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Wu C, Ling Z, Wang Y, Lv Y, Miao Z, Liu L, Ji X. Clinical Analysis of Risk Factors and Perinatal Outcomes in Recurrent Pre-Eclampsia with Severe Features. Reprod Sci 2024:10.1007/s43032-024-01529-4. [PMID: 38575810 DOI: 10.1007/s43032-024-01529-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
To analyze the differences in risk factors and pregnancy outcomes between recurrent and initial pre-eclampsia(PE) with severe features. Data from recurrent (n = 128) and initial (n = 904) PE with severe features who terminated their pregnancy or gave birth at 20 weeks of gestation or later at the tertiary teaching hospital (Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital) from January 2016 to December 2022 were collected. Risk factors for recurrent PE with severe features and differences in pregnancy outcomes between the two groups were assessed using the chi-square test, student t-test, or nonparametric test. Independent risk factors for recurrent PE with severe features were further analyzed by logistic regression. (1) Logistic regression analysis identified 3 independent risk factors for recurrent PE with severe features: history of cesarean section, rural residence and chronic hypertension. In addition, assisted reproductive technology (ART) is an independent risk factor for initial PE with severe features; (2) The incidence of oligohydramnios, chorioamnionitis, preterm birth, stillbirth, fetal growth restriction (FGR) and abnormal umbilical blood flow was higher in the recurrent PE with severe features group than in the initial PE with severe features group(P < 0.05). In contrast, the incidence of premature rupture of membrane (PROM) and postpartum hemorrhage (PPH) was higher in the group of initial PE with severe features(P < 0.05); (3) In the recurrent PE with severe features group, gestational age(GA) of birth and birth weight were lower than those in the initial PE with severe features group(P < 0.05). Also, the incidence of mild asphyxia, the rate of neonatal intensive care unit (NICU) hospitalization, length of stay in NICU, and the rate of abandoning treatment in the recurrent PE with severe features group were higher than those in the initial PE with severe features group(P < 0.05). 3 independent risk factors was identified for recurrent PE with severe features: history of cesarean section, rural residence and chronic hypertension. Women with recurrent PE with severe features are more likely to have adverse perinatal outcomes than those with initial PE with severe features.
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Affiliation(s)
- Chengqian Wu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Zhonghui Ling
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Yixiao Wang
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Yan Lv
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Zhijing Miao
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Lan Liu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China.
| | - Xiaohong Ji
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China.
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Malik N, Jain S, Ranjan R, Maurya D, Madan N, Singh UK, Malik V, Choudhary S, Singhal A, Tyagi N. Cerebroplacental Ratio as a Predictor of Perinatal Outcome in Hypertensive Disorders of Pregnancy and Its Comparison With Its Constituent Doppler Indices. Cureus 2023; 15:e49951. [PMID: 38179359 PMCID: PMC10765206 DOI: 10.7759/cureus.49951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Objective Doppler velocimetry is an established method of antepartum fetal surveillance in pre-eclampsia. Cerebroplacental ratio detects the centralization of fetal blood flow and the insufficiency in placental circulation. It is postulated to be a better marker of perinatal outcome than either vessel Doppler alone. The current study aims to assess the cerebroplacental ratio as a predictor of adverse perinatal outcomes and compare it to the systolic/diastolic (S/D) ratio of umbilical artery (UA) and middle cerebral artery (MCA) in hypertensive disorders of pregnancy. Material and methods The present prospective observational cohort study included 100 patients with hypertensive disorders of pregnancies between 32 and 37 weeks. Ultrasound with Doppler was done and the following parameters were assessed: fetal biometry, amniotic fluid index, umbilical artery pulsatility index, middle cerebral artery pulsatility index, S/D ratio of umbilical artery, S/D ratio of middle cerebral artery, and cerebroplacental ratio. Sensitivity, specificity, positive and negative predictive values were calculated for the cerebroplacental ratio and S/D ratios of umbilical and middle cerebral arteries. McNemar's test was used for the comparison of sensitivity and specificity. Results Thirty-two patients had an abnormal cerebroplacental ratio. Adverse perinatal outcomes such as a cesarean section for fetal distress, small for gestational age, APGAR < 7 at 1 and 5 minutes, NICU admission, and perinatal mortality were more in the group with abnormal cerebraplacental ratio and the difference was statistically significant. Conclusion The cerebroplacental ratio is a more reliable predictor of adverse perinatal outcomes and should be routinely calculated during obstetrical Doppler for antepartum fetal surveillance in case of hypertensive disorders of pregnancy.
