Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal

Determinants of mobile health (M-Health) application adoption, usage and discontinuity among corporate workers diagnosed with hypertension and diabetes

PURPOSE

This study examined the determinants of mobile health (M-Health) application, adoption, usage and discontinuation among corporate workers diagnosed with hypertension and diabetes in Ghana.

DESIGN/METHODOLOGY/APPROACH

The diffusion innovation and reasoned action theories were employed using an exploratory design. Three hundred corporate workers diagnosed with diabetes and hypertension from three health facilities for the past six months were sampled for the study using a multi-stage sampling technique and administered questionnaires. Descriptive statistics and logistic regression tools were employed in the analysis of data.

FINDINGS

The study found a significant number of factors influencing m-health applications adoption, usage and discontinuity. These factors include nature and demand of job, perceived advantage, compatibility, complexity, triability, aesthetics and trust. Aesthetics emerged as the strongest predictive factor for the adoption, usage and discontinuity of use among diabetic and hypertensive corporate workers. With the adoption of M-Health applications, compatibility, as well as nature and demand of job, were significant predictors. With the usage of M-Health applications, complexity, triability, aesthetics and trust were significant predictors. Moreover, perceived advantage, compatibility, complexity and triability influenced significantly the choice to discontinue using M-Health applications. The study concluded that M-Health application functionalities play a valuable role in patients' intention to adopt, use and discontinue the use of an M-Health application in Ghana.

ORIGINALITY/VALUE

This exploratory study offers in-depth insight into how major M-Health application features affect its adoption, usage and discontinuity, providing crucial information for future research and the improvement of chronic condition healthcare delivery.

Relationship between Androgens and Vascular and Placental Function during Pre-eclampsia

Hypertensive disorders of pregnancy (HDP) represent a substantial risk to maternal and fetal health. Emerging evidence suggests an association between testosterone and pre-eclampsia (PE), potentially mediated through androgen receptors (AR). Nevertheless, the mechanism driving this association is yet to be elucidated. On the other hand, reports of transgender men's pregnancies offer a limited and insightful opportunity to understand the role of high androgen levels in the development of HDP. In this sense, a literature review was performed from a little over 2 decades (1998-2022) to address the association of testosterone levels with the development of HDP. Furthermore, this review addresses the case of transgender men for the first time. The main in vitro outcomes reveal placenta samples with greater AR mRNA expression. Moreover, ex vivo studies show that testosterone-induced vasorelaxation impairment promotes hypertension. Epidemiological data point to greater testosterone levels in blood samples during PE. Studies with transgender men allow us to infer that exogenous testosterone administration can be considered a risk factor for PE and that the administration of testosterone does not affect fetal development. Overall, all studies analyzed suggested that high testosterone levels are associated with PE.

An association of deficiencies in balanced dietary practices and inadequate iron and folic acid supplement's intake during pregnancy and increasing risk of pre-eclampsia or eclampsia among Indian women

Pre-eclampsia or eclampsia is a serious reproductive health problem which can cause maternal, fetal and neonatal morbidity and mortality worldwide. However till the notable reasons of it is not very clear at all. The main essence of the present study was to examine the association between dietary intake, iron and folic acid consumption during pregnancy and the chances of occurrences of pre-eclampsia or eclampsia among Indian women. A cross sectional observational study was performed by using NFHS-5 (2019-21) data. 190,797 ever married women aged between 15-49 years who had a live birth in the past five years preceding the survey were availed for this study. Multivariable logistic regression analysis was carried out to find out the association between dietary and supplementary intake and occurrences of eclampsia. About 3.6% of the sample women had pre-eclampsia or eclampsia. The results of the study indicated that the likelihood of the prevalence of pre-eclampsia or eclampsia was significantly higher among those women who did not take adequate diet and as well as not consumed iron and folic acid tablet or syrup for at least 90 days during pregnancy compared to those women who took adequate diet and iron and folic acid supplementation even after controlling some maternal, health and lifestyle, socio-economic and demographic characteristics. Integrated and quality ANC services can only ensure adequate nutritional intake in terms of healthy and balanced diet. So, quality ANC services and with this micronutrients intake could be an effective way to reduce the prevalence of pre-eclampsia or eclampsia.

Posterior reversible encephalopathy syndrome in postpartum patients with gestational hypertension: A case report emphasizing early recognition and management

Posterior reversible encephalopathy syndrome (PRES) is a rare neuroradiological condition causing headaches, altered mental status, seizures, visual disturbances, and focal deficits. It is often associated with preeclampsia and eclampsia in pregnancy, but can also occur in patients with other medical conditions, such as hypertension, autoimmune diseases, renal dysfunction etc. This case report highlights the importance of recognizing PRES in postpartum patients with hypertension and the need for prompt diagnosis and management to prevent potential complications. A 30-year-old woman with gestational hypertension underwent scheduled induction of labor. After a successful delivery, she experienced a sudden headache but no other neurological symptoms. Imaging showed bilateral frontoparietal white matter edema, consistent with PRES. She was closely monitored, treated with analgesics, and improved within a week. The case highlights the rarity of PRES in postpartum patients without preeclampsia or eclampsia. It underscores the importance of considering PRES as a possible diagnosis in postpartum patients with hypertension, even in the absence of typical risk factors. Prompt control of blood pressure and careful monitoring are essential to ensure a positive outcome, as PRES can lead to life-threatening complications if not managed appropriately. The study highlights the importance of heightened awareness of PRES in postpartum patients with gestational hypertension. Early detection and timely management can improve prognosis, even in atypical cases. Healthcare professionals should be vigilant in assessing hypertension patients to diagnose and manage PRES, preventing neurological sequelae. Further research is needed to better understand PRES pathophysiology and risk factors in postpartum patients.

