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Nguyen-Hoang L, Sahota DS, Tai AST, Chen Y, Feng Q, Wang X, Moungmaithong S, Leung MBW, Tse AW, Wong NKL, Kwan AH, Lau SL, Lee NMW, Chong MKC, Poon LC. Effect of aspirin on biomarker profile in women at high risk for preeclampsia. Am J Obstet Gynecol 2025; 232:561.e1-561.e20. [PMID: 39547345 DOI: 10.1016/j.ajog.2024.11.007] [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: 06/29/2024] [Revised: 10/21/2024] [Accepted: 11/08/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND There is limited evidence in the literature regarding the temporal changes of preeclampsia-related biomarkers during pregnancy in high-risk women who develop preeclampsia despite the administration of aspirin prophylaxis. OBJECTIVE This study aimed to compare the temporal changes in mean arterial pressure, uterine artery pulsatility index, placental growth factor, and soluble fms-like tyrosine kinase-1 across gestation in women identified as having high risk for preterm preeclampsia receiving aspirin prophylaxis and low-risk women without aspirin treatment. STUDY DESIGN This was a prospective longitudinal nested case-control study of 2007 women with singleton pregnancies who participated in the first-trimester screen-and-prevent program for preeclampsia at the Prince of Wales Hospital, Hong Kong Special Administrative Region, China, between January 2020 and May 2023. The risk of developing preterm preeclampsia was determined using the Fetal Medicine Foundation triple test (maternal factors, mean arterial pressure, uterine artery pulsatility index, and placental growth factor). High-risk women (adjusted risk ≥1:100) were administered a daily dose of aspirin at either 100 or 160 mg according to maternal weight, starting before 16 weeks until 36 weeks or until delivery or the onset of preeclampsia before 36 weeks. Low-risk women were matched according to maternal age, weight, and the date of the scan. The participants were followed up at 12 to 15+6, 20 to 24+6, and 30 to 37+6 weeks to measure mean arterial pressure, uterine artery pulsatility index, placental growth factor, and soluble fms-like tyrosine kinase-1 at each visit. The level of biomarker was expressed as multiple of the median. Log10 transformation was applied to fit the data to a Gaussian distribution before statistical analysis. A linear mixed-effects analysis was performed to compare the longitudinal changes of these biomarkers across gestation between the study groups. RESULTS Our study involved 403 low-risk women without preeclampsia, 1471 high-risk women without preeclampsia, and 133 high-risk women who developed preeclampsia. The low-risk group had significantly lower estimated marginal mean log10 mean arterial pressure multiple of the median, log10 uterine artery pulsatility index multiple of the median, and log10 soluble fms-like tyrosine kinase-1 multiple of the median, and higher estimated marginal mean log10 placental growth factor multiple of the median across gestation compared with the high-risk groups (P<.001). Among high-risk women, those who developed preeclampsia exhibited a significantly higher estimated marginal mean log10 mean arterial pressure multiple of the median (0.06378 vs 0.02985; P<.001), log10 uterine artery pulsatility index multiple of the median (0.08651 vs 0.02226; P<.001), and log10 soluble fms-like tyrosine kinase-1 multiple of the median (0.13204 vs 0.01234; P<.001), and lower estimated marginal mean log10 placental growth factor multiple of the median (-0.33504 vs -0.16388; P<.001) across gestation compared with those without preeclampsia. In the individual gestational time point analysis, compared with high-risk women without preeclampsia, those who developed preeclampsia exhibited higher log10 mean arterial pressure multiple of the median in all 3 trimesters, higher log10 uterine artery pulsatility index multiple of the median and lower log10 placental growth factor multiple of the median in the second and third trimesters, and higher log10 soluble fms-like tyrosine kinase-1 multiple of the median in the third trimester. CONCLUSION This study demonstrated that high-risk women who developed preeclampsia consistently exhibited high mean arterial pressure levels from the first trimester that remained unchanged during pregnancy, high uterine artery pulsatility index levels and low placental growth factor levels starting from the second trimester, and high soluble fms-like tyrosine kinase-1 levels in the third trimester compared with those who did not develop preeclampsia despite the administration of low-dose aspirin. These findings underscore the role of these biomarkers in further risk stratification for the development of preeclampsia among high-risk women following aspirin administration.
