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Bian Y, Zheng S, Liu X, Jiang X. Prediction model for severe maternal morbidity in pregnant women with hypertensive disorders of pregnancy. Pak J Med Sci 2024; 40:1054-1062. [PMID: 38952510 PMCID: PMC11190401 DOI: 10.12669/pjms.40.6.9095] [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: 10/10/2023] [Revised: 11/10/2023] [Accepted: 03/18/2024] [Indexed: 07/03/2024] Open
Abstract
Objectives To investigate risk factors for severe maternal morbidity (SMM) in pregnant women with hypertensive disorders of pregnancy (HDP) and to develop a risk prediction model. Methods A prospective observational cohort study was conducted among pregnant women who were hospitalized for hypertensive disorders of pregnancy (HDP) between January 2016 and December 2020 in Fujian College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Province, China (a training set), and a risk predictive model was constructed. Pregnant women with HDP who were hospitalized between January 2021 and December 2021 were selected as a validation set. Concordance index (C-index) and calibration curves were used to test predictive model discrimination and calibration. Results We included 970 pregnant women (790 in the training set and 180 in the validation set). Least absolute shrinkage and selection operator regression was used to screen for nine related variables such as intra-uterine growth retardation (IUGR), diastolic blood pressure (DBP) and systolic blood pressure (SBP) at suspected diagnosis, total bilirubin, albumin (ALB), uric acid, total cholesterol, serum magnesium, and suspected gestational age. SBP at suspected diagnosis (OR =1.22, 95%CI:1.08-1.42) and total cholesterol (OR = 1.78, 95%CI:1.17-2.80) were independent risk factors of severe maternal morbidity in pregnant women with HDP. A nomogram was constructed, and internal validation of the nomogram model was done using the bootstrap self-sampling method. C-index in the training and the validation set was 0.798 and 0.909, respectively. Conclusion Our prediction model can be used to determine gestational hypertension severity in pregnant women.
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Affiliation(s)
- Yan Bian
- Yan Bian, Labour Ward, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University,Fuzhou City, Fujian Province, China
| | - Shuisen Zheng
- Shuisen Zheng, Department of of Obstetrics Resident Physician. Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University,Fuzhou City, Fujian Province, China
| | - Xiuwu Liu
- Xiuwu Liu, Department of Nursing, Labour Ward, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University,Fuzhou City, Fujian Province, China
| | - Xiuming Jiang
- Xiuming Jiang, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University,Fuzhou City, Fujian Province, China
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Xue Y, Yang N, Gu X, Wang Y, Zhang H, Jia K. Risk Prediction Model of Early-Onset Preeclampsia Based on Risk Factors and Routine Laboratory Indicators. Life (Basel) 2023; 13:1648. [PMID: 37629504 PMCID: PMC10455518 DOI: 10.3390/life13081648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Background: Globally, 10-15% of maternal deaths are statistically attributable to preeclampsia. Compared with late-onset PE, the severity of early-onset PE remains more harmful with higher morbidity and mortality. Objective: To establish an early-onset preeclampsia prediction model by clinical characteristics, risk factors and routine laboratory indicators were investigated from pregnant women at 6 to 10 gestational weeks. Methods: The clinical characteristics, risk factors, and 38 routine laboratory indicators (6-10 weeks of gestation) including blood lipids, liver and kidney function, coagulation, blood count, and other indicators of 91 early-onset preeclampsia patients and 709 normal controls without early-onset preeclampsia from January 2010 to May 2021 in Peking University Third Hospital (PUTH) were retrospectively analyzed. A logistic regression, decision tree model, and support vector machine (SVM) model were applied for establishing prediction models, respectively. ROC curves were drawn; area under curve (AUCROC), sensitivity, and specificity were calculated and compared. Results: There were statistically significant differences in the rates of diabetes, antiphospholipid syndrome (APS), kidney disease, obstructive sleep apnea (OSAHS), primipara, history of preeclampsia, and assisted reproductive technology (ART) (p < 0.05). Among the 38 routine laboratory indicators, there were no significant differences in the levels of PLT/LYM, NEU/LYM, TT, D-Dimer, FDP, TBA, ALP, TP, ALB, GLB, UREA, Cr, P, Cystatin C, HDL-C, Apo-A1, and Lp(a) between the two groups (p > 0.05). The levels of the rest indicators were all statistically different between the two groups (p < 0.05). If only 12 risk factors of PE were analyzed with the logistic regression, decision tree model, and support vector machine (SVM), and the AUCROC were 0.78, 0.74, and 0.66, respectively, while 12 risk factors of PE and 38 routine laboratory indicators were analyzed with the logistic regression, decision tree model, and support vector machine (SVM), and the AUCROC were 0.86, 0.77, and 0.93, respectively. Conclusions: The efficacy of clinical risk factors alone in predicting early-onset preeclampsia is not high while the efficacy increased significantly when PE risk factors combined with routine laboratory indicators. The SVM model was better than logistic regression model and decision tree model in early prediction of early-onset preeclampsia incidence.
