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Andronikidi PE, Orovou E, Mavrigiannaki E, Athanasiadou V, Tzitiridou-Chatzopoulou M, Iatrakis G, Grapsa E. Placental and Renal Pathways Underlying Pre-Eclampsia. Int J Mol Sci 2024; 25:2741. [PMID: 38473987 DOI: 10.3390/ijms25052741] [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: 01/31/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Pre-eclampsia is a serious complication of pregnancy characterized by a state of multiorgan hypertensive disorders, with or without proteinuria and possible multiorgan dysfunction. Chronic kidney disease is an established risk factor for the development of pre-eclampsia, as angiogenic homeostasis is altered and the maternal circulation is already hypertensive. Facing pre-eclampsia in the context of chronic kidney disease is a challenging emergency for both the mother and the fetus. The clinical features and the management of this multi-organ disorder are clearly defined in the modern literature but the underlying pathophysiologic mechanisms remain not fully elucidated. Understanding the pathophysiology that mediates the onset of pre-eclampsia itself and in synergy with chronic kidney disease is fundamental for developing prompt prevention strategies, treatment planning, and patient counseling. This review aims to summarize the main molecular mechanisms involved in the process of pre-eclampsia, with a particular focus on the role of the kidneys and hormonal pathways related to renal function in normal pregnancy and pre-eclamptic syndromes.
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Affiliation(s)
- Paraskevi Eva Andronikidi
- Department of Nephrology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Eirini Orovou
- Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Greece
| | | | - Virginia Athanasiadou
- Department of Nephrology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - George Iatrakis
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Eirini Grapsa
- Department of Nephrology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Woldeamanuel GG, Tlaye KG, Wu L, Poon LC, Wang CC. Platelet count in preeclampsia: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100979. [PMID: 37098392 DOI: 10.1016/j.ajogmf.2023.100979] [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: 01/10/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE Many studies have reported the association between platelets and preeclampsia. However, sample sizes were small, and their findings were inconsistent. We conducted a systematic review and meta-analysis to evaluate the association in pooled samples and in detail. DATA SOURCES A systematic literature search was performed using Medline, Embase, ScienceDirect, Web of Science, Cochrane Library, NICHD-DASH, LILACS, and Scopus from inception to April 22, 2022. STUDY ELIGIBILITY CRITERIA Observational studies comparing platelet count between women with preeclampsia and normotensive pregnant women were included. METHODS The mean differences with 95% confidence interval in platelet count were calculated. Heterogeneity was assessed using I2 statistics. Sensitivity and subgroup analyses were conducted. Statistical analysis was performed using RevMan 5.3 and ProMeta 3 software. RESULTS A total of 56 studies comprising 4892 preeclamptic and 9947 normotensive pregnant women were included. Meta-analysis showed that platelet count was significantly lower in women with preeclampsia than in normotensive controls (overall: mean difference, -32.83; 95% confidence interval, -40.13 to -25.52; P<.00001; I2=92%; mild preeclampsia: mean difference, -18.65; 95% confidence interval, -27.17 to -10.14; P<.00001; I2=84%; severe preeclampsia: mean difference, -42.61; 95% confidence interval, -57.53 to -27.68; P<.00001; I2=94%). Significantly lower platelet count was also observed in the second trimester (mean difference, -28.84; 95% confidence interval, -44.59 to -13.08; P=.0003; I2=93%), third trimester (mean difference, -40.67; 95% confidence interval, -52.14 to -29.20; P<.00001; I2=92%), and before the diagnosis of preeclampsia (mean difference, -18.81; 95% confidence interval, -29.98 to -7.64; P=.009; I2=87%), but not in the first trimester (mean difference, -15.14; 95% confidence interval, -37.71 to 7.43; P=.19; I2=71%). Overall, the pooled sensitivity and specificity of platelet count were 0.71 and 0.77, respectively. The area under the curve was 0.80. CONCLUSION This meta-analysis confirmed that platelet count was significantly lower in preeclamptic women, irrespective of severity and presence or absence of associated complications, even before the onset of preeclampsia and in the second trimester of pregnancy. Our findings suggest that platelet count may be a potential marker to identify and predict preeclampsia.