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Affiliation(s)
- Long Nguyen-Hoang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Daljit S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Angela S T Tai
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Yunyu Chen
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Qiaoli Feng
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xueqin Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Sakita Moungmaithong
- Department of Obstetrics and Gynecology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Maran B W Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ada W Tse
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Natalie K L Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Angel H Kwan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - So Ling Lau
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Nikki M W Lee
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Marc K C Chong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Zhang M, Ren X, Song D. The impact of aspirin combined with labetalol on coagulation function and pregnancy outcomes in pre-eclamptic pregnant women. BMC Pregnancy Childbirth 2025; 25:215. [PMID: 40016668 PMCID: PMC11866632 DOI: 10.1186/s12884-025-07314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 02/10/2025] [Indexed: 03/01/2025] Open
Abstract
BACKGROUND This study aimed to analyze the impact of aspirin combined with labetalol on coagulation function and pregnancy outcomes in women with pre-eclampsia. METHODS A total of 98 pregnant women with pre-eclampsia admitted to our hospital from September 2019 to March 2021 were selected for the retrospective analysis. Patient records were reviewed and divided into a control group (n = 49) who received labetalol and an observation group (n = 49) who received aspirin combined with labetalol. Extracted from the case collection system and observed: clinical efficacy, occurrence of adverse pregnancy outcomes, and adverse reactions. RESULTS The total effective rate in the observation group was higher than that in the control group. After treatment, the observation group had lower systolic blood pressure, diastolic blood pressure, D-D, Scr, β2-MG, and MA levels compared to the control group, and higher TT, PT and APTT levels. The occurrence rate of adverse pregnancy outcomes such as preterm delivery, intrauterine distress, postpartum hemorrhage, and fetal heart abnormalities was lower in the observation group than in the control group. There were no statistically significant differences in adverse reactions such as nausea, vomiting, hypotension, ocular tremor, and facial flushing between the two groups. CONCLUSION Aspirin combined with labetalol has ideal therapeutic efficacy in women with pre-eclampsia. It can enhance the antihypertensive effect, improve the coagulation status of the body, protect renal function, improve adverse pregnancy outcomes, and is considered safe and reliable, deserving adoption.
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Affiliation(s)
- Min Zhang
- The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin City, China
| | - Xiaoxuan Ren
- The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin City, China
| | - Dianrong Song
- The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin City, China.
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Aldika Akbar MI, Rosaudyn R, Gumilar KE, Shanmugalingam R, Dekker G. Secondary prevention of preeclampsia. Front Cell Dev Biol 2025; 13:1520218. [PMID: 39989985 PMCID: PMC11842342 DOI: 10.3389/fcell.2025.1520218] [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: 10/30/2024] [Accepted: 01/23/2025] [Indexed: 02/25/2025] Open
Abstract
Preventing preeclampsia (PE) is crucial for the wellbeing of the mother, fetus, and the neonate with three levels: primary, secondary, and tertiary. Secondary prevention involves pharmacological therapies aimed at stopping the disease's progression before clinical signs. The predominant approach currently employed is the daily administration of low dose Aspirin and calcium. PE is a multifaceted illness characterized by syncytiotrophoblast (STB) stress, leading to endothelial dysfunction and systemic inflammation. Various subtypes of PE, in particular early-onset PE (EOP) and late-onset PE (LOP), have different pathophysiological pathways leading to STB stress and also different perinatal outcomes. Low-dose Aspirin (LDA) has been shown to be beneficial in lowering the occurrence of EOP, especially when started before 16 weeks of pregnancy. Calcium supplementation is advantageous for women with poor dietary calcium intake, reducing endothelium activation and hypertension. Low molecular weight heparins (LMWH), have pleiotropic effects, besides their anticoagulant effects, LMWH have significant anti-inflammatory effects, and have a potential restricted use in patients with history of prior severe placental vasculopathy with or without the maternal preeclamptic syndrome. Pravastatin and other statins have shown positive results in lowering preterm PE and improving outcomes for both the mother and baby. Proton pump inhibitors (PPIs) have shown potential in lowering soluble FMS-like tyrosine kinase-1 (sFlt-1) levels and enhancing endothelial function, but clinical trials have been inconsistent. Metformin, primarily used for improving insulin sensitivity, has potential advantages in decreasing PE incidence due to its anti-inflammatory and vascular properties, particularly in morbidly obese women. Nitric oxide (NO) donors and L-arginine have been shown to effectively reduce vascular resistance and improving blood flow to placenta, potentially reducing PE risk. In conclusion, various pharmacological treatments have the potential to prevent secondary PE, but their effectiveness depends on underlying risk factors and intervention time. Further research is needed to determine the optimal (combination) of method(s) for the individual patient with her individual risk profile.