Association between endothelial nitric oxide synthase (eNOS) gene variants and nitric oxide production in preeclampsia: a case-control study in Ghana

Evidence suggests that a major cause of PE is endothelial dysfunction emanating from the reduced bioavailability of Nitric oxide (NO). Variants of endothelial nitric oxide synthase (eNOS) gene may lead to decreased NO levels. We explored the association between eNOS gene variants and nitric oxide levels among preeclamptic women in the Ghanaian population. This case-control study included 75 preeclamptic women and 75 healthy normotensive pregnant women attending antenatal care at the Nkawie-Toase Government Hospital, Ghana. A well-structured questionnaire was used to collect socio-demographic, obstetric and clinical data. Blood was obtained for DNA extraction; the gene variants were determined using PCR and RFLP. Preeclamptic women had significantly lower NO concentration compared to the normotensives (p < 0.0001) and was significantly different between VNTR variants (p < 0.0001). A significant difference in VNTR intron 4 distribution was also observed between the preeclamptic and normotensive women with 4c4c" (12.0%) and "4a4c" (1.3%) genotypes found predominantly in preeclamptic women (p < 0.0001). There was significantly higher distribution of "TC" genotype in preeclamptic women (44.0%) compared to normotensives (22.7%) (p = 0.019). However, possessing "4a4b" (cOR: 0.17, 95% CI 0.04-0.64) and "4b4b" (cOR: 0.09, 95% CI 0.02-0.38) significantly decreased the likelihood of experiencing preeclampsia by 83% and 91% respectively. Nitric oxide is reduced in preeclamptic women. NO levels in preeclampsia are altered by VNTR intron 4 variants but not T786C variants. Possessing VNTR intron 4 "4b" allele decreases the risk of PE while the "4c" allele increases the risk of PE. There is the need for eNOS variant screening and nitric oxide estimation among pregnant women for early prediction of women at risk of preeclampsia.

Perceived Cardiovascular Disease Risk Following Preeclampsia: A Cross-Sectional Study

Preeclampsia has been linked to an increased risk of cardiovascular disease (CVD), and the preeclamptic women were unaware of this link. Therefore, this study aims to assess women's knowledge and perception of future CVD after preeclampsia. This study used a cross-sectional descriptive design. Two hundred and forty-six women with a preeclampsia history were recruited from the Al Salam MCH Center and Suez Canal University Hospital. Data were collected during March 2022 using a socio-demographic questionnaire, an Adapted Coronary Heart disease knowledge tool for preeclamptic women, and The Perception of Risk of Heart Disease Scale (PRHDS). Most women (96%) were unaware of the relationship between CVD and preeclampsia. The women had a low CVD knowledge level (10.26 ± 6.08) as well as a low perception of cardiovascular disease risk (37.15 ± 7.22). There was a significant positive correlation between CVD knowledge and CVD risk perception (r = 0.434, p = 0.000). This study found that preeclampsia survivors underestimated their CVD risk. Based on these findings, preeclamptic women should receive health education sessions on CVD risk and prevention from their nurses and obstetricians. The hospital pre-discharge plan must contain these sessions in written and electronic formats to help women remember and follow CVD risk reduction measures.

Aspartame consumption during pregnancy impairs placenta growth in mice through sweet taste receptor-reactive oxygen species-dependent pathway

The prevalence of obesity has risen dramatically over recent years, and so has the prevalence of adverse obesity-associated pregnancy outcomes. To combat obesity, the calorie contents of many foods and beverages may be reduced by the use of artificial sweeteners, such as aspartame. However, animal studies suggest that aspartame and its metabolites may exhibit toxicity, and the effects of aspartame on pregnancy are largely unknown. In this study, we treated pregnant mice with aspartame by oral gavage and found that the treatment decreased fasting blood glucose level, whereas systolic blood pressure was elevated. Importantly, the aspartame-treated animals also had low placenta and fetus weights, as well as reduced thickness of the placenta decidua layer. Moreover, aspartame decreased the expression of epithelial-mesenchymal transition proteins and manganese superoxide dismutase (MnSOD) in mouse placentae. In order to clarify the mechanisms though which aspartame affects placenta, we performed experiments on 3A-sub-E trophoblasts. In the cells, aspartame treatments induced cell cycle arrest and reduced the proliferation rate, epithelial-mesenchymal transition, migration activity and invasion activity. We also found that aspartame increased reactive oxygen species (ROS) levels to hyper-activate Akt and downregulate MnSOD expression. Pretreatment with antioxidants or sweet taste receptor inhibitors reversed the effects of aspartame on trophoblast function. We also found that the aspartame metabolite phenylalanine similarly induced ROS production and affected proliferation of trophoblasts. Taken together, our data suggest that aspartame consumption during pregnancy may impact the structure, growth and function of the placenta via sweet taste receptor-mediated stimulation of oxidative stress.

Labetalol and soluble endoglin aggravate bile acid retention in mice with ethinylestradiol-induced cholestasis

Labetalol is used for the therapy of hypertension in preeclampsia. Preeclampsia is characterized by high soluble endoglin (sEng) concentration in plasma and coincides with intrahepatic cholestasis during pregnancy (ICP), which threatens the fetus with the toxicity of cumulating bile acids (BA). Therefore, we hypothesized that both labetalol and increased sEng levels worsen BA cumulation in estrogen-induced cholestasis. C57BL/6J, transgenic mice overexpressing human sEng, and their wild-type littermates were administrated with ethinylestradiol (EE, 10 mg/kg s.c., the mice model of ICP) and labetalol (10 mg/kg s.c.) for 5 days with sample collection and analysis. Plasma was also taken from healthy pregnant women and patients with ICP. Administration of labetalol to mice with EE cholestasis aggravated the increase in BA plasma concentrations by induction of hepatic Mrp4 efflux transporter. Labetalol potentiated the increment of sEng plasma levels induced by estrogen. Increased plasma levels of sEng were also observed in patients with ICP. Moreover, increased plasma levels of human sEng in transgenic mice aggravated estrogen-induced cholestasis in labetalol-treated mice and increased BA concentration in plasma via enhanced reabsorption of BAs in the ileum due to the upregulation of the Asbt transporter. In conclusion, we demonstrated that labetalol increases plasma concentrations of BAs in estrogen-induced cholestasis, and sEng aggravates this retention. Importantly, increased sEng levels in experimental and clinical forms of ICPs might present a novel mechanism explaining the coincidence of ICP with preeclampsia. Our data encourage BA monitoring in the plasma of pregnant women with preeclampsia and labetalol therapy.

