang
- Department of Obstetrics and GynecologyChiping People's HospitalLiaochengShandongChina
| | - Yanling Xing
- Department of Obstetrics and GynecologyChiping People's HospitalLiaochengShandongChina
| | - Qian Wang
- Department of ObstetricsWeifang Maternal and Child Health HospitalWeifangShandongChina
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