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Affiliation(s)
- Yuting Xue
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing 100191, China;
| | - Nan Yang
- Department of Blood Transfusion, Peking University Third Hospital, Beijing 100191, China;
| | - Xunke Gu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China;
| | - Yongqing Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China;
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China;
| | - Keke Jia
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing 100191, China;
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Poniedziałek-Czajkowska E, Mierzyński R, Leszczyńska-Gorzelak B. Preeclampsia and Obesity-The Preventive Role of Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1267. [PMID: 36674022 PMCID: PMC9859423 DOI: 10.3390/ijerph20021267] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 06/10/2023]
Abstract
Obesity is now recognized as a worldwide epidemic. An inadequate diet and reduced physical activity are acknowledged as the leading causes of excess body weight. Despite growing evidence that obesity is a risk factor for unsuccessful pregnancies, almost half of all women who become pregnant today are overweight or obese. Common complications of pregnancy in this group of women are preeclampsia and gestational hypertension. These conditions are also observed more frequently in women with excessive weight gain during pregnancy. Preeclampsia is one of the most serious pregnancy complications with an unpredictable course, which in its most severe forms, threatens the life and health of the mother and her baby. The early identification of the risk factors for preeclampsia development, including obesity, allows for the implementation of prophylaxis and a reduction in maternal and fetal complications risk. Additionally, preeclampsia and obesity are the recognized risk factors for developing cardiovascular disease in later life, so prophylaxis and treating obesity are paramount for their prevention. Thus, a proper diet and physical activity might play an essential role in the prophylaxis of preeclampsia in this group of women. Limiting weight gain during pregnancy and modifying the metabolic risk factors with regular physical exercise creates favorable metabolic conditions for pregnancy development and benefits the elements of the pathogenetic sequence for preeclampsia development. In addition, it is inexpensive, readily available and, in the absence of contraindications to its performance, safe for the mother and fetus. However, for this form of prevention to be effective, it should be applied early in pregnancy and, for overweight and obese women, proposed as an essential part of planning pregnancy. This paper aims to present the mechanisms of the development of hypertension in pregnancy in obese women and the importance of exercise in its prevention.