Implementation of maternal guidelines for gravid teenagers with hypertensive disorders in KwaZulu-Natal

BACKGROUND

 The worldwide phenomenon of teenage pregnancy among 13-9-year-olds is complicated by obstetric conditions. Among the top three causes of maternal mortality, hypertension is the third in South Africa. Quality maternal care is assured by obstetric practitioners (OPs) implementing guidelines specific for management of hypertension in pregnancy.

OBJECTIVE

 The objective of this study was to investigate implementation of maternal guidelines for hypertension in pregnancy among teenagers.

METHODS

 As a retrospective quantitative research design was used, 173 maternal records of pregnant teenagers from 13 to 19 years were sampled from six district hospitals and Community Health Centres (CHCs) between 01 January 2017 and 31 December 2019 to undergo systematic random sampling. A pretested structured checklist was used to record data from sampled maternal records. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis, and results were presented using simple descriptive statistics.

RESULTS

 Research results indicated that teenagers who suffered from hypertension intrapartum and postpartum did not receive maternal care according to the guidelines for maternity care in South Africa. Blood pressure was not measured of six (3.47%) intrapartum and five (2.9%) postpartum teenagers. Seventeen (9.8%) hypertensive postpartum teenagers received their antihypertensives.

CONCLUSION

 Public health institutions (PHIs) compromised provision of quality maternal care among teenagers, evidenced by incomplete intrapartum and postpartum assessment, diagnosis and management of hypertensive disorders in pregnancy (HDP).Contribution: This study contributed to facilitating adherence to guidelines improving healthcare of teenagers in government facilities.

Postpartum Assessment of the Correlation between Serum Hormone Levels of Estradiol, Progesterone, Prolactin and ß-HCG and Blood Pressure Measurements in Pre-Eclampsia Patients

Background: Preeclampsia is a pregnancy-related hypertensive disease. Aberrant hormone levels have been implicated in blood pressure disorders. This study investigated the association of postpartum maternal serum hormone levels of estradiol, progesterone, prolactin, and ß-HCG with poorer PE-related complications including arterial hypertension. Methods: Thirty patient women with preeclampsia, and twenty women with uncomplicated pregnancy were included in this study. Serum levels of estradiol, progesterone, prolactin, and ß-HCG were determined immediately after delivery, and on the first and third postpartum days by means of ECLIA. Results: Compared with normal pregnancy cases, preeclampsia cases had higher serum levels of ß-HCG levels on Day-0 (319%), of progesterone on Day-0 (207%) and Day-1 (178%), and of estradiol on Day-1 (187%) and Day-3 (185%). Increased prolactin levels were positively associated with disease severity and estradiol and progesterone levels were decreased in poorer preeclampsia features including disease onset and IUGR diagnosis. No significant correlation between different hormone levels and blood pressure measurements was reported. Conclusions: This study is the first that detected postpartum maternal serum hormone levels and their correlation with blood pressure measurements in preeclampsia. We believe that the persistent arterial hypertension in the puerperium in preeclampsia as well as poorer disease specifications are most likely not of hormonal origin. Larger, well-defined prospective studies are recommended.

Ultrasonographic Changes in Transorbital Measurement of Optic Nerve Sheath Diameter in Magnesium Sulfate-Treated Severely Preeclamptic Patients: A Prospective Observational Study

Introduction

Severe preeclampsia can lead to various complications including increased intracranial pressure (ICP) which can be catastrophic but difficult to detect because of variable nonspecific symptoms. Ultrasonography has been used as noninvasive measure to monitor optic nerve sheath diameter (ONSD) as a marker of raised ICP. Effect of MgSO4 on ICP can modify the management approach, need for additional monitoring, targeting hemodynamic goals, timing of delivery, and choice of anesthesia. We evaluated the effect of MgSO4 on raised ICP in severely preeclamptic patients using ultrasound-guided ONSD as a surrogate marker of ICP.

Methodology

This prospective observational study was conducted after ethical committee approval and written informed consent from patients. Ultrasound-guided ONSD was measured and compared in 47 severe preeclamptic patients before and at 1 h, 4 h, 12 h, and 24 h after starting MgSO4 therapy. The analysis of data was done by one-way analysis of variance using Statistical Package for the Social Science.

Results

Mean ONSD was 5.56 ± 0.30 mm in our study group. ONSD above 5.8 mm was seen in 17 (36.17%) patients and was considered as marker of raised ICP. There was a significant decrease in ONSD after 4 h of administration of MgSO4. No significant correlation was observed between mean arterial pressure, serum magnesium level, and ONSD.

Conclusion

Ultrasound-guided ONSD measurement can be used as a quick, noninvasive bedside tool in severe preeclamptic patient on MgSO4 treatment as marker of ICP which help us in determining clinical severity, therapeutic response, and to decide further course of management.

Novel insights into the SLC7A11-mediated ferroptosis signaling pathways in preeclampsia patients: identifying pannexin 1 and toll-like receptor 4 as innovative prospective diagnostic biomarkers

PURPOSE

Ferroptosis is associated with oxidative stress (OS) and is caused by iron-dependent lipid-peroxidative damage, but its role in PE is unclear. The aim of this study is to determine whether pannexin 1 (Panx1) and toll-like receptor 4 (TLR4) are key regulators of ferroptosis in PE.

METHODS

The study included 65 patients with PE and 25 healthy pregnant women. In normal and PE placental tissues, OS and ferroptosis markers, including Fe²⁺, malondialdehyde (MDA), reduced glutathione (GSH) levels, heme oxygenase-1 (HO-1) and glutathione peroxidase 4 (Gpx4) activity, were estimated. Panx1 and solute carrier family 7 member 11 (SLC7A11) mRNA expression levels were relatively quantified in placental tissues using real-time polymerase chain reaction (RT-PCR), while serum Panx1, serum TLR4, and placental activating transcription factor 3 (ATF3) levels were measured by ELISA.

RESULTS

In placental tissues, Panx1 and TLR4 expression levels were significantly increased in patients with PE compared to controls and were positively correlated with pro-ferroptosis mediators such as placental Fe²⁺ and MDA levels and negatively correlated with anti-ferroptosis regulators such as placental GSH level, HO-1, and Gpx4 activity. Additionally, Panx1 and TLR4 had a positive correlation with ATF3 and a negative correlation with SLC7A11. Serum Panx1 and TLR4 levels were positively correlated with their placental tissue expression and showed good diagnostic capabilities for ferroptosis in PE.