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Affiliation(s)
- Gashaw Garedew Woldeamanuel
- Department of Obstetrics and Gynaecology, Li Ka Shing Institute of Health Sciences, School of Biomedical Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR
| | - Kenean Getaneh Tlaye
- Department of Obstetrics and Gynaecology, Li Ka Shing Institute of Health Sciences, School of Biomedical Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR
| | - Ling Wu
- Department of Obstetrics and Gynaecology, Li Ka Shing Institute of Health Sciences, School of Biomedical Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Li Ka Shing Institute of Health Sciences, School of Biomedical Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, Li Ka Shing Institute of Health Sciences, School of Biomedical Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR.
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Utility of sFtl-1 and Placental Growth Factor Ratio for Adequate Preeclampsia Management. Healthcare (Basel) 2023; 11:healthcare11030381. [PMID: 36766955 PMCID: PMC9914058 DOI: 10.3390/healthcare11030381] [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: 12/27/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction: The pathophysiology of preeclampsia is represented by placental ischemia and the release of angiogenic factors. Recent research suggests that using the value of the sFtl-1/PIGF ratio is more accurate for monitoring angiogenic activity. The aim of this study consists in assessing the clinical utility of the sFtl-1/PIGF ratio in determining the diagnosis and severity of preeclampsia. Material and Methods: In our study a descriptive and prospective plan was used for analyzing the specific value of the sFtl-1/PIGF ratio in women with preeclampsia and in women with gestational hypertension, depending on the gestational age and severity. Results: The study included 59 women with preeclampsia and 25 women with gestational hypertension. The mean value of the sFtl-1/PIGF ratio of pregnant women with preeclampsia was 209.2 pg/mL, while in the gestational hypertension group, the mean value of the sFtl-1/PIGF ratio was 46.08 pg/mL. The difference between the value of the sFtl-1/PIGF ratio of the group with preeclampsia and the gestational hypertension group was > 67 (pg/mL), with a sensitivity of 86.44% and a specificity of 92.00%. Significant differences were found between the median values of the sFtl-1/PIGF ratio in pregnant women with severe preeclampsia in the early-onset subgroup compared to those in the late-onset subgroup (307 pg/mL, and 98 pg/mL, respectively, p = 0.009 < α = 0.05). Conclusions: The sFtl-1/PIGF ratio may be an alternative method for diagnosing preeclampsia and it can provide data about this condition's severity.
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Mokha S, Heintz C, Agrawal V, Reynolds AM, Berkelhamer SK. Increased prevalence of severe neonatal hyperbilirubinaemia during social distancing. J Paediatr Child Health 2022; 58:991-995. [PMID: 34997787 DOI: 10.1111/jpc.15881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 12/16/2022]
Abstract
AIM Social distancing guidelines implemented with the COVID-19 pandemic impacted health-care utilisation and disrupted critical social supports. Resurgence of highly transmissible strains has resulted in revisiting restrictions with potential impacts on newborn health. With concerns for inadequate post-partum support, we sought to determine if social distancing correlated with increased rates of readmission for hyperbilirubinaemia. METHODS Retrospective chart review identified all readmissions for hyperbilirubinaemia between 1/18 and 4/20 in Western New York. Infant/maternal demographics and data on hospital course were collected on control (1/1/18-31/1/20) and social distancing (1/2/20-30/4/20) cohorts. Nineteen outpatient clinics were surveyed regarding lactation support. RESULTS Monthly readmissions for hyperbilirubinaemia nearly tripled during social distancing (0.90 ± 0.91 vs. 2.63 ± 2.29 per 1000 births during early COVID, P = 0.015). Comparable severity of disease at readmission was observed with no difference in the need for therapies (phototherapy, intravenous immunoglobulin or exchange transfusion) or length of hospital stay. Mothers were younger (25.8 ± 3.3 vs. 31.3 ± 4.7 years; P = 0.005) with higher rates of primiparity and exclusive breastfeeding than national norms, however not significantly higher than controls in our small cohort (62.5 vs. 37.0% for primiparity; 87.5 vs. 81.5% for breastfeeding). Of 19 clinics surveyed, only six confirmed a telemedicine option for lactation support. CONCLUSIONS Rates of readmission for hyperbilirubinaemia increased during social distancing. Younger maternal age with high rates of primiparity and exclusive breastfeeding raise concern for inadequate social and/or lactation support. Proactive identification of mothers at risk and expansion of remote lactation services may be indicated with recurrent waves of the pandemic.