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Liu Z, Wang M, Zhang C, Zhou S, Ji G. Molecular Functions of Ceruloplasmin in Metabolic Disease Pathology. Diabetes Metab Syndr Obes 2022; 15:695-711. [PMID: 35264864 PMCID: PMC8901420 DOI: 10.2147/dmso.s346648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/04/2022] [Indexed: 12/12/2022] Open
Abstract
Ceruloplasmin (CP) is a multicopper oxidase and antioxidant that is mainly produced in the liver. CP not only plays a crucial role in the metabolic balance of copper and iron through its oxidase function but also exhibits antioxidant activity. In addition, CP is an acute-phase protein. In addition to being associated with aceruloplasminemia and neurodegenerative diseases such as Wilson's disease, Alzheimer's disease, and Parkinson's disease, CP also plays an important role in metabolic diseases, which are caused by metabolic disorders and vigorous metabolism, mainly including diabetes, obesity, hyperlipidemia, etc. Based on the physiological functions of CP, we provide an overview of the association of type 2 diabetes, obesity, hyperlipidemia, coronary heart disease, CP oxidative stress, inflammation, and metabolism of copper and iron. Studies have shown that metabolic diseases are closely related to systemic inflammation, oxidative stress, and disorders of copper and iron metabolism. Therefore, we conclude that CP, which can reduce the formation of free radicals in tissues, can be induced during inflammation and infection, and can correct the metabolic disorder of copper and iron, has protective and diagnostic effects on metabolic diseases.
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Affiliation(s)
- Zhidong Liu
- Department of Internal Medicine of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| | - Miao Wang
- Department of Internal Medicine of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| | - Chunbo Zhang
- School of Pharmacy, Nanchang University, Nanchang, Jiangxi, 330031, People’s Republic of China
| | - Shigao Zhou
- Department of Internal Medicine of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| | - Guang Ji
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
- Correspondence: Guang Ji, Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, People’s Republic of China, Tel +86 18156416071, Fax +86 21-64385700, Email
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5
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Oxidative stress in pregnancy complicated by preeclampsia. Arch Biochem Biophys 2020; 681:108255. [PMID: 31904364 DOI: 10.1016/j.abb.2020.108255] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/28/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
Preeclampsia is a multisystemic disorder of pregnancy that causes perinatal morbidity and mortality. Studies published in the last decade have contributed to a better understanding of physiopathogenesis through key mechanisms involved, such as altered immune response, endothelial dysfunction, oxidative stress and systemic inflammatory response, as well as genetic susceptibility. Oxidative stress (OS) plays an important role in the development of preeclampsia, since it alters placental remodeling and placental vascular endothelial dysfunction, resulting in an ischemia/reperfusion injury with an increase in xanthine oxidase activity that produces high levels of reactive oxygen species (ROS). ROS can be generated through many pathways within cells, mitochondria, endoplasmic reticulum (ER) and enzymes such as NADPH oxidase are the most important sources, causing widespread and indiscriminate damage to cells and tissues, which leads to an intravascular inflammatory response and maternal systemic endothelial dysfunction characteristic of this prenatal syndrome. Therefore, the following review aims to identify the main risk factors and the role of OS as a pathophysiological mechanism in the development of preeclampsia.
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Lopez-Jaramillo P, Barajas J, Rueda-Quijano SM, Lopez-Lopez C, Felix C. Obesity and Preeclampsia: Common Pathophysiological Mechanisms. Front Physiol 2018; 9:1838. [PMID: 30618843 PMCID: PMC6305943 DOI: 10.3389/fphys.2018.01838] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/06/2018] [Indexed: 01/25/2023] Open
Abstract
Preeclampsia is a disorder specific of the human being that appears after 20 weeks of pregnancy, characterized by new onset of hypertension and proteinuria. Abnormal placentation and reduced placental perfusion associated to impaired trophoblast invasion and alteration in the compliance of uterine spiral arteries are the early pathological findings that are present before the clinical manifestations of preeclampsia. Later on, the endothelial and vascular dysfunction responsible of the characteristic vasoconstriction of preeclampsia appear. Different nutritional risk factors such as a maternal deficit in the intake of calcium, protein, vitamins and essential fatty acids, have been shown to play a role in the genesis of preeclampsia, but also an excess of weight gain during pregnancy or a pre-pregnancy state of obesity and overweight, which are associated to hyperinsulinism, insulin resistance and maternal systemic inflammation, are proposed as one of the mechanism that conduce to endothelial dysfunction, hypertension, proteinuria, thrombotic responses, multi-organ damage, and high maternal mortality and morbidity. Moreover, it has been demonstrated that pregnant women that suffer preeclampsia will have an increased risk of future cardiovascular disease and related mortality in their later life. In this article we will discuss the results of studies performed in different populations that have shown an interrelationship between obesity and overweight with the presence of preeclampsia. Moreover, we will review some of the common mechanisms that explain this interrelationship, particularly the alterations in the L-arginine/nitric oxide pathway as a crucial mechanism that is common to obesity, preeclampsia and cardiovascular diseases.