CONCLUSION

Therefore, Panx1 and TLR4 are suggested to induce ferroptosis in PE via SLC7A11-mediated signaling pathways, offering a novel perspective on PE pathogenesis and novel diagnostic tools for PE.

Cardiovascular Disease-Associated MicroRNA Dysregulation during the First Trimester of Gestation in Women with Chronic Hypertension and Normotensive Women Subsequently Developing Gestational Hypertension or Preeclampsia with or without Fetal Growth Restriction

The aim of the study was to assess if cardiovascular disease-associated microRNAs would be able to predict during the early stages of gestation (within 10 to 13 weeks) subsequent onset of hypertensive pregnancy-related complications: gestational hypertension (GH) or preeclampsia (PE). Secondly, the goal of the study was to assess if cardiovascular disease-associated microRNAs would be able to detect the presence of chronic hypertension in early pregnancies. The retrospective study was performed on whole peripheral blood samples collected from singleton Caucasian pregnancies within the period November 2012 to March 2020. The case control study, nested in a cohort, involved all women with chronic hypertension (n = 29), all normotensive women that later developed GH (n = 83) or PE with or without fetal growth restriction (FGR) (n = 66), and 80 controls selected on the base of equal sample storage time. Whole peripheral blood profiling was performed with the selection of 29 cardiovascular disease-associated microRNAs using real-time RT-PCR. Upregulation of miR-1-3p (51.72% at 10.0% FPR) was observed in patients with chronic hypertension only. Upregulation of miR-20a-5p (44.83% and 33.33% at 10.0% FPR) and miR-146a-5p (65.52% and 42.42% at 10.0% FPR) was observed in patients with chronic hypertension and normotensive women with later occurrence of PE. Upregulation of miR-181a-5p was detected in normotensive women subsequently developing GH (22.89% at 10.0% FPR) or PE (40.91% at 10.0% FPR). In a part of women with subsequent onset of PE, upregulation of miR-143-3p (24.24% at 10.0% FPR), miR-145-5p (21.21% at 10.0% FPR), and miR-574-3p (27.27% at 10.0% FPR) was also present. The combination of microRNA biomarkers (miR-20a-5p, miR-143-3p, miR-145-5p, miR-146a-5p, miR-181a-5p, and miR-574-3p) can predict the later occurrence of PE in 48.48% of pregnancies at 10.0% FPR in early stages of gestation. The combination of upregulated microRNA biomarkers (miR-1-3p, miR-20a-5p, and miR-146a-5p) is able to identify 72.41% of pregnancies with chronic hypertension at 10.0% FPR in early stages of gestation. Cardiovascular disease-associated microRNAs represent promising biomarkers with very good diagnostical potential to be implemented into the current first trimester screening program to predict later occurrence of PE with or without FGR. The comparison of the predictive results of the routine first trimester screening for PE and/or FGR based on the criteria of the Fetal Medicine Foundation and the first trimester screening for PE wo/w FGR using a panel of six cardiovascular disease-associated microRNAs only revealed that the detection rate of PE increased 1.45-fold (48.48% vs. 33.33%).

Antenatal care parameters that are the risk factors in the event of preeclampsia in primigravida

OBJECTIVE

This study aimed to analyze the parameters of antenatal care, which becomes a risk factor against the incidence of preeclampsia in primigravidae in Kolaka.

METHODS

The study uses case-control studies (case-control), which use a retrospective approach. The population in this study were all primigravida pregnant women recorded in the medical records at the BLUD Hospital. HM Djafar Harun as many as 5796 women and BLUD Benyamin Guluh Hospital as many as 5065 women. The sample in this case group is the primary mother Gravida, who suffered from preeclampsia from January 2014 to September 2018, and the control group was primigravida mothers who did not suffer from preeclampsia in the same period.

RESULTS

The results showed that the age of primigravida mothers 14-28 years had a risk of 1.581 times more significant for having preeclampsia than the age group 29-49 years with CI (1.186-2.108), the incidence of hypertension in trimester 1 in primigravida mothers had a risk of 3.405 times greater for preeclampsia than mothers without a history of hypertension in trimester 1 with CI (2.164-5.358), irregular antenatal visits are 1.095 times more likely to develop preeclampsia than regular antenatal visits with CI (0.799-1.539), weight gain primigravida maternal body 1-10kg 1.540 times greater risk of developing preeclampsia than 10-20kg of weight gain with CI (1.074-2.207), pregnancy checks according to Antenatal Care non-compliant care standards are 1.333 times more likely to develop preeclampsia than primigravida mothers who obediently do the inspection antenatal care with CI (0.970-1.831).

CONCLUSION

Variables that are very risky with preeclampsia in primigravida mothers based on multivariate analysis are the hypertension incidence in the first trimester with an OR: 3.363 with a CI value of 2.126 and a lower value of 5.318.

Correlation of platelet parameters with adverse maternal and neonatal outcomes in severe preeclampsia: A case-control study

BACKGROUND

Pre-eclampsia (PET) is a potentially devastating multi-systemic disorder resulting in the generation of oxidative stress. Platelet activation causes vasoconstriction and release of inflammatory cytokines, resulting in an intensified inflammatory response, endothelial damage, and coagulopathy which culminate in adverse pregnancy outcomes.

AIM

To compare the platelet parameters between preeclamptic and normotensive pregnant women and their relationship to adverse outcomes in women with pre-eclampsia.

MATERIALS AND METHODS

This was a case-control study of platelet indices of 60 pre-eclamptic and 60 normotensive pregnant women recruited at 28 weeks and followed till delivery. A blood sample was collected at entry into the study and just before delivery. The sample was analyzed within 1 h of collection using the Mythic 18 hematological auto-analyzer. Data were analyzed using IBM-SPSS version 22. A P-value of <0.05 was considered statistically significant.

