Vision for Improving Pregnancy Health: Innovation and the Future of Pregnancy Research

Identifying the timing and type of inflammatory markers for potential prediction of preeclampsia in women with obesity

BACKGROUND

Preeclampsia is a leading contributor to maternal and infant mortality, and early risk identification is a high priority. Inflammatory markers have shown potential as biomarkers for preeclampsia prediction, though optimal timing and marker selection remain unclear.

METHODS

We measured 20 inflammatory markers using the Luminex platform across all three trimesters in 37 participants who developed preeclampsia and 74 normotensive controls, matched for pre-pregnancy body mass index (>25), smoking status, and race. We examined individual markers by trimester, changes in marker levels between trimesters, and ratios of pro- to anti-inflammatory markers, adjusting analyses for maternal age, gestational age, and fetal sex.

RESULTS

First-trimester levels of proinflammatory cytokines (GM-CSF, IFN-α, IFN-γ, IL-1α, IL-1β, IL-8, IL-12p70, IL-17a, TNF-α) and anti-inflammatory cytokines (IL-4, IL-10, and IL-13) were strongly associated with preeclampsia (standardized odds ratios > 2). First-trimester pro-anti-inflammatory ratios (e.g. TNF-α:IL-10 and IFN-γ:IL-10) also correlated with preeclampsia. Changes in inflammatory markers across trimesters and interactions with fetal sex were not significant.

CONCLUSION

Our results suggest that the first trimester inflammatory markers and ratios may offer utility for preeclampsia prediction. Future research should explore these associations in diverse populations and validate their clinical utility. Early risk identification can inform interventions to prevent preeclampsia and improve perinatal outcomes.

Healthy Moms, Healthy Babies: Culinary and Lifestyle Medicine for PCOS and Preconception Health

Purpose of the Research: Women's reproductive health issues represent a major source of burden to quality of life, productivity, and health care cost, with uneven access to care. Foundational interventions based on lifestyle and food as medicine hold promise as one equitable way to improve individual and family health. In this paper, we summarize the lifestyle and culinary medicine approaches to two of the most common reproductive health diagnoses, polycystic ovary syndrome (PCOS) and infertility. Major findings: For women with PCOS and/or infertility, an overall healthy eating pattern, including a whole-food plant-based or Mediterranean diet, carries clear health benefits. Exercise is of benefit in the PCOS population, and likely so for infertility patients as well. Both diagnoses are risk factors for anxiety and/or depression, and so more attention to mental health and behavioral strategies is needed. Given these findings, the notion of lifestyle interventions holds promise, but studies are overall mixed. Conclusions: PCOS and infertility can respond well to lifestyle and culinary interventions. These approaches, currently underutilized, can be implemented widely with minimal cost, and can also improve obstetric, neonatal, and child health outcomes via epigenetic phenomena. More research is needed to elucidate the best target populations and delivery methods for such interventions.

Clinical decisions in fetal-neonatal neurology I. reproductive and pregnancy health influence the neural exposome over multiple generations

Interdisciplinary fetal neonatal neurology (FNN) training requires integration of reproductive health factors into evaluations of the maternal-placental-fetal (MPF) triad, neonate, and child over the first 1000 days. Serial events that occur before one or multiple pregnancies impact successive generations. A maternal-child dyad history highlights this continuity of health risk, beginning with a maternal grandmother's pregnancy. Her daughter was born preterm and later experienced polycystic ovarian syndrome further complicated by cognitive and mental health disorders. Medical problems during her pregnancy contributed to MPF triad diseases that resulted in her son's extreme prematurity. Postpartum maternal death from the complications of diabetic ketoacidosis and her child's severe global neurodevelopmental delay were adverse mother-child outcomes. A horizontal/vertical diagnostic approach to reach shared clinical decisions during FNN training requires perspectives of a dynamic neural exposome. Career-long learning is then strengthened by continued interactions from al stakeholders. Developmental origins theory applied to neuroplasticity principles help interpret phenotypic expressions as dynamic gene-environment interactions across a person's lifetime. Debiasing strategies applied to the cognitive process reduce bias to preserve therapeutic and prognostic accuracy. Social determinants of health are essential components of this strategy to be initiated during FNN training. Reduction of the global burden of neurologic disorders requires applying the positive effects from reproductive and pregnancy exposomes that will benefit the neural exposome across the lifespan.