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Affiliation(s)
- Muhammad Ilham Aldika Akbar
- Department Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Roudhona Rosaudyn
- Department Obstetrics and Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Khanisyah Erza Gumilar
- Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Surabaya, Indonesia
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | | | - Gustaaf Dekker
- Department Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department Obstetrics and Gynecology, Lyell McEwin Hospital, University of Adelaide, Adelaide, SA, Australia
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Wang X, Sahota DS, Wong L, Nguyen‐Hoang L, Chen Y, Tai AST, Liu F, Lau SL, Lee APW, Poon LC. Prediction of pre-eclampsia using maternal hemodynamic parameters at 12 + 0 to 15 + 6 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2025; 65:173-182. [PMID: 39825806 PMCID: PMC11788463 DOI: 10.1002/uog.29177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 12/15/2024] [Accepted: 12/23/2024] [Indexed: 01/20/2025]
Abstract
OBJECTIVES To compare the maternal hemodynamic profile at 12 + 0 to 15 + 6 weeks' gestation in women who subsequently developed pre-eclampsia (PE) and those who did not, and to assess the screening performance of maternal hemodynamic parameters for PE in combination with the Fetal Medicine Foundation (FMF) triple test, including maternal factors (MF), mean arterial pressure (MAP), uterine artery pulsatility index and placental growth factor. METHODS This was a prospective case-control study involving Chinese women with a singleton pregnancy who underwent preterm PE screening at 11 + 0 to 13 + 6 weeks' gestation using the FMF triple test, between February 2020 and February 2023. Women identified as being at high risk (≥ 1:100) for preterm PE by the FMF triple test were matched 1:1 with women identified as low risk (< 1:100) for maternal age ± 3 years, maternal weight ± 5 kg and date of screening ± 14 days. Two-dimensional transthoracic echocardiography was performed at 12 + 0 to 15 + 6 weeks to evaluate maternal hemodynamic parameters (heart rate (HR), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR)). Maternal hemodynamic parameters were expressed as multiples of the median (MoM) values, determined by linear regression models to adjust for gestational age (GA) and MF. The distribution of log10 MoM values of maternal hemodynamic parameters in cases of PE and unaffected pregnancies, and the association between these hemodynamic parameters and GA at delivery, were assessed. The risks of preterm PE (delivery before 37 weeks) and any-onset PE (delivery at any time) were reassessed using Bayes' theorem after maternal hemodynamic parameters were added to the FMF triple test. The screening performance for preterm PE and any-onset PE was determined by the area under the receiver-operating-characteristics curve (AUC) and detection rate at a 10% fixed false-positive rate (FPR). Differences in AUC (ΔAUC) were assessed using DeLong's test. RESULTS A total of 743 cases were analyzed, of whom 39 (5.2%) subsequently developed PE, including 29 (3.9%) cases of preterm PE and 10 (1.3%) cases of term PE. Mean log10 SVR MoM was significantly higher in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log10 SV MoM and log10 CO MoM were significantly lower in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log10 HR MoM was not significantly different between the study groups. Mean log10 CO MoM and log10 SVR MoM were not significantly correlated with GA at delivery in preterm PE and any-onset PE. For the prediction of preterm PE and any-onset PE, adding CO or SVR or replacing MAP with CO and SVR in the FMF triple test achieved an identical or greater AUC compared with the FMF triple test, but ΔAUC was not significantly different. In addition, adding CO or SVR or replacing MAP by CO and SVR in the FMF triple test did not improve the detection rate for preterm PE and any-onset PE at a fixed FPR of 10%. CONCLUSIONS Women with preterm PE or any-onset PE exhibited increased SVR and decreased CO before the clinical manifestations of PE became apparent. These changes may serve as early indicators of cardiovascular maladaptation. However, assessment of maternal hemodynamics at 12 + 0 to 15 + 6 weeks does not enhance the screening performance for preterm PE and any-onset PE of these parameters. The FMF triple test remains superior to other biomarker combinations for predicting PE. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- X. Wang
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongSARChina
| | - D. S. Sahota
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongSARChina
- Shenzhen Research InstituteThe Chinese University of Hong KongHong KongSARChina
| | - L. Wong
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongSARChina
| | - L. Nguyen‐Hoang
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongSARChina
| | - Y. Chen
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongSARChina
| | - A. S. T. Tai
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongSARChina
| | - F. Liu
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongSARChina
| | - S. Ling Lau
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongSARChina
| | - A. P. W. Lee
- Department of Medicine & Therapeutics, Prince of Wales HospitalThe Chinese University of Hong KongHong KongSARChina
| | - L. C. Poon
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongSARChina
- Shenzhen Research InstituteThe Chinese University of Hong KongHong KongSARChina
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5