RESULTS

The mean platelet count, Platelet distribution width (PDW), plateletcrit were statistically significantly different between normotensive and severe preeclamptic participants (p= <0.001). Statistically significant differences were not present in any of the platelet parameters between mild and severe PET. The odds of developing eclampsia was low at higher mean platelet count and plateletcrit levels above 161.36 ± 73.74 × 109/L [p = 0.02, AOR = 0.27, 95% CI (0.08-0.88)] and 0.13 ± 0.05% [p = 0.001, AOR = 0.22, 95% CI (0.08-0.58)] respectively. Eclampsia was strongly associated with P-LCR (platelet-large cell ratio) above 23.15 ± 4.92% [p = 0.004, AOR = 11.00, 95%CI (1.48-89.02)]. Abruptio placentae had low odds at lower levels of mean plateletcrit. Pre-term birth was significantly lower at mean plateletcrit levels above 0.14 ± 0.05%; admission into neonatal intensive care unit was strongly associated with a mean PLC ratio above 22.73 ± 5.91%.

CONCLUSION

This study demonstrated significant differences in platelet count, plateletcrit, platelet distribution width, and P-LCR between pre-eclamptic and normotensive women. Increase in P-LCR is a risk factor for eclampsia although the effect size is low.

An unusual presentation of posterior reversible encephalopathy syndrome—a case report

Background

Acute neurological emergencies in pregnant and postpartum women presenting as headache, visual disturbances, seizures, and elevated blood pressure are usually attributed to preeclampsia and eclampsia. However cerebral venous sinus thrombosis (CVST) and posterior reversible encephalopathy syndrome (PRES) are two important, rare conditions which should be considered. PRES is a rare neuroradiological syndrome characterised by vasogenic oedema of subcortical white matter, commonly involving posterior cerebral hemispheres. Preeclampsia and eclampsia are the common causes of PRES. However, late postpartum eclampsia concurrent to PRES is rare. Here, we report a rare case of PRES secondary to late postpartum eclampsia with atypical radiological findings.

Case presentation

A 25-year-old married woman with prior history of two spontaneous abortions presented to us on day 5 postpartum, post lower segment caesarean section (LSCS) with complaints of headache followed by one episode of new onset generalised tonic-clonic seizures. There was no history of seizures prior to the pregnancy and no history of hypertension or diabetes during any of her pregnancies. On examination, BP was 140/90 mm Hg and PR 98 bpm. Systemic examination revealed GCS 15/15, no focal neurological deficits, and bilateral flexor plantar response. Fundus examination was normal with no evidence of hypertensive retinopathy. Preliminary haematological and biochemical tests including antiphospholipid antibody (APLA) profile were done in view of prior abortions and were within normal limits. Lumbar puncture was done—normal study. EEG was normal. MRI with MRV was suggestive of atypical posterior encephalopathy. In view of late onset postpartum seizure, the patient was started on injection of magnesium sulphate, anti-hypertensives, and antiepileptics; following which, she improved and was discharged.

Conclusion

Though preeclampsia and eclampsia are usually screened entities, we should also follow women in puerperium for late postpartum eclampsia which is defined as seizures beyond 48 h of delivery up to 4 weeks postpartum. So it is important to follow-up postpartum women for complications like PRES because early detection and treatment can lessen the morbidity and mortality as they are completely reversible. Thus, health care professionals should be educated about the same. Apart from antenatal and intrapartum care, postpartum care should also be given equal importance.

Comparison of Maternal Serum Levels and Placental mRNA Levels of Dickkopf-1 in Preeclamptic and Normal Pregnant Women at Delivery

Background Preeclampsia remains a major cause of perinatal and maternal mortality and morbidity worldwide. Wnt/β-catenin signaling is known to be critically involved in placenta development processes. Dickkopf-1 (DKK1) is a key regulator of this transduction pathway. The aim of this study is to compare maternal serum DKK1 levels and placental mRNA levels of DKK1 and β-catenin in preeclamptic and normal pregnant women at delivery.

Methods The present study included 30 women with preeclampsia and 30 women with normal pregnancy. Maternal serum DKK1 levels were measured by ELISA. Placental mRNA levels of DKK1 and β-catenin were detected using RT-PCR.

Results Decreased maternal serum DKK1 levels were associated with worse maternal and fetal complications including HELLP syndrome, determination of one or more pathological symptom and IUGR diagnosis. No significant difference in maternal serum DKK1 levels was reported between preeclamptic women and women with normal pregnancy. Placental mRNA DKK1 levels were lower in preeclamptic women compared with normal pregnant women. Placental mRNA β-catenin levels showed no significant difference between two groups.

Conclusions Our findings reported the aberrant placental mRNA DKK1 levels in patients with preeclampsia. In addition, worse preeclampsia features were associated with decreased maternal serum DKK1 levels. Hence, aberrant Wnt/β-catenin signaling might present a plausible mechanism in preeclampsia pathogenicity. Dysregulated expression of DKK1 at gene level in the placenta but not at protein level in the maternal serum might confirm the notion that preeclampsia is a type of placenta-derived disease.

Increased FUN14 domain containing 1 (FUNDC1) ubiquitination level inhibits mitophagy and alleviates the injury in hypoxia-induced trophoblast cells

Preeclampsia (PE) is a pregnancy disorder characterized by excessive trophoblast cell death. This study aims to explore the exact mechanism of the ubiquitination level of FUN14 domain containing 1 (FUNDC1) in mitophagy and injury in hypoxic trophoblast cells. In this study, HTR-8/SVneo trophoblast cells were cultured under normoxic and hypoxic conditions and PE mouse model was established. We found low ubiquitination level of FUNDC1 in hypoxic trophoblast cells and placenta of pregnant women with PE. Proteasome inhibitor MG-132 and protease activator MF-094 were added into HTR-8/SVneo trophoblast cells. Proteasome inhibitor MG-132 decreased FUNDC1 ubiquitination level while protease activator MF-094 increased FUNDC1 ubiquitination level. Inhibition of FUNDC1 ubiquitination promoted mitophagy and mitochondrial membrane potential (Δψm) in normoxic trophoblast cells, increased levels of reactive oxygen species (ROS) and malondialdehyde (MDA) and decreased levels of glutathione (GSH) and superoxide dismutase (SOD). In addition, FUNDC1 ubiquitination alleviated cell injury in PE mice in vivo. In conclusion, increased FUNDC1 ubiquitination level inhibited mitophagy and Δψm changes in hypoxic trophoblast cells, and thus alleviated oxidative injury.