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Affiliation(s)
- Patricio Lopez-Jaramillo
- Clinic of Metabolic Syndrome, Prediabetes, and Diabetes, Research Department, FOSCAL, Floridablanca, Colombia.,Masira Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia.,Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnologica Equinoccial, Quito, Ecuador
| | - Juan Barajas
- Clinic of Metabolic Syndrome, Prediabetes, and Diabetes, Research Department, FOSCAL, Floridablanca, Colombia
| | - Sandra M Rueda-Quijano
- Clinic of Metabolic Syndrome, Prediabetes, and Diabetes, Research Department, FOSCAL, Floridablanca, Colombia
| | | | - Camilo Felix
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnologica Equinoccial, Quito, Ecuador
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Sak S, Barut M, Çelik H, Incebiyik A, Ağaçayak E, Uyanikoglu H, Kirmit A, Sak M. Copper and ceruloplasmin levels are closely related to the severity of preeclampsia. J Matern Fetal Neonatal Med 2018; 33:96-102. [PMID: 29886772 DOI: 10.1080/14767058.2018.1487934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: The aim of this study was to investigate the maternal serum concentrations of copper (Cu) and ceruloplasmin (CP) in patients with mild preeclampsia, severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and to determine their association with the severity of the disease.Methods: This study was carried out at the largest tertiary care health center in the southeast region in Turkey and Department of Obstetrics and Gynecology, Dicle University Hospital. A total of 179 pregnant women, including 58 healthy pregnant women and 71 mild preeclampsia, 26 severe preeclampsia, and 24 HELLP syndrome cases classified according to the American College of Obstetricians and Gynecologists' 2013 guidelines were included in this prospective study. Blood samples were taken from all the pregnant women to evaluate the serum Cu and CP levels. The Cu level was determined via atomic absorption/emission spectroscopy, while the serum CP level was assessed with a nephelometric assay using an automatic image analyzer. Spearman's rank correlation tests were used to determine the correlations between the serum levels of the antioxidative markers and the preeclampsia severity.Results: The mean ± SD of the Cu was 81.2 ± 11.84 µg/dl in the mild preeclampsia cases and 160.2 ± 20.89 µg/dl in the severe preeclampsia cases (p < .001). The mean ± SD of the CP was 33.0 ± 4.81 mg/dl in the mild preeclampsia cases and 65.3 ± 9.17 mg/dl in the severe preeclampsia cases (p < .001). The Cu and CP levels were significantly higher in the patients with HELLP syndrome, which is an advanced and more severe form of severe preeclampsia, than in the mild and severe preeclampsia patients (p < .001 and p < .001, respectively). Therefore, the serum Cu and CP levels were correlated with the severity of preeclampsia (r = 859, p < .001 and r = 786, p < .001, respectively). In addition, there was a positive correlation between the serum Cu and CP levels and the systolic and diastolic blood pressure values and aspartate amino transferase levels (AST), and a negative correlation between the serum Cu and CP levels and the platelet count.Conclusion: This was the first study in which the ceruloplasmin and Cu levels were investigated in HELLP syndrome patients. When considering the results obtained in the present study, there were significant relationships between the Cu, CP levels which are the markers of oxidative stress and the preeclampsia severity.