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Khalil A, Bellesia G, Norton ME, Jacobsson B, Haeri S, Egbert M, Malone FD, Wapner RJ, Roman A, Faro R, Madankumar R, Strong N, Silver RM, Vohra N, Hyett J, MacPherson C, Prigmore B, Ahmed E, Demko Z, Ortiz JB, Souter V, Dar P. The role of cell-free DNA biomarkers and patient data in the early prediction of preeclampsia: an artificial intelligence model. Am J Obstet Gynecol 2024; 231:554.e1-554.e18. [PMID: 38432413 DOI: 10.1016/j.ajog.2024.02.299] [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: 05/12/2023] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Accurate individualized assessment of preeclampsia risk enables the identification of patients most likely to benefit from initiation of low-dose aspirin at 12 to 16 weeks of gestation when there is evidence for its effectiveness, and enables the guidance of appropriate pregnancy care pathways and surveillance. OBJECTIVE The primary objective of this study was to evaluate the performance of artificial neural network models for the prediction of preterm preeclampsia (<37 weeks' gestation) using patient characteristics available at the first antenatal visit and data from prenatal cell-free DNA screening. Secondary outcomes were prediction of early-onset preeclampsia (<34 weeks' gestation) and term preeclampsia (≥37 weeks' gestation). METHODS This secondary analysis of a prospective, multicenter, observational prenatal cell-free DNA screening study (SMART) included singleton pregnancies with known pregnancy outcomes. Thirteen patient characteristics that are routinely collected at the first prenatal visit and 2 characteristics of cell-free DNA (total cell-free DNA and fetal fraction) were used to develop predictive models for early-onset (<34 weeks), preterm (<37 weeks), and term (≥37 weeks) preeclampsia. For the models, the "reference" classifier was a shallow logistic regression model. We also explored several feedforward (nonlinear) neural network architectures with ≥1 hidden layers, and compared their performance with the logistic regression model. We selected a simple neural network model built with 1 hidden layer and made up of 15 units. RESULTS Of the 17,520 participants included in the final analysis, 72 (0.4%) developed early-onset, 251 (1.4%) preterm, and 420 (2.4%) term preeclampsia. Median gestational age at cell-free DNA measurement was 12.6 weeks, and 2155 (12.3%) had their cell-free DNA measurement at ≥16 weeks' gestation. Preeclampsia was associated with higher total cell-free DNA (median, 362.3 vs 339.0 copies/mL cell-free DNA; P<.001) and lower fetal fraction (median, 7.5% vs 9.4%; P<.001). The expected, cross-validated area under the curve scores for early-onset, preterm, and term preeclampsia were 0.782, 0.801, and 0.712, respectively, for the logistic regression model, and 0.797, 0.800, and 0.713, respectively, for the neural network model. At a screen-positive rate of 15%, sensitivity for preterm preeclampsia was 58.4% (95% confidence interval, 0.569-0.599) for the logistic regression model and 59.3% (95% confidence interval, 0.578-0.608) for the neural network model. The contribution of both total cell-free DNA and fetal fraction to the prediction of term and preterm preeclampsia was negligible. For early-onset preeclampsia, removal of the total cell-free DNA and fetal fraction features from the neural network model was associated with a 6.9% decrease in sensitivity at a 15% screen-positive rate, from 54.9% (95% confidence interval, 52.9-56.9) to 48.0% (95% confidence interval, 45.0-51.0). CONCLUSION Routinely available patient characteristics and cell-free DNA markers can be used to predict preeclampsia with performance comparable to that of other patient characteristic models for the prediction of preterm preeclampsia. Logistic regression and neural network models showed similar performance.
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Affiliation(s)
- Asma Khalil
- Department of Obstetrics and Gynaecology, St. George's Hospital, St. George's University of London, London, United Kingdom.
| | | | - Mary E Norton
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sina Haeri
- Austin Maternal-Fetal Medicine, Austin, TX
| | | | - Fergal D Malone
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Ashley Roman
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY
| | - Revital Faro
- Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, NJ
| | - Rajeevi Madankumar
- Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Noel Strong
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Nidhi Vohra
- Department of Obstetrics and Gynecology, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Jon Hyett
- Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Western Sydney University, Sydney, Australia
| | - Cora MacPherson
- Biostatistics Center, George Washington University, Rockville, MD
| | | | | | | | | | | | - Pe'er Dar
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
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Lee CC, Chen CP, Chen CY, Wang LK, Chen YY. Clinical and sonographic risk factors for developing pre-eclampsia refractory to aspirin prophylaxis. Taiwan J Obstet Gynecol 2024; 63:874-879. [PMID: 39481995 DOI: 10.1016/j.tjog.2024.01.038] [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] [Accepted: 01/05/2024] [Indexed: 11/03/2024] Open
Abstract
OBJECTIVE Identify risk factors for development of preeclampsia refractory to aspirin prophylaxis in women at high-risk of preeclampsia. MATERIAL AND METHODS A retrospective cohort study analyzed 206 women identified as high-risk for preeclampsia through first-trimester screening and prescribed aspirin prophylaxis. We compared maternal characteristics, medical history, biochemical markers, and uterine artery Doppler indices between those with and without preeclampsia. RESULTS Women with preeclampsia had significantly higher rates of chronic hypertension (54.3% vs. 8.2%), higher first-trimester mean arterial pressure (MAP, 109.6 vs. 95.4 mmHg), and higher body mass index (BMI, 27.6 vs. 24.9) compared to controls. Second-trimester MAP and mean uterine artery pulsatility index (UtA-PI) were also significantly elevated in the preeclampsia group (103.3 mmHg and 1.39, respectively) compared to controls (89.7 mmHg and 1.05). ROC curve analysis identified an optimal second trimester UtA-PI cut-off of 1.36 for predicting preeclampsia, with sensitivity of 49% and specificity of 87.1%. When using a cut-off value of 0.77 for the second-to-first trimester UtA-PI ratio, the sensitivity and specificity were 60% and 90.6%, respectively. CONCLUSION Chronic hypertension, high first and second trimester MAP, higher BMI, and elevated second trimester UtA-PI are associated with preeclampsia despite aspirin prophylaxis. Evaluating second trimester UtA-PI or the ratio of second to first trimester UtA-PI may be a promising tool for identifying women who do not respond to aspirin.
