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Mukosha M, Hatcher A, Lubeya MK, Maposa I, Chi BH, Mutale W. Persistent hypertension among postpartum women with comorbid HIV and preeclampsia in Zambia. PLoS One 2024; 19:e0309915. [PMID: 39231156 PMCID: PMC11373822 DOI: 10.1371/journal.pone.0309915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/20/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Persistent hypertension is common after preeclampsia and is causally tied to later cardiovascular risks. This study examined whether being HIV-infected and on antiretroviral therapy (ART) is associated with persistent postpartum hypertension among women diagnosed with preeclampsia. METHODS We conducted a six-month prospective cohort study at Kanyama and Women and Newborn hospitals from January 01, 2022, to June 30, 2023, among 190 women diagnosed with preeclampsia (59 HIV-positive, 131 HIV-negative). Sociodemographic and clinical characteristics were collected at delivery, six weeks, three months and six months after giving birth. Persistent hypertension was diagnosed if a participant presented with elevated blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg and/or taking medication for hypertension at the study visit. We used a generalized estimating equation to describe the relationship between treated HIV and persistent hypertension six months following delivery. RESULTS We retained 136 participants (71.6%) to six months postpartum, at a median age of 30 years. Overall, persistent hypertension at six weeks, three months, and six months postpartum was common (37.4%, 17.1% and 16.9%, respectively). Six-week postpartum prevalence was higher in the HIV group than HIV-negative group (54.6% vs 28.8%, p<0.001), with no measurable difference at three months (24.3% vs 13.2%, p = 0.145) or six months (18.2% vs 16.3%, p = 0.787). Multivariable analysis demonstrates higher odds (adjusted odds ratio [aOR] = 1.68, 95% CI: 1.09-2.60) of persistent hypertension among the HIV+treatment group than HIV-negative counterparts after accounting for age, body mass index and time since delivery. CONCLUSION We demonstrate an elevated risk of persistent hypertension among postpartum women with comorbid preeclampsia and treated HIV. Peripartum patients in HIV-endemic settings may benefit from timely detection of hypertension and treatment interventions to improve health outcomes.
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Affiliation(s)
- Moses Mukosha
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Abigail Hatcher
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, University of Zambia, Lusaka, Zambia
| | - Innocent Maposa
- Department of Global Health, Division of Epidemiology & Biostatistics, Stellenbosch University, Cape Town, South Africa
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Wilbroad Mutale
- Department of Health Policy and Management, University of Zambia, Lusaka, Zambia
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Huang P, Song Y, Yang Y, Bai F, Li N, Liu D, Li C, Li X, Gou W, Zong L. Identification and verification of diagnostic biomarkers based on mitochondria-related genes related to immune microenvironment for preeclampsia using machine learning algorithms. Front Immunol 2024; 14:1304165. [PMID: 38259465 PMCID: PMC10800455 DOI: 10.3389/fimmu.2023.1304165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality worldwide. Preeclampsia is linked to mitochondrial dysfunction as a contributing factor in its progression. This study aimed to develop a novel diagnostic model based on mitochondria-related genes(MRGs) for preeclampsia using machine learning and further investigate the association of the MRGs and immune infiltration landscape in preeclampsia. In this research, we analyzed GSE75010 database and screened 552 DE-MRGs between preeclampsia samples and normal samples. Enrichment assays indicated that 552 DE-MRGs were mainly related to energy metabolism pathway and several different diseases. Then, we performed LASSO and SVM-RFE and identified three critical diagnostic genes for preeclampsia, including CPOX, DEGS1 and SH3BP5. In addition, we developed a novel diagnostic model using the above three genes and its diagnostic value was confirmed in GSE44711, GSE75010 datasets and our cohorts. Importantly, the results of RT-PCR confirmed the expressions of CPOX, DEGS1 and SH3BP5 were distinctly increased in preeclampsia samples compared with normal samples. The results of the CIBERSORT algorithm revealed a striking dissimilarity between the immune cells found in preeclampsia samples and those found in normal samples. In addition, we found that the levels of SH3BP5 were closely associated with several immune cells, highlighting its potential involved in immune microenvironment of preeclampsia. Overall, this study has provided a novel diagnostic model and diagnostic genes for preeclampsia while also revealing the association between MRGs and immune infiltration. These findings offer valuable insights for further research and treatment of preeclampsia.