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Affiliation(s)
- Sibel Sak
- Harran University School of Medicine, Sanliurfa, Turkey
| | - Mert Barut
- Harran University School of Medicine, Sanliurfa, Turkey
| | - Hakim Çelik
- Harran University School of Medicine, Sanliurfa, Turkey
| | | | - Elif Ağaçayak
- Department of Obstetrics and Gynecology, School of Medicine, Dicle University, Diyarbakir, Turkey
| | | | - Adnan Kirmit
- Harran University School of Medicine, Sanliurfa, Turkey
| | - Muhammet Sak
- Harran University School of Medicine, Sanliurfa, Turkey
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8
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McCarthy FP, Ryan RM, Chappell LC. Prospective biomarkers in preterm preeclampsia: A review. Pregnancy Hypertens 2018; 14:72-78. [PMID: 30527122 DOI: 10.1016/j.preghy.2018.03.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 01/28/2023]
Abstract
Preterm pre-eclampsia (prior to 37 weeks' gestation) remains a major cause of maternal and fetal morbidity and mortality particularly in low to middle income countries. Much research has focused on first and second trimester predictors of pre-eclampsia with the aim of allowing stratification of antenatal care and trialling of potential preventative and therapeutic agents. However, none have been shown to be of benefit in randomised controlled trials. In this literature review we critically evaluate predictive and diagnostic tests for preterm pre-eclampsia and discuss their clinical use and potential value in the management of preterm pre-eclampsia. We defined preterm pre-eclampsia as pre-eclampsia occurring prior to 37 weeks' gestation. Substantial progress has been made in the development of predictive screening tests for preterm pre-eclampsia, but further research is needed prior to their introduction and integration into routine clinical practice. The performance of diagnostic tests mainly utilising angiogenic and anti-angiogenic factors for determining time to delivery in later pregnancy currently hold more promise than first trimester predictive tests, possible reflecting the heterogeneity of pre-eclampsia.
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Affiliation(s)
- Fergus P McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Wilton, Ireland; Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, London SE1 7EH, UK.
| | - Roisin M Ryan
- London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy C Chappell
- NIHR Research Professor in Obstetrics, King's College London. Honorary Consultant Obstetrician, St Thomas' Hospital, London SE1 7EH, UK
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9
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Wang Y, Shi D, Chen L. Lipid profile and cytokines in hypertension of pregnancy: A comparison of preeclampsia therapies. J Clin Hypertens (Greenwich) 2018; 20:394-399. [PMID: 29316154 DOI: 10.1111/jch.13161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/24/2017] [Accepted: 09/29/2017] [Indexed: 12/31/2022]
Abstract
Hypertensive disorders complicating pregnancy can be classified as gestational hypertension, mild preeclampsia, and severe preeclampsia. It is necessary to evaluate and predict the grade in advance. The first study comprised 40 healthy pregnancies, 40 gestational hypertension, 40 mild preeclampsia, and 40 severe preeclampsia cases. The participants' lipid profile and cytokine levels were statistically compared. The efficacy and safety of oral nifedipine (n = 71) and intravenous labetalol (n = 72) for the treatment of severe preeclampsia were evaluated in the next study according to maternal and neonatal outcomes. The levels of lipid profile and cytokines were linked with the presence and severity of hypertensive disorders complicating pregnancy. Both oral nifedipine and intravenous labetalol are effective for safely reducing blood pressure to target levels in patients with severe preeclampsia. Our study suggests that lipid profile and cytokines can be used in the evaluation of the severity of hypertensive disorders complicating pregnancy, and oral nifedipine requires more study.