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Affiliation(s)
- Chia-Chen Lee
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chie-Pein Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yu Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Liang-Kai Wang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yi-Yung Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
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Wang M, Zheng L, Meng Y, Ma S, Zhao D, Xu Y. Broadening horizons: intestinal microbiota as a novel biomarker and potential treatment for hypertensive disorders of pregnancy. Front Cell Infect Microbiol 2024; 14:1446580. [PMID: 39239636 PMCID: PMC11374776 DOI: 10.3389/fcimb.2024.1446580] [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: 06/10/2024] [Accepted: 07/24/2024] [Indexed: 09/07/2024] Open
Abstract
Hypertensive disorders of pregnancy (HDP) are severe complications of pregnancy with high morbidity and are a major cause of increased maternal and infant morbidity and mortality. Currently, there is a lack of effective early diagnostic indicators and safe and effective preventive strategies for HDP in clinical practice, except for monitoring maternal blood pressure levels, the degree of proteinuria, organ involvement and fetal conditions. The intestinal microbiota consists of the gut flora and intestinal environment, which is the largest microecosystem of the human body and participates in material and energy metabolism, gene expression regulation, immunity regulation, and other functions. During pregnancy, due to changes in hormone levels and altered immune function, the intestinal microecological balance is affected, triggering HDP. A dysregulated intestinal microenvironment influences the composition and distribution of the gut flora and changes the intestinal barrier, driving beneficial or harmful bacterial metabolites and inflammatory responses to participate in the development of HDP and promote its malignant development. When the gut flora is dysbiotic and affects blood pressure, supplementation with probiotics and dietary fiber can be used to intervene. In this review, the interaction between the intestinal microbiota and HDP was investigated to explore the feasibility of the gut flora as a novel biomarker of HDP and to provide a new strategy and basis for the prevention and treatment of clinical HDP.
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Affiliation(s)
- Min Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Lianwen Zheng
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Yang Meng
- Jilin Province Product Quality Supervision and Inspection Institute, Changchun, China
| | - Shuai Ma
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Donghai Zhao
- Department of Pathology, Jilin Medical College, Jilin, China
| | - Ying Xu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
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Rottenstreich A. Controversies and Clarifications Regarding the Role of Aspirin in Preeclampsia Prevention: A Focused Review. J Clin Med 2024; 13:4427. [PMID: 39124694 PMCID: PMC11312818 DOI: 10.3390/jcm13154427] [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: 06/16/2024] [Revised: 07/23/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. In recent decades, many studies have evaluated different interventions in order to prevent the occurrence of preeclampsia. Among these, administration of low-dose aspirin from early pregnancy showed consistent evidence of its prophylactic role. In this article, we review the scientific literature on this topic, highlighting the rationale for aspirin use, who should be treated, the timing of initiation and cessation of therapy, the importance of proper dosing, and its role in the prevention of other adverse outcomes.
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Affiliation(s)
- Amihai Rottenstreich
- Laboratory of Blood and Vascular Biology, Rockefeller University, New York, NY 10065, USA; ; Tel.: +1-212-327-7494; Fax: +1-212-327-7493
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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Rezende KBDC, Bornia RG, Rolnik DL, Amim J, Ladeira LP, Teixeira VM, da Cunha AJL. Performance of the first-trimester Fetal Medicine Foundation competing risks model for preeclampsia prediction: an external validation study in Brazil. AJOG GLOBAL REPORTS 2024; 4:100346. [PMID: 38694483 PMCID: PMC11061323 DOI: 10.1016/j.xagr.2024.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The current version of the Fetal Medicine Foundation competing risks model for preeclampsia prediction has not been previously validated in Brazil. OBJECTIVE This study aimed (1) to validate the Fetal Medicine Foundation combined algorithm for the prediction of preterm preeclampsia in the Brazilian population and (2) to describe the accuracy and calibration of the Fetal Medicine Foundation algorithm when considering the prophylactic use of aspirin by clinical criteria. STUDY DESIGN This was a cohort study, including consecutive singleton pregnancies undergoing preeclampsia screening at 11 to 14 weeks of gestation, examining maternal characteristics, medical history, and biophysical markers between October 2010 and December 2018 in a university hospital in Brazil. Risks were calculated using the 2018 version of the algorithm available on the Fetal Medicine Foundation website, and cases were classified as low or high risk using a cutoff of 1/100 to evaluate predictive performance. Expected and observed cases with preeclampsia according to the Fetal Medicine Foundation-estimated risk range (≥1 in 10; 1 in 11 to 1 in 50; 1 in 51 to 1 in 100; 1 in 101 to 1 in 150; and <1 in 150) were compared. After identifying high-risk pregnant women who used aspirin, the treatment effect of 62% reduction in preterm preeclampsia identified in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial was used to evaluate the predictive performance adjusted for the effect of aspirin. The number of potentially unpreventable cases in the group without aspirin use was estimated. RESULTS Among 2749 pregnancies, preterm preeclampsia occurred in 84 (3.1%). With a risk cutoff of 1/100, the screen-positive rate was 25.8%. The detection rate was 71.4%, with a false positive rate of 24.4%. The area under the curve was 0.818 (95% confidence interval, 0.773-0.863). In the risk range ≥1/10, there is an agreement between the number of expected cases and the number of observed cases, and in the other ranges, the predicted risk was lower than the observed rates. Accounting for the effect of aspirin resulted in an increase in detection rate and positive predictive values and a slight decrease in the false positive rate. With 27 cases of preterm preeclampsia in the high-risk group without aspirin use, we estimated that 16 of these cases of preterm preeclampsia would have been avoided if this group had received prophylaxis. CONCLUSION In a high-prevalence setting, the Fetal Medicine Foundation algorithm can identify women who are more likely to develop preterm preeclampsia. Not accounting for the effect of aspirin underestimates the screening performance.