Falciparum but not vivax malaria increases the risk of hypertensive disorders of pregnancy in women followed prospectively from the first trimester

BACKGROUND

Malaria and hypertensive disorders of pregnancy (HDoP) affect millions of pregnancies worldwide, particularly those of young, first-time mothers. Small case-control studies suggest a positive association between falciparum malaria and risk of pre-eclampsia but large prospective analyses are lacking.

METHODS

We characterized the relationship between malaria in pregnancy and the development of HDoP in a large, prospectively followed cohort. Pregnant women living along the Thailand-Myanmar border, an area of low seasonal malaria transmission, were followed at antenatal clinics between 1986 and 2016. The relationships between falciparum and vivax malaria during pregnancy and the odds of gestational hypertension, pre-eclampsia, or eclampsia were examined using logistic regression amongst all women and then stratified by gravidity.

RESULTS

There were 23,262 singleton pregnancies in women who presented during the first trimester and were followed fortnightly. Falciparum malaria was associated with gestational hypertension amongst multigravidae (adjusted odds ratio (AOR) 2.59, 95%CI 1.59-4.23), whereas amongst primigravidae, it was associated with the combined outcome of pre-eclampsia/eclampsia (AOR 2.61, 95%CI 1.01-6.79). In contrast, there was no association between vivax malaria and HDoP.

CONCLUSIONS

Falciparum but not vivax malaria during pregnancy is associated with hypertensive disorders of pregnancy.

Plant Phenolics and Extracts in Animal Models of Preeclampsia and Clinical Trials-Review of Perspectives for Novel Therapies

The current health requirements set the direction in pharmacological research, especially as regards diseases that require improvement of existing therapeutic regimens. Such diseases include preeclampsia, which is a hypertensive disorder of pregnancy during which there occurs progressive increasing activation of the immune system through elevation of pro-inflammatory cytokines and antiangiogenic factors, which is dangerous for the mother and fetus. A promising field of research for new drugs to treat this disease is the study of natural phenolic compounds of plant origin and herbal extracts, which are complex matrices of chemical compounds with broad biological activities. Many plant substances with anti‑inflammatory and anti‑hypertensive properties are known, but studies in animal models of preeclampsia and clinical trials concerning this disease constitute a new and developing research trend of significant medical importance. The aim of our research review was to identify and analyze the results of already available studies on baicalin, curcumin, epigallocatechin gallate, punicalagin, quercetin, resveratrol, salvianolic acid A (danshensu), silibinin, and vitexin, as well as plant extracts from Brassica oleracea L., Euterpe oleracea Mart., Moringa oleifera Lam., Punica granatum L., Silybum marianum (L.) Gaertner, Thymus schimperi Ronniger, Uncaria rhynchophylla (Miq.) Miq. ex Havil., and Vitis vinifera L., which are potential and promising candidates for further research and for potential new therapies.

Antepartum and postpartum changes in adipokines, endothelial dysfunction, inflammatory markers and other biochemical parameters in preeclamptic women: A prospective observational cohort study

This study aimed at evaluating the role played by insulin resistance, lipid metabolism disorder, oxidative stress, resistin, vaspin, Interleukin-18 and asymmetric dimethyl arginine as a marker for endothelial dysfunction in the pathogenesis of preeclampsia. This prospective observational cohort study involved 60 women who were classified into: 20 non-pregnant women (group 1 or control group), 20 normally pregnant women (group 2) and 20 preeclamptic women (group 3) at their third trimester. The pregnant women were assessed at their third trimester and further re-evaluated four weeks after delivery. The assessment included demography, assessment of proteinuria and urinary protein to creatinine ratio, blood pressure measurement and assessment of fasting blood glucose, fasting insulin level, lipid panel and the circulating levels of malondialdehyde, resistin, vaspin, interleukin-18 and asymmetric dimethyl arginine. Preeclamptic women showed more atherogenic lipid profile, significantly higher Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and significantly elevated levels of malondialdehyde, resistin, vaspin and interleukin-18 than the other study groups. Serum asymmetric dimethyl arginine concentration showed non-significant difference among the three study groups. The levels of resistin and vaspin showed significant decrease four weeks postpartum in preeclamptic group. We concluded that, preeclampsia was associated with insulin resistance, dyslipidemia, oxidative stress, inflammation and significant changes in adipokines; resistin and vaspin. Furthermore, the significant increase in the serum levels of resistin and vaspin at the third trimester and their significant decline four weeks postpartum in preeclamptic group focus the attention on the role played by these adipokines in the pathogenesis of preeclampsia.

Impact of Melatonin on Full-Term Fetal Brain Development and Transforming Growth Factor-β Level in a Rat Model of Preeclampsia

Preeclampsia (PE) is a leading cause of stroke and cognitive impairment in the offspring. Melatonin is involved in the outcome of normal pregnancy. Its receptors are widespread in the embryo. This study aimed to investigate the fetal neuroprotective effect of melatonin in experimentally induced PE. After induction of pregnancy in 18 female rats, they were divided into three equal groups. PE was induced in groups II and III by injection of deoxycorticosterone acetate and drinking isotonic saline. Melatonin was supplied to group III orally (10 mg/kg body weight) throughout pregnancy. Pregnancy was terminated on day 20, and macroanatomical investigation of three fetuses from each pregnant rat and their placentae was performed. Placental and brain homogenates were analyzed for malondialdehyde (MDA), placental growth factor (PLGF), tumor necrosis factor-α (TNF-α), and brain transforming growth factor-β (TGF-β). Histopathological analysis of fetal brain sections was performed. Melatonin improved placental, fetal, and brain weight; significantly reduced fetal death rate; significantly increased PLGF, placental and brain superoxide dismutase, and brain TGF-β; and significantly decreased placental TNF-α and brain MDA. Brain micromorphological study found normal glial cells and neuropil in the melatonin-treated group and a loss of neuronal cell outlines with an accumulation of cellular debris in the untreated group. In conclusion, melatonin approximately showed a neuroprotective activity by managing PE-induced oxidative stress in the placenta and fetal cerebral cortex of rats.

Prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar: a cross-sectional study

Background

Severe pre-eclampsia is more dominant in low and middle-income countries. In Sub-Saharan Africa, severe pre-eclampsia remains a major public health problem contributing to high rates of maternal mortality. Few studies have investigated the relationship between severe pre-eclampsia and associated factors in East Africa. The aim of this study was to determine the prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar.

Methods

A hospital based analytical cross-sectional study design was used. Purposive sampling was utilized for the selection of hospitals. Proportionate sampling was used for selection of representatives from each hospital and participants were selected using systematic random sampling. Postpartum mothers were included in the study. The study was conducted by an interviewer who administered a questionnaire with close ended questions and chart review for data gathering. SPSS version 23 was used for data analysis and descriptive and multiple logistic regression was performed for control of confounders.

Results

This study included a total of 400 participants with a 100% response rate. Participants ranged from 17 to 45 years of age with mean age (SD) of 28.78 (±6.296). The prevalence of severe pre-eclampsia among postpartum women was 26.3% (n = 105). After adjusting for the possible confounders, factors associated with severe pre-eclampsia were; maternal age group of 15–20 years (AOR 3.839; 95% C. I 1.037–14.210), pregnancy from new partner/husband (AOR 7.561; 95% C. I 3.883–14.724), family history of high blood pressure (AOR 6.446; C. I 3.217–12.917), diabetes prior to conception (AOR 55.827; 95% C. I 5.061–615.868), having high blood pressure in a previous pregnancy (AOR 19.382; 95% C. I 4.617–81.364), paternal age above 45 (AOR 2.401; 95% C. I 1.044–5.519) and multifetal gestation (AOR 7.62; 95% CI 2.01–28.84).

Conclusion

The prevalence of severe pre-eclampsia among postpartum women in Zanzibar is high. Common risk factors in this setting include maternal age of 15–20 years, pregnancy with a new partner, family history of high blood pressure, pre-existing diabetes prior to conception, a history of high blood pressure in previous pregnancy paternal age greater than 45 and multifetal gestation.

Evaluation of total LDH and its isoenzymes as markers in preeclampsia

Background

Preeclampsia, a rapidly progressing pregnancy-specific multi-systemic syndrome is globally the leading cause of maternal and neonatal morbidity and mortality. This study aims to evaluate the serum total Lactate dehydrogenase levels in women with preeclampsia when compared to normotensive pregnant women and assess the electrophoretic pattern of the LDH isoenzymes in normal pregnancy, preeclampsia and eclampsia.

Methods

The study, carried out in the Department of Biochemistry of MVJ Medical College, included 30 patients of preeclampsia and 30 normotensive gestational age-matched pregnant women admitted to the Department of OBG. Serum total LDH was analysed by DGKC method. Serum and cord blood samples for isoenzyme distribution analysis were collected from a normal pregnant woman undergoing delivery, a woman with mild eclampsia, two women with eclampsia, and analysed by slab gel electrophoresis followed by activity staining.

Results

LDH was significantly elevated in cases as well as between the case (mild and severe) groups, showed a moderate positive statistically significant correlation with systolic, diastolic blood pressure and a sensitivity of 50% and a specificity of 80%. Further, the isoenzyme pattern showed a decreasing distribution of aerobic forms of LDH in preeclampsia-eclampsia.

Conclusions

Serum total LDH may serve as a robust and affordable marker of preeclampsia. Serum total LDH, along with its isoenzyme profile, might serve as a predictor and a stronger marker of preeclampsia when compared to serum LDH analysis alone. It may also be used to assess the severity of preeclampsia and hence help in predicting and preventing adverse maternal and foetal outcomes.

Clinical Importance of the Human Umbilical Artery Potassium Channels

Potassium (K⁺) channels are usually predominant in the membranes of vascular smooth muscle cells (SMCs). These channels play an important role in regulating the membrane potential and vessel contractility-a role that depends on the vascular bed. Thus, the activity of K⁺ channels represents one of the main mechanisms regulating the vascular tone in physiological and pathophysiological conditions. Briefly, the activation of K⁺ channels in SMC leads to hyperpolarization and vasorelaxation, while its inhibition induces depolarization and consequent vascular contraction. Currently, there are four different types of K⁺ channels described in SMCs: voltage-dependent K⁺ (K_V) channels, calcium-activated K⁺ (K_Ca) channels, inward rectifier K⁺ (Kir) channels, and 2-pore domain K⁺ (K_2P) channels. Due to the fundamental role of K⁺ channels in excitable cells, these channels are promising therapeutic targets in clinical practice. Therefore, this review discusses the basic properties of the various types of K⁺ channels, including structure, cellular mechanisms that regulate their activity, and new advances in the development of activators and blockers of these channels. The vascular functions of these channels will be discussed with a focus on vascular SMCs of the human umbilical artery. Then, the clinical importance of K⁺ channels in the treatment and prevention of cardiovascular diseases during pregnancy, such as gestational hypertension and preeclampsia, will be explored.

Phthalates Implications in the Cardiovascular System

Today’s sedentary lifestyle and eating habits have been implicated as some of the causes of the increased incidence of several diseases, including cancer and cardiovascular diseases. However, environmental pollutants have also been identified as another possible cause for this increase in recent decades. The constant human exposure to plastics has been raising attention regarding human health, particularly when it comes to phthalates. These are plasticizers used in the manufacture of industrial and consumer products, such as PVC (Polyvinyl Chloride) plastics and personal care products, with endocrine-disrupting properties, as they can bind molecular targets in the body and interfere with hormonal function. Since these compounds are not covalently bound to the plastic, they are easily released into the environment during their manufacture, use, or disposal, leading to increased human exposure and enhancing health risks. In fact, some studies have related phthalate exposure with cardiovascular health, having already shown a positive association with the development of hypertension and atherosclerosis in adults and some cardiometabolic risk factors in children and adolescents. Therefore, the main purpose of this review is to present and relate the most recent studies concerning the implications of phthalates effects on the cardiovascular system.