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Affiliation(s)
- Yong Wang
- Department of Gynaecology and Obstetrics, Cangzhou Central Hospital, Cangzhou, China
| | - Dandan Shi
- Department of Gynaecology and Obstetrics, Cangzhou Central Hospital, Cangzhou, China
| | - Ling Chen
- Cangzhou Medical College, Cangzhou, China
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Bellos I, Papantoniou N, Pergialiotis V. Serum ceruloplasmin levels in preeclampsia: a meta-analysis. J Matern Fetal Neonatal Med 2017; 31:2342-2348. [DOI: 10.1080/14767058.2017.1340449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ioannis Bellos
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papantoniou
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Pergialiotis
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Varfolomeeva EY, Semenova EV, Sokolov AV, Aplin KD, Timofeeva KE, Vasilyev VB, Filatov MV. Ceruloplasmin decreases respiratory burst reaction during pregnancy. Free Radic Res 2016; 50:909-19. [DOI: 10.1080/10715762.2016.1197395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Nikolic A, Cabarkapa V, Novakov Mikic A, Jakovljević A, Stosic Z. Ceruloplasmin and antioxidative enzymes in pre-eclampsia. J Matern Fetal Neonatal Med 2015; 29:2987-93. [PMID: 26571141 DOI: 10.3109/14767058.2015.1111333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate diagnostic value of ceruloplasmin together with other enzymatic and nonenzymatic antioxidants (superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and uric acid) and to evaluate the level of oxidative stress in patients with pre-eclampsia (PE) and compare it with normal pregnancy. METHODS In this prospective study, antioxidative markers were investigated in two groups of pregnant women: patients with pre-eclampsia (n = 32) and the healthy pregnant women (n = 60). The following antioxidative markers and enzymes were evaluated: serum ceruloplasmin levels, uric acid, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). RESULTS Serum levels of ceruloplasmin, uric acid and SOD were significantly higher in the PE group compared to the control group. Serum levels of GSH-Px were not significantly higher in the PE group compared to the control group. Serum ceruloplasmin and serum uric acid have the best diagnostic accuracy for oxidative stress in PE and are more accurate compared to antioxidative enzymes -SOD and specially more accurate than GSH-Px. CONCLUSIONS Serum ceruloplasmin level may have significant role as the markers of oxidative stress in pre-eclampsia especially when used in combination with uric acid levels.
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Affiliation(s)
| | - Velibor Cabarkapa
- b Department of Laboratory Medicine , Clinical Centre of Vojvodina, University of Novi Sad , Novi Sad , Serbia , and
| | | | - Ana Jakovljević
- b Department of Laboratory Medicine , Clinical Centre of Vojvodina, University of Novi Sad , Novi Sad , Serbia , and
| | - Zoran Stosic
- b Department of Laboratory Medicine , Clinical Centre of Vojvodina, University of Novi Sad , Novi Sad , Serbia , and
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Spradley FT, Palei AC, Granger JP. Increased risk for the development of preeclampsia in obese pregnancies: weighing in on the mechanisms. Am J Physiol Regul Integr Comp Physiol 2015; 309:R1326-43. [PMID: 26447211 DOI: 10.1152/ajpregu.00178.2015] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/28/2015] [Indexed: 11/22/2022]
Abstract
Preeclampsia (PE) is a pregnancy-specific disorder typically presenting as new-onset hypertension and proteinuria. While numerous epidemiological studies have demonstrated that obesity increases the risk of PE, the mechanisms have yet to be fully elucidated. Growing evidence from animal and human studies implicate placental ischemia in the etiology of this maternal syndrome. It is thought that placental ischemia is brought about by dysfunctional cytotrophoblast migration and invasion into the uterus and subsequent lack of spiral arteriole widening and placental perfusion. Placental ischemia/hypoxia stimulates the release of soluble placental factors into the maternal circulation where they cause endothelial dysfunction, particularly in the kidney, to elicit the clinical manifestations of PE. The most recognized of these factors are the anti-angiogenic sFlt-1 and pro-inflammatory TNF-α and AT1-AA, which promote endothelial dysfunction by reducing levels of the provasodilator nitric oxide and stimulating production of the potent vasoconstrictor endothelin-1 and reactive oxygen species. We hypothesize that obesity-related metabolic factors increase the risk for developing PE by impacting various stages in the pathogenesis of PE, namely, 1) cytotrophoblast migration and placental ischemia; 2) release of soluble placental factors into the maternal circulation; and 3) maternal endothelial and vascular dysfunction. This review will summarize the current experimental evidence supporting the concept that obesity and metabolic factors like lipids, insulin, glucose, and leptin affect placental function and increase the risk for developing hypertension in pregnancy by reducing placental perfusion; enhancing placental release of soluble factors; and by increasing the sensitivity of the maternal vasculature to placental ischemia-induced soluble factors.