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Affiliation(s)
- Karina Bilda de Castro Rezende
- Clinical Medicine Postgraduate Program, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende and da Cunha)
- Maternity School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende, Bornia, Amim, and Ladeira and XX Teixeira)
- Multidisciplinary Laboratory of Epidemiology and Health – LAMPES, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Rezende and da Cunha)
| | - Rita G. Bornia
- Maternity School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende, Bornia, Amim, and Ladeira and XX Teixeira)
- Professional Master Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Bornia and Amim)
| | - Daniel L. Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia (Drs Rolnik)
| | - Joffre Amim
- Maternity School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende, Bornia, Amim, and Ladeira and XX Teixeira)
- Professional Master Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Bornia and Amim)
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Amim, XX Teixeira, and Dr da Cunha)
| | - Luiza P. Ladeira
- Maternity School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende, Bornia, Amim, and Ladeira and XX Teixeira)
- Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Ladeira)
| | - Valentina M.G. Teixeira
- Maternity School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende, Bornia, Amim, and Ladeira and XX Teixeira)
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Amim, XX Teixeira, and Dr da Cunha)
| | - Antonio Jose L.A. da Cunha
- Clinical Medicine Postgraduate Program, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Drs Rezende and da Cunha)
- Multidisciplinary Laboratory of Epidemiology and Health – LAMPES, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Rezende and da Cunha)
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr Amim, XX Teixeira, and Dr da Cunha)
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Stubert J, Hinz B, Berger R. The Role of Acetylsalicylic Acid in the Prevention of Pre-Eclampsia, Fetal Growth Restriction, and Preterm Birth. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:617-626. [PMID: 37378599 PMCID: PMC10568740 DOI: 10.3238/arztebl.m2023.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Recent studies suggest that low-dose acetylsalicylic acid (ASA) can lower pregnancy-associated morbidity. METHODS This review is based on pertinent publications that were retrieved by a selective search in PubMed, with special attention to systematic reviews, metaanalyses, and randomized controlled trials. RESULTS Current meta-analyses document a reduction of the risk of the occurrence of pre-eclampsia (RR 0.85, NNT 50), as well as beneficial effects on the rates of preterm birth (RR 0.80, NNT 37), fetal growth restriction (RR 0.82, NNT 77), and perinatal death (RR 0.79, NNT 167). Moreover, there is evidence that ASA raises the rate of live births after a prior spontaneous abortion, while also lowering the rate of spontaneous preterm births (RR 0.89, NNT 67). The prerequisites for therapeutic success are an adequate ASA dose, early initiation of ASA, and the identification of women at risk of pregnancy-associated morbidity. Side effects of treatment with ASA in this patient group are rare and mainly involve bleeding in connection with the pregnancy (RR 0.87, NNH 200). CONCLUSION ASA use during pregnancy has benefits beyond reducing the risk of pre-eclampsia. The indications for taking ASA during pregnancy may be extended at some point in the future; at present, in view of the available evidence, it is still restricted to high-risk pregnancies.
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Affiliation(s)
- Johannes Stubert
- Department of Obstetrics and Gynecology, Klinikum Südstadt Rostock, Rostock University Hospital, Rostock, Germany
| | - Burkhard Hinz
- Department of Pharmacology and Toxicology, Rostock University Hospital, Rostock, Germany
| | - Richard Berger
- Department of Obstetrics and Gynecology, Marienhaus Klinikum St. Elisabeth Neuwied
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Johnson JM, Walsh JD, Okun NB, Metcalfe A, Pastuck ML, Maxey CM, Soliman N, Mahallati H, Kuret VH, Dwinnell SJ, Chada R, O'Quinn CP, Schacher J, Somerset DA, Paterson K, Suchet IB, Silang KA, Paul H, Nerenberg KA, Johnson DW. The Implementation of Preeclampsia Screening and Prevention (IMPRESS) Study. Am J Obstet Gynecol MFM 2023; 5:100815. [PMID: 36400421 DOI: 10.1016/j.ajogmf.2022.100815] [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: 09/05/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preeclampsia affects between 2% and 5% of pregnancies and is one of the leading causes of perinatal morbidity and mortality worldwide. Despite strong evidence that the combination of systematic preeclampsia screening based on the Fetal Medicine Foundation preeclampsia risk calculation algorithm with treatment of high-risk patients with low-dose aspirin reduces the incidence of preterm preeclampsia more than currently used risk-factor-based screening, real-world implementation studies have not yet been done in Canada. OBJECTIVE This study aimed to assess the operational feasibility of implementing first-trimester screening and prevention of preterm preeclampsia (<37 weeks) alongside a publicly funded first-trimester combined screening program for aneuploidies. STUDY DESIGN This was a prospective implementation study. Consecutive pregnant patients referred for first-trimester combined screening (11-13+6 weeks) were offered screening for preeclampsia based on the Fetal Medicine Foundation algorithm concomitantly with their aneuploidy screen. Consenting participants were screened using maternal risk factors, mean arterial pressure, uterine artery Doppler pulsatility index, pregnancy-associated plasma protein-A, and placental growth factor. Risk for preterm preeclampsia (<37 weeks) was calculated using the Fetal Medicine Foundation algorithm, and individuals with a risk score ≥1 per 100 were recommended to use aspirin (162 mg once daily at bedtime, <16-36 weeks). Implementation metrics assessed included: acceptability, operational impact, proportion of aspirin initiation, quality and safety measures, and screen performance. RESULTS Between December 1, 2020 and April 23, 2021, 1124 patients consented to preeclampsia screening (98.3% uptake), and 92 (8.2%) screened positive. Appointments for patients receiving first-trimester combined screening aneuploidy and preeclampsia screening averaged 6 minutes longer than first-trimester combined screening alone, and adding uterine artery Doppler pulsatility index averaged 2 minutes. Of the 92 patients who screened as high-risk for preeclampsia, 72 (78.3%) were successfully contacted before 16 weeks' gestation. Of these, 62 (86.1%) initiated aspirin, and 10 (13.9%) did not. Performance audit identified a consistent negative bias with mean arterial pressure measurements (median multiple of the median <1 in 10%); other variables were satisfactory. There were 7 cases of preterm preeclampsia (0.69%): 5 and 2 in the high- and low-risk groups, respectively. Screening detected 5 of 7 (71.4 %) preterm preeclampsia cases, with improved performance after adjustment for aspirin treatment effect. CONCLUSION This study confirms the operational feasibility of implementing an evidence-based preeclampsia screening and prevention program in a publicly funded Canadian setting. This will facilitate implementation into clinical service and the scaling up of this program at a regional and provincial level.