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Affiliation(s)
- Sonam Mokha
- Department of Pediatrics, University of California Davis, Sacramento, California, United States
| | - Chana Heintz
- Department of Pediatrics, University at Buffalo SUNY, Buffalo, New York, United States
| | - Vikash Agrawal
- Department of Pediatrics, Loma Linda University, San Bernardino, California, United States
| | - Anne Marie Reynolds
- Department of Pediatrics, University at Buffalo SUNY, Buffalo, New York, United States
| | - Sara K Berkelhamer
- Department of Pediatrics, University of Washington, Seattle, Washington, United States
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Kang T, Liu Y, Chen X, Huang X, Cao Y, Dou W, Duan D, Bo Y, Traore SS, Zhao X, Fu W, Zeng F, Liu J, Lyu Q. Dietary carotenoid intake and risk of developing preeclampsia: a hospital-based case-control study. BMC Pregnancy Childbirth 2022; 22:427. [PMID: 35597902 PMCID: PMC9123797 DOI: 10.1186/s12884-022-04737-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background The effect of carotenoids on the risk of preeclampsia (PE) is uncertain. We aimed to examine the associations between the intake of dietary carotenoids and related compounds by pregnant women in China, and the risk of their developing PE. Methods Four hundred and forty PE cases and 440 age- (± 3 years), gestational age- (± 1 weeks) and gestational diabetes mellitus status- (yes/no) matched healthy controls were recruited from March 2016 to June 2019. Dietary intake of carotenoids was assessed using a 79-item validated food-frequency questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. Results After adjusting for potential confounders, we found that the intake of total carotenoids, β-carotene, β-cryptoxanthin, lycopene, and lutein and zeaxanthin (lut-zea) were negatively associated with the odds of developing PE. Compared with the lowest quartile intake, the multivariate-adjusted OR (95% CI) of the highest quartile intake was 0.29 (0.16–0.54, Ptrend < 0.001) for total carotenoids, 0.31 (0.16–0.58, Ptrend < 0.001) for β-carotene, 0.50 (0.27–0.90, Ptrend = 0.007) for β-cryptoxanthin, 0.55 (0.30–0.99, Ptrend = 0.04) for lycopene and 0.32 (0.17–0.61, Ptrend = 0.001) for lut-zea. However, no significant associations were observed between the risk of developing PE and α-carotene intake (OR = 0.75, 95% CI: 0.41–1.36, Ptrend = 0.28). Moreover, similar negative associations were found for every one-standard-deviation increase in the intake of total carotenoids, β-carotene, β-cryptoxanthin, lycopene and lut-zea. Conclusion These results indicate that a high intake of total carotenoids, β-carotene, β-cryptoxanthin, lycopene and lut-zea may be associated with a low risk of developing PE. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04737-5.
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Affiliation(s)
- Ting Kang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yanhua Liu
- Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| | - Xi Chen
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Xuemin Huang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yuan Cao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Weifeng Dou
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Dandan Duan
- Department of Clinical Nutrition, Luoyang New Area Peoples Hospital, Luoyang, 471023, Henan, China
| | - Yacong Bo
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Stanislav Seydou Traore
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Xianlan Zhao
- Department of Obstetrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Wenjun Fu
- Department of Obstetrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Fangfang Zeng
- Department of Epidemiology, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Jun Liu
- Department of Preventive Medicine, School of Public Health, Zunyi Medical University, Zunyi, 563006, Guizhou, China
| | - Quanjun Lyu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China. .,Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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