A risk model of prenatal screening markers in first trimester for predicting hypertensive disorders of pregnancy

Background

We aimed to construct a risk model to assess the diagnostic value of predicting hypertensive disorders of pregnancy (HDPs) by screening a range of prenatal markers, including pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotropin (free β-hCG), and fetal nuchal translucency (NT).

Method

We analyzed 902 women, classified into four groups: healthy gravidas (n = 680, controls), gravidas with gestational hypertension (n = 61; GH), gravidas with preeclampsia (n = 90; PE), and gravidas with severe preeclampsia (n = 71, SPE). We then compared the multiple of median (MoM) of PAPP-A, free β-hCG, and NT. A risk model was constructed and receiver operating characteristic curve (ROC) analysis was used to diagnose HDPs.

Results

Levels of PAPP-A and free β-hCG levels in the GH, PE, and SPE groups were significantly lower than those in the control group (χ ² = 7.522, P = 0.001; χ ² = 17.775, P < 0.001). NT did not differ significantly when compared across all four groups (χ ² = 1.592, P > 0.05). When the cut-off values for PAPP-A and free β-hCG were 0.795 MoM and 1.185 MoM, the corresponding sensitivities and specificities were 0.514 and 0.635, and 0.734 and 0.450, respectively. The best risk calculation featured PAPP-A, free β-hCG, and NT; this model exhibited the highest diagnostic value in the SPE group, followed by the GH group and then the PE group.

Conclusion

The use of prenatal screening markers during early pregnancy can identify fetal aneuploidy and can also predict HDPs. The development of innovative screening strategies for gravidas and the targeted prevention of HDPs in high-risk gravidas are essential for perinatal care and early intervention, thus creating significant opportunities for predictive and preventive personalized medicine. In our study, we found that the combination of a series of prenatal screening markers in early pregnancy is better than a single marker; our data clearly demonstrate the diagnostic value of combining PAPP-A, free β-hCG, and NT for patients with SPE.

Gene polymorphisms of uric acid are associated with pre-eclampsia in South Africans of African ancestry

Objectives: To investigate the association of uric acid gene polymorphisms and Pre-eclampsia.Methods: 637 women of African ancestry [280 controls, 357 pre-eclampsia (early-onset = 187, late-onset = 170]) retrospectively. The rs505802, rs1212986, and rs1014290 SNPs were genotyped from purified DNA using real-time PCR.Results: CT genotype (rs505802) was higher in pre-eclampsia [Adjusted p = 0.028*: OR (95% CI) = 1.73 (1.258-2.442)] and late-onset pre-eclampsia [Adjusted p = 0.027*: OR (95% CI) = 1.75 (1.165-2.2628)] than controls. CT genotype (rs1014290) was higher in early-onset pre-eclampsia [Adjusted p-value = 0.040*: OR (95% CI) = 1.60 (1.102-2.325)] than controls.Conclusion: The genotyped rs505802 and rs1014290 are significantly associated with pre-eclampsia.

Concept and connotation of oxidative stress in preeclampsia

BACKGROUND:

Preeclampsia (PE) is a systemic pregnancy-related disorder characterized by hypertension, proteinuria, and edema. Free radicals seem to play an important role in the induction of endothelial dysfunction in PE.

AIM:

The aim of the present study was to investigate serum levels of nitric oxide (NO), peroxynitrite (ONOO⁻), paraoxonase (PON-1), malondialdehyde (MDA), and lipid profile in preeclamptic patients compared to the women with normal pregnancy.

MATERIALS AND METHODS:

A total of 68 pregnant women were recruited. They were divided into two groups - Group A, 40 women were a newly diagnosed with PE and Group B, 28 women with normal pregnancy. Anthropometric measurements including body mass index and blood pressure in accordance with biochemical measurements including NO, ONOO⁻, PON-1, MDA, and lipid profile were done for preeclamptic pregnant women compared to the controls.

RESULTS:

Pregnant women with pre-eclampsia illustrated insignificant differences in the age (31.22±2.87) compared to the age of control P > 0.05. There were significant changes in the body mass index (BMI), type of delivery and smoking status of pregnant women with pre-eclampsia compared to the control P < 0.05. Both systolic and diastolic blood pressures were high in pregnant women with pre-eclampsia compared to the control P < 0.01. PON-1 and NO serum levels were significantly decreased (P < 0.01) while ONOO⁻ and MDA serum levels were significantly increased in PE compared to the women with normal pregnancy.

CONCLUSIONS:

This study concluded that PE is associated with the augmentation of oxidative stress and reduction of endogenous antioxidant capacity regarding PON-1.

Electrical field stimulation induces endothelium-dependent contraction of human umbilical cord vessels

Electrical field stimulation (EFS) has been used for decades in classical pharmacological preparations in order to characterize the mediators released by neural endings involved in smooth muscle contraction or relaxation. Since most of the human umbilical cord has no innervation, EFS has never been used in this preparation. This study aimed to investigate the effect of EFS on vascular responsiveness from human umbilical cord. Segments of the human umbilical cord were obtained from normotensive parturients and the human umbilical artery (HUA) and the human umbilical vein (HUV) were isolated and mounted in organ bath chambers. Electrical field stimulation-induced contractions in both HUA (2.35 ± 1.31 mN and 3.77 ± 2.31 mN for 8 Hz and 16 Hz respectively, n = 24) and HUV (3.81 ± 2.54 mN and 6.26 ± 4.51 mN for 8 Hz and 16 Hz respectively, n = 25). The addition of tetrodotoxin (1 μM) did not alter the EFS-induced contractions in both tissues (n = 5). Pre-incubation with atropine (10 and 100 μM), glibenclamide (10 μM) and indomethacin (10 μM) did not affect the EFS-induced contractions in both tissues. The contractions of both vessels were significantly reduced by pre-incubation of the tissues with phentolamine (10 and 100 μM). The endothelium removal almost abolished the EFS- induced contractions in both vessels (n = 5). In sandwich preparation, donor tissue (with endothelium) released a factor (s) that promoted contraction of the recipient tissue (endothelium removal) in both HUA and HUV (n = 5, respectively). Our findings indicate a potential role of endothelium-derived catecholamines in modulating HUA and HUV reactivities.