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Affiliation(s)
- Frank T Spradley
- Department of Physiology and Biophysics, Cardiovascular-Renal Research Center, Women's Health Research Center, The University of Mississippi Medical Center, Jackson, Mississippi
| | - Ana C Palei
- Department of Physiology and Biophysics, Cardiovascular-Renal Research Center, Women's Health Research Center, The University of Mississippi Medical Center, Jackson, Mississippi
| | - Joey P Granger
- Department of Physiology and Biophysics, Cardiovascular-Renal Research Center, Women's Health Research Center, The University of Mississippi Medical Center, Jackson, Mississippi
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Ozgu-Erdinc AS, Cavkaytar S, Aktulay A, Buyukkagnici U, Erkaya S, Danisman N. Mid-trimester maternal serum and amniotic fluid biomarkers for the prediction of preterm delivery and intrauterine growth retardation. J Obstet Gynaecol Res 2015; 40:1540-6. [PMID: 24888913 DOI: 10.1111/jog.12371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 12/05/2013] [Indexed: 11/29/2022]
Abstract
AIM Our purpose was to evaluate the predictive value of maternal serum and amniotic fluid biomarkers that were obtained at the time of genetic amniocentesis for preterm delivery and intrauterine growth retardation (IUGR). METHODS A prospective cohort analysis was conducted in 107 singleton pregnancies that underwent amniocentesis at 16-22 weeks according to standard genetic indications. Maternal blood and amniotic fluid obtained from genetic amniocentesis were tested for glucose, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), ceruloplasmin, ferritin, high-sensitivity C-reactive protein and interleukin-6 (IL-6). Ninety-four pregnancies were followed until delivery. RESULTS Of the 94 patients, 16 (18.1%) delivered before 37 weeks and seven (7.5%) delivered a baby below the 10th percentile for gestational age. Amniotic fluid glucose levels were significantly lower in patients with preterm delivery than term deliveries (P = 0.01). Median amniotic fluid ferritin and IL-6 levels and mean amniotic fluid ALP levels were higher in the preterm group but this difference did not reach statistical significance. Mean maternal ALP and LDH levels tended to be insignificantly higher. Only median maternal blood ferritin levels in the IUGR group were found to be higher than patients who were appropriate for gestational age (P = 0.03). CONCLUSION Low amniotic fluid glucose levels are associated with risk of preterm delivery, whereas high maternal blood ferritin levels increase the risk for IUGR. Although this result is significant and notable, there is not enough clinical evidence to recommend their use as a screening test for preterm delivery and IUGR in routine practice.