Interdisciplinary fetal-neonatal neurology training applies neural exposome perspectives to neurology principles and practice

An interdisciplinary fetal-neonatal neurology (FNN) program over the first 1,000 days teaches perspectives of the neural exposome that are applicable across the life span. This curriculum strengthens neonatal neurocritical care, pediatric, and adult neurology training objectives. Teaching at maternal-pediatric hospital centers optimally merges reproductive, pregnancy, and pediatric approaches to healthcare. Phenotype-genotype expressions of health or disease pathways represent a dynamic neural exposome over developmental time. The science of uncertainty applied to FNN training re-enforces the importance of shared clinical decisions that minimize bias and reduce cognitive errors. Trainees select mentoring committee participants that will maximize their learning experiences. Standardized questions and oral presentations monitor educational progress. Master or doctoral defense preparation and competitive research funding can be goals for specific individuals. FNN principles applied to practice offer an understanding of gene-environment interactions that recognizes the effects of reproductive health on the maternal-placental-fetal triad, neonate, child, and adult. Pre-conception and prenatal adversities potentially diminish life-course brain health. Endogenous and exogenous toxic stressor interplay (TSI) alters the neural exposome through maladaptive developmental neuroplasticity. Developmental disorders and epilepsy are primarily expressed during the first 1,000 days. Communicable and noncommunicable illnesses continue to interact with the neural exposome to express diverse neurologic disorders across the lifespan, particularly during the critical/sensitive time periods of adolescence and reproductive senescence. Anomalous or destructive fetal neuropathologic lesions change clinical expressions across this developmental-aging continuum. An integrated understanding of reproductive, pregnancy, placental, neonatal, childhood, and adult exposome effects offers a life-course perspective of the neural exposome. Exosome research promises improved disease monitoring and drug delivery starting during pregnancy. Developmental origins of health and disease principles applied to FNN practice anticipate neurologic diagnoses with interventions that can benefit successive generations. Addressing health care disparities in the Global South and high-income country medical deserts require constructive dialogue among stakeholders to achieve medical equity. Population health policies require a brain capital strategy that reduces the global burden of neurologic diseases by applying FNN principles and practice. This integrative neurologic care approach will prolong survival with an improved quality of life for persons across the lifespan confronted with neurological disorders.

Inflammatory markers are elevated in early pregnancy, but not late pregnancy, in women with overweight and obesity that later develop preeclampsia

PROBLEM

Obesity and preeclampsia both involve a pathological inflammatory response, which may be how obesity increases preeclampsia risk. Previous studies have failed to assess robust measurements of inflammatory markers across gestation, specifically in overweight/ obese women in the context of preeclampsia.

METHOD OF STUDY

We measured 20 inflammatory markers in plasma via multiplex assay (ThermoFisher Inflammation 20 plex Human ProcartaPlex Panel) across the three trimesters of pregnancy in an existing cohort of overweight and obese women who developed preeclampsia (n = 37) and without preeclampsia (n = 74). Mann-Whitney U tests examined differences in inflammatory marker concentrations between cases and controls. Repeated measures ANOVA tests were used to explore differences in inflammatory marker concentrations over time within cases and controls.

RESULTS

Pro-inflammatory markers (IL-1α, IL-1β, IL-6, IFN-α, IFN-γ, GM-CSF, IL-12p70, IL-17α, TNF-α, IL-8) and anti-inflammatory markers (IL-4, IL-10, IL-13) were higher in the first and second trimester in participants who later developed preeclampsia compared to those who did not (p < .05). Only TNF-α and IL-8 remained elevated in the third trimester. Inflammatory markers did not change across pregnancy in preeclampsia cases but did increase across pregnancy in controls.

CONCLUSION

Our findings diverge from prior studies, predominantly of non-obese women, that report lower circulating concentrations of anti-inflammatory cytokines in preeclampsia versus normotensive pregnancy, particularly by late pregnancy. We posit that women with overweight and obesity who develop preeclampsia entered pregnancy with a heightened pro-inflammatory state likely related to obesity, which increased risk for preeclampsia. Further studies are needed to investigate if inflammatory maker profiles differ between obese and non-obese women.