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Affiliation(s)
- J M Johnson
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset).
| | - Jennifer D Walsh
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Nanette B Okun
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada (Dr Okun)
| | - Amy Metcalfe
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Melanie L Pastuck
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Connor M Maxey
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Nancy Soliman
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Houman Mahallati
- Radiology (Drs Mahallati, Paterson, and Suchet), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Verena H Kuret
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Shannon J Dwinnell
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Rati Chada
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Candace P O'Quinn
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Jaime Schacher
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - David A Somerset
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Kimiko Paterson
- Radiology (Drs Mahallati, Paterson, and Suchet), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ian B Suchet
- Radiology (Drs Mahallati, Paterson, and Suchet), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Katherine A Silang
- Department of Psychology, University of Calgary, Calgary, Canada (Ms Silang)
| | - Heather Paul
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada (Dr Paul)
| | - Kara A Nerenberg
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada (Dr Nerenberg)
| | - David W Johnson
- Departments of Pediatrics, Emergency Medicine, and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Canada (Dr D Johnson)
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Abstract
Hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia, are a worldwide health problem. Hypertensive disorders of pregnancy affect more than 10% of pregnancies and are associated with increased mortality and morbidity for both mother and fetus. Although patients' outcomes and family's experience will always be the primary concern regarding hypertensive complications during pregnancy, the economic aspect of this disease is also worth noting. Compared with normotensive pregnancies, those related with hypertension resulted in an excess increase in hospitalization and healthcare cost. Hence, the focus of this review is to analyze hypertensive disorders of pregnancy and to present practical tips with clear instructions for the clinical management of hypertensive disorders of pregnancy. This overview offers a detailed approach from the diagnosis to treatment and follow-up of a pregnant women with hypertension, evidence based, to support these instructions.
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13
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Zhang ML, Yang Q, Zhu YD, Zhang YD, Zhang R, Liu J, Zhao XY, Dang QY, Huang DX, Zhang MY, Wei YC, Hu Z, Cai XX, Gao LF, Shan Y, Yu HL. Nobiletin Inhibits Hypoxia-Induced Placental Damage via Modulating P53 Signaling Pathway. Nutrients 2022; 14:nu14112332. [PMID: 35684132 PMCID: PMC9183106 DOI: 10.3390/nu14112332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
In this study, we aimed to evaluate the effect of Nobiletin (NOB) on the placenta of Sprague–Dawley (SD) rats that had undergone reduced uterine perfusion pressure (RUPP) surgery and to evaluate the safety of NOB intervention during pregnancy. The results showed that NOB alleviated placental hypoxia, attenuated placental cell apoptosis, and inhibited placental damage in RUPP rats. No side effect of NOB intervention during pregnancy was observed. BeWo cell lines with P53 knockdown were then constructed using lentiviral transfection, and the P53 signaling pathway was found to be essential for NOB to reduce hypoxia-induced apoptosis of the BeWo cell lines. In summary, NOB attenuated hypoxia-induced placental damage by regulating the P53 signaling pathway, and those findings may contribute some insights into the role of NOB in placental development and the prevention of placental-related diseases.