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Affiliation(s)
- A Seval Ozgu-Erdinc
- Zekai Tahir Burak Women Health Care, Education and Research Hospital, Ankara, Turkey
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15
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Onuegbu AJ, Olisekodiaka JM, Udo JU, Umeononihu O, Amah UK, Okwara JE, Atuegbu C. Evaluation of high-sensitivity C-reactive protein and serum lipid profile in southeastern Nigerian women with pre-eclampsia. Med Princ Pract 2015; 24:276-9. [PMID: 25896579 PMCID: PMC5588228 DOI: 10.1159/000381778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 03/19/2015] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To evaluate the serum C-reactive protein (CRP) and lipid profile in women with pre-eclampsia. MATERIALS AND METHODS Thirty-five women with and 35 women without pre-eclampsia, who were in the 3rd trimester of pregnancy, were enrolled in this study. Weight in kilogrammes and height in metres were measured to calculate the mean body mass index (BMI) for each group. The diastolic and systolic blood pressures were measured. Lipid profile tests and serum CRP assay were done for all patients. Total cholesterol, triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) were determined using enzymatic methods, while low-density lipoprotein cholesterol (LDL-C) was calculated using Friedewald's formula. RESULTS The mean values of the BMI were 29.47 ± 6.90 versus 26.14 ± 2.92, of the diastolic blood pressure 109.14 ± 15.41 versus 72.29 ± 9.42 mm Hg and of the systolic blood pressure 170.57 ± 19.55 versus 120.86 ± 17.72 mm Hg for women with and without pre-eclampsia, respectively, and the differences were statistically significant (p = 0.012, p = 0.001 and p = 0.001, respectively). The biochemical analysis also indicated that the women with pre-eclampsia had a significantly higher mean serum CRP (8.57 ± 2.68 vs. 6.46 ± 2.46 mg/l, p = 0.001), TG (2.84 ± 0.45 vs. 1.87 ± 0.38 mmol/l, p = 0.001) and total cholesterol (5.59 ± 0.92 vs. 4.63 ± 0.78 mmol/l, p = 0.001) level but a lower mean HDL-C (1.10 ± 0.12 vs. 1.26 ± 0.15 mmol/l, p = 0.001) level than the controls. There was no statistical difference in the mean LDL-C values between the 2 groups (1.58 ± 0.8 vs. 1.45 ± 0.78 mmol/l, p > 0.05). CONCLUSION Significant changes in CRP as well as TG, total cholesterol and HDL-C were associated with pre-eclampsia in these Southeastern Nigerian women.
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Affiliation(s)
- Anaelechi J. Onuegbu
- Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi, Nigeria
- *Dr. Anaelechi J. Onuegbu, Department of Chemical Pathology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, PMB 5001, Nnewi, Anambra State (Nigeria), E-Mail
| | | | - John U. Udo
- Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Osita Umeononihu
- Department of Obstetrics and Gynaecology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Ubuoh K. Amah
- Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - John E. Okwara
- Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Chidiadi Atuegbu
- Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi, Nigeria
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Spracklen CN, Smith CJ, Saftlas AF, Robinson JG, Ryckman KK. Maternal hyperlipidemia and the risk of preeclampsia: a meta-analysis. Am J Epidemiol 2014; 180:346-58. [PMID: 24989239 DOI: 10.1093/aje/kwu145] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Published reports examining lipid levels during pregnancy and preeclampsia have been inconsistent. The objective of this meta-analysis was to test the association between preeclampsia and maternal total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and triglyceride levels measured during pregnancy. We conducted a systematic search for studies published between the index date until July 2013 reporting maternal lipid levels in women with preeclampsia and normotensive pregnant women. Seventy-four studies met all eligibility criteria and were included in the meta-analysis. Weighted mean differences in lipid levels were calculated using a random-effects model. Statistical heterogeneity was investigated using the I(2) statistic. Meta-regression was used to identify sources of heterogeneity. Preeclampsia was associated with elevated total cholesterol, non-HDL-C, and triglyceride levels, regardless of gestational age at the time of blood sampling, and with lower levels of HDL-C in the third trimester. A marginal association was found with LDL-C levels. Statistical heterogeneity was detected in all analyses. Meta-regression analyses suggested that differences in body mass index (weight (kg)/height (m)(2)) across studies may be partially responsible for the heterogeneity in the triglyceride and LDL-C analyses. This systematic review and meta-analysis demonstrates that women who develop preeclampsia have elevated levels of total cholesterol, non-HDL-C, and triglycerides during all trimesters of pregnancy, as well as lower levels of HDL-C during the third trimester.
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Total cholesterol and leptin concentrations are associated with prospective changes in systemic blood pressure in healthy pregnant women. J Hypertens 2014; 32:127-34. [DOI: 10.1097/hjh.0000000000000037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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