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Affiliation(s)
- Pu Huang
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, China
| | - Yuchun Song
- Department of Gynecology and Obstetrics, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Yu Yang
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, China
| | - Feiyue Bai
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, China
| | - Na Li
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, China
| | - Dan Liu
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, China
| | - Chunfang Li
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, China
| | - Xuelan Li
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, China
| | - Wenli Gou
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, China
| | - Lu Zong
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, China
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Singh S, Moodley J, Naicker T. Differential expression of the angiotensin receptors (AT1, AT2, and AT4) in the placental bed of HIV-infected preeclamptic women of African ancestry. Hypertens Res 2023; 46:1970-1982. [PMID: 37308552 PMCID: PMC10404513 DOI: 10.1038/s41440-023-01314-x] [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: 11/25/2022] [Revised: 04/05/2023] [Accepted: 04/28/2023] [Indexed: 06/14/2023]
Abstract
The Renin-Angiotensin-Aldosterone System (RAAS) is implicated in the pathophysiology of preeclampsia (PE). There is a paucity of data on uteroplacental angiotensin receptors AT1-2 and 4. We evaluated the immunoexpression of AT1R, AT2R, and AT4R within the placental bed of PE vs. normotensive (N) pregnancies stratified by HIV status. Placental bed (PB) biopsies (n = 180) were obtained from N and PE women. Both groups were stratified by HIV status and gestational age into early-and late onset-PE. Immuno-labeling of AT1R, AT2R, and AT4R was quantified using morphometric image analysis. Immunostaining of PB endothelial cells (EC) and smooth muscle cells of spiral arteries (VSMC) displayed an upregulation of AT1R expression compared to the N group (p < 0.0001). Downregulation of AT2R and AT4R expression was observed in PE vs. N group (p = 0.0042 and p < 0.0001), respectively. AT2R immunoexpression declined between HIV+ve and HIV-ve groups, while AT1R and AT4R displayed an increase. An increase in AT1R expression was noted in the EOPE-ve/+ve and LOPE-ve/+ve compared to N-ve/N+ve. In contrast, AT2R and AT4R expression decreased in EOPE-ve/+ve and LOPE-ve/+ve compared to N-ve/N+ve. We demonstrate a significant downregulation of AT2R and AT4R with a concomitant elevated AT1R immunoexpression within PB of HIV-infected PE women. In addition, a decline in AT2R and AT4R with an increase in AT1R immunoexpression in PE, EOPE, and LOPE vs. normotensive pregnancies, irrespective of HIV status. Thus highlighting differential immunoexpression of uteroplacental RAAS receptors based on pregnancy type, HIV status, and gestational age.
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Affiliation(s)
- Shoohana Singh
- Optics and Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- Optics and Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Slogrove AL, Davies MA, Phelanyane F, De Beer S, Theron G, Williams PL, Abrams EJ, Cotton MF, Boulle A. Hypertensive disorders of pregnancy and HIV: analysis of a province-wide cohort during 2018 and 2019. AIDS 2023; 37:1047-1055. [PMID: 36779497 PMCID: PMC10155679 DOI: 10.1097/qad.0000000000003506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE We evaluated the prevalence of de novo hypertensive disorders of pregnancy (dnHDP) in pregnant people with HIV (PPHIV) in the Western Cape Province, South Africa in 2018-2019 by HIV and antiretroviral therapy (ART) status. METHODS All people with a pregnancy outcome from 1 January 2018 to 31 December 2019 in the Western Cape Provincial Health Data Centre (WCPHDC) were included. The WCPHDC integrates data from multiple electronic platforms according to unique identifiers. dnHDP was classified by ICD-10 code or first-time prescription of antihypertensive drugs less than 140 days before delivery. Pregnant people with preexisting hypertension without superimposed preeclampsia/eclampsia were not considered to have dnHDP. Adjusted prevalence ratios (aPR) for dnHDP by HIV/ART status were calculated using Poisson regression with robust variance. RESULTS Among 180 553 pregnant people studied, 13 677 (7.6%) had dnHDP and 33 978 (18.8%) were PPHIV. Among PPHIV, 11.3% ( N = 3827) had no evidence of ART, 59.7% ( N = 20 283) initiated ART preconception and 29.0% ( N = 9868) had ART initiated during pregnancy. Compared to those without HIV (7.7%), dnHDP prevalence was lower in PPHIV with preconception [6.9%; aPR 0.78; 95% confidence interval (CI) 0.74-0.83] or pregnancy-initiated ART (7.0%; aPR 0.83; 95% CI 0.75-0.92) and higher in PPHIV without ART (9.8%; aPR 1.17; 95% CI 1.06-1.29) adjusted for maternal age, multiparity, multigestation pregnancy and preexisting hypertension. ART duration by delivery of at least 100 weeks versus pregnancy-initiated ART of 20-<40 weeks was protective (aPR 0.88; 95% CI 0.78-0.98). CONCLUSIONS In the context of universal ART, these findings are reassuring for most PPHIV. ART was not associated with increased dnHDP prevalence and longer ART duration was protective.