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Affiliation(s)
- Meng-Ling Zhang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
- Hunan Agricultural Product Processing Institute, Hunan Academy of Agricultural Sciences, Hunan Provincial Key Laboratory for Fruits and Vegetables Storage Processing and Quality Safety, Changsha 410082, China;
- Hunan Provincial Key Laboratory for Fruits and Vegetables Storage Processing and Quality Safety, Changsha 410082, China
- Hunan Province International Joint Lab on Fruits & Vegetables Processing, Quality and Safety, Changsha 410082, China
- Longping Branch Graduate School, Hunan University, Changsha 410082, China
| | - Qian Yang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Yan-Di Zhu
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Ya-Di Zhang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Rui Zhang
- School of Medical Humanity, Peking University, Beijing 100191, China;
| | - Jian Liu
- Hunan Agricultural Product Processing Institute, Hunan Academy of Agricultural Sciences, Hunan Provincial Key Laboratory for Fruits and Vegetables Storage Processing and Quality Safety, Changsha 410082, China;
- Hunan Provincial Key Laboratory for Fruits and Vegetables Storage Processing and Quality Safety, Changsha 410082, China
- Hunan Province International Joint Lab on Fruits & Vegetables Processing, Quality and Safety, Changsha 410082, China
- Longping Branch Graduate School, Hunan University, Changsha 410082, China
| | - Xiao-Yan Zhao
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Qin-Yu Dang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Dong-Xu Huang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Ming-Yuan Zhang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Yu-Chen Wei
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Zhuo Hu
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Xia-Xia Cai
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Li-Fang Gao
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
| | - Yang Shan
- Hunan Agricultural Product Processing Institute, Hunan Academy of Agricultural Sciences, Hunan Provincial Key Laboratory for Fruits and Vegetables Storage Processing and Quality Safety, Changsha 410082, China;
- Hunan Provincial Key Laboratory for Fruits and Vegetables Storage Processing and Quality Safety, Changsha 410082, China
- Hunan Province International Joint Lab on Fruits & Vegetables Processing, Quality and Safety, Changsha 410082, China
- Longping Branch Graduate School, Hunan University, Changsha 410082, China
- Correspondence: (Y.S.); (H.-L.Y.); Tel.: +86-731-84691289 (Y.S.); +86-10-83911652 (H.-L.Y.)
| | - Huan-Ling Yu
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; (M.-L.Z.); (Q.Y.); (Y.-D.Z.); (Y.-D.Z.); (X.-Y.Z.); (Q.-Y.D.); (D.-X.H.); (M.-Y.Z.); (Y.-C.W.); (Z.H.); (X.-X.C.); (L.-F.G.)
- Correspondence: (Y.S.); (H.-L.Y.); Tel.: +86-731-84691289 (Y.S.); +86-10-83911652 (H.-L.Y.)
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14
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Poon LC, Martinez-Portilla R. Reply. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:643-644. [PMID: 34596308 DOI: 10.1002/uog.24761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- L C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - R Martinez-Portilla
- Clinical Research Division, National Institute of Perinatology 'Isidro Espinosa de lo Reyes', Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
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15
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Giorgione V, Di Fabrizio C, Thilaganathan B. Re: ASPRE trial: risk factors for development of preterm pre-eclampsia despite aspirin prophylaxis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:642-643. [PMID: 34596307 DOI: 10.1002/uog.24760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Affiliation(s)
- V Giorgione
- Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - C Di Fabrizio
- Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - B Thilaganathan
- Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
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Martinez-Portilla RJ, Poon LC, Benitez-Quintanilla L, Sotiriadis A, Lopez M, Lip-Sosa DL, Figueras F. Incidence of pre-eclampsia and other perinatal complications among pregnant women with congenital heart disease: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:519-528. [PMID: 32770749 DOI: 10.1002/uog.22174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE It has been proposed recently that pre-eclampsia (PE) may originate from maternal cardiac maladaptation rather than primary placental insult. As congenital heart disease (CHD) is associated with reduced adaptation to the hemodynamic needs of pregnancy, it is hypothesized that women with CHD have an increased risk of PE. The aim of this systematic review was to investigate the risk of PE in pregnant women with CHD. METHODS A systematic search was performed to identify relevant studies published in English, Spanish, French, Italian, Chinese or German, with no time restrictions, using databases such as PubMed, Web of Science and SCOPUS. Randomized controlled trials and observational studies (prospective or retrospective cohorts) of pregnant women with a history of CHD were sought. The main outcome was the incidence of PE (including eclampsia and HELLP syndrome). For quality assessment of the included studies, two reviewers assessed independently the risk of bias. For the meta-analysis, the incidence of PE in pregnancies (those beyond 20 weeks' gestation) was calculated using single-proportion analysis by random-effects modeling (weighted by inverse variance). Heterogeneity between studies was assessed using the χ2 (Cochran's Q), tau2 and I2 statistics. Subgroup analysis was performed, and meta-regression was used to assess the influence of several covariates on the pooled results. RESULTS A total of 33 studies were included in the meta-analysis, including 40 449 women with CHD and a total of 40 701 pregnancies. The weighted incidence of PE was 3.1% (95% CI, 2.2-4.0%), with true-effect heterogeneity of 93% according to I2 , and no publication bias found. No difference was found in the weighted incidence of PE between studies including cyanotic CHD vs those excluding (or not reporting) cyanotic CHD (2.5% (95% CI, 1.6-3.4%) vs 4.1% (95% CI, 2.4-5.7%); P = 0.0923). Meta-regression analysis showed that the only cofactor that significantly influenced the incidence of PE in each study was the reported incidence of aortic stenosis; studies with a higher incidence of aortic stenosis had a higher incidence of PE (estimate: 0.0005; P = 0.038). CONCLUSIONS We failed to demonstrate an incidence of PE above the expected baseline risk in women with CHD. This observation contradicts the theory of the cardiac origin of PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R J Martinez-Portilla
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - L C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - L Benitez-Quintanilla
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M Lopez
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - D L Lip-Sosa
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - F Figueras
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
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