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Affiliation(s)
- Amy L. Slogrove
- Department of Paediatrics & Child Health, Faculty of Medicine & Health Sciences
- Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Worcester
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town
- Health Intelligence Directorate, Western Cape Government Health, Cape Town, South Africa
| | - Florence Phelanyane
- Health Intelligence Directorate, Western Cape Government Health, Cape Town, South Africa
| | - Shani De Beer
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town
- Division of Population Health Sciences, University of Bristol, Bristol, UK
| | - Gerhard Theron
- Department of Obstetrics & Gynaecology, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Paige L. Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Elaine J. Abrams
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Mark F. Cotton
- Department of Paediatrics & Child Health, Faculty of Medicine & Health Sciences
- Family Centre for Research with Ubuntu, Department of Paediatrics & Child Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town
- Health Intelligence Directorate, Western Cape Government Health, Cape Town, South Africa
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Stevenson DK, Wong RJ, Nayak NR. Molecular Mechanisms of Pregnancy-Related Vascular Remodeling and Pregnancy Complications. Int J Mol Sci 2023; 24:3712. [PMID: 36835124 PMCID: PMC9965456 DOI: 10.3390/ijms24043712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
The purpose of this editorial is to highlight the various observations made in this Special Issue in the International Journal of Molecular Sciences [...].
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Affiliation(s)
- David K. Stevenson
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA 94305-1509, USA
| | - Ronald J. Wong
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA 94305-1509, USA
| | - Nihar R. Nayak
- Department of Obstetrics and Gynecology, UMKC School of Medicine, Kansas City, MO 64108, USA
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Placental Morphology and Morphometry: Is It a Prerequisite for Future Pathological Investigations? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1392:85-105. [DOI: 10.1007/978-3-031-13021-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Orish VN, Ansong-Boateng J, Puplampu PN, Ibine B, Azanu W, Amoh MY, Lokpo SY, Afeke I, Alalbila TM, Agordoh PD, Marinkovic A, Sanyaolu A. HIV and malaria prevalence among pregnant women with and without pre-eclampsia at the Atua Government Hospital in Ghana's eastern region. Int J Gynaecol Obstet 2022; 159:912-917. [PMID: 35514313 DOI: 10.1002/ijgo.14255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/23/2022] [Accepted: 05/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the association of malaria and HIV with pre-eclampsia by evaluating their prevalence among pregnant women. METHODS Using a case-control study design, we randomly sampled the antenatal records of 125 pregnant women with clinician-diagnosed pre-eclampsia (cases) and 125 others without pre-eclampsia (controls) who visited Atua Government Hospital in the eastern region of Ghana between June 2014 and January 2017. All selected records had available routine HIV and malaria test results and were analyzed statistically. RESULTS In all 250 records, 122 (48.8%) were HIV positive and 35 (14.0%) had malaria. Of the 122 HIV-positive pregnant women, 29 (23.8%) were cases and 93 (76.2%) were controls; of the 35 women with malaria, one was in the case group (1/35, 2.9%) and the other 34 (97.1%) were in the control. Group. Pregnant women with pre-eclampsia had lower odds of HIV infection (odds ratio [OR] 0.10, 95% confidence interval [CI] 0.06-0.19: adjusted AOR 0.07, 95% CI 0.04-0.13, P < 0.001). Similarly, pregnant women with pre-eclampsia had lower odds of having malaria infection (OR 0.02, 95% CI 0.00-0.17, P = 0.025; adjusted OR 0.00, 95% CI 0.00-0.01, P < 0.001). CONCLUSIONS Women with pre-eclampsia had lower odds of HIV and malaria infection in pregnancy.
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Affiliation(s)
- Verner N Orish
- Department of Microbiology and Immunology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Jude Ansong-Boateng
- Department of Physician Assistant, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Prince N Puplampu
- Department of Physician Assistant, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Bolade Ibine
- Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Wisdom Azanu
- Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Michael Y Amoh
- Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Sylvester Y Lokpo
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Innocent Afeke
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Thelma Mpoku Alalbila
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Percival D Agordoh
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
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