It suggested that the cerebroplacental ratio may be calibrated in the software of
the Doppler ultrasonography machine for routine use in high-risk pregnancies.
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Affiliation(s)
- Neeru Malik
- Obstetrics and Gynecology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Sandhya Jain
- Obstetrics and Gynecology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Rajiv Ranjan
- Radiology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Divya Maurya
- Obstetrics and Gynecology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Nikita Madan
- Obstetrics and Gynecology, Employees' State Insurance Corporation (ESIC) Hospital & Post-Graduate Institute of Medical Science & Research (PGIMSR), Delhi, IND
| | - Uday K Singh
- Radiology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Vinayak Malik
- Computer Science, University of Wisconsin, Madison, USA
| | - Sanjay Choudhary
- Pediatrics and Neonatology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Anupa Singhal
- Obstetrics and Gynecology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Natasha Tyagi
- Obstetrics and Gynecology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
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Mao Y, Gao Q, Zhang Y, Yue Y, Ruan T, Yang Y, Xiong T. Associations between extreme temperature exposure and hypertensive disorders in pregnancy: a systematic review and meta-analysis. Hypertens Pregnancy 2023; 42:2288586. [PMID: 38053322 DOI: 10.1080/10641955.2023.2288586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Hypertensive disorders in pregnancy (HDP) are a major cause of maternal mortality and morbidity. Recent studies indicated that pregnant women are the most vulnerable populations to ambient temperature influences, but it affected HDP with inconsistent conclusions. Our objective is to systematically review whether extreme temperature exposure is associated with a changed risk for HDP. METHOD We searched PubMed, EMBASE, Web of Science and Cochrane Library databases. We included cohort or case control studies examining the association between extreme temperature exposure before or during pregnancy and HDP. Heat sources such as saunas and hot baths were excluded. We pooled the odds ratio (OR) to assess the association between extreme temperature exposure and preeclampsia or eclampsia. RESULTS Fifteen studies involving 4,481,888 patients were included. Five studies were included in the meta-analysis. The overall result demonstrated that in the first half of pregnancy, heat exposure increases the risk of developing preeclampsia or eclampsia and gestational hypertension, and cold exposure decreases the risk. The meta-analysis revealed that during the first half of pregnancy, heat exposure increased the risk of preeclampsia or eclampsia (OR 1.54, 95% confidence interval (CI): 1.10, 2.15), whereas cold exposure decreased the risk (OR 0.90, 95% CI: 0.84, 0.97). CONCLUSION The ambient temperature is an important determinant for the development of HDP, especially for preeclampsia or eclampsia. The effects of extreme temperatures may be bidirectional during the different trimesters of pregnancy, which should be evaluated by future studies. This review provided hints of temperature regulation in HDP administration.
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Affiliation(s)
- Yanxia Mao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Qian Gao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Ying Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Yan Yue
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Tiechao Ruan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Yi Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
- Department of Pediatric otolaryngology head and neck surgery, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Tao Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
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Chen Y, Huang X, Wu S, Guo P, Huang J, Zhou L, Tan X. Machine-learning predictive model of pregnancy-induced hypertension in the first trimester. Hypertens Res 2023; 46:2135-2144. [PMID: 37160966 DOI: 10.1038/s41440-023-01298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/17/2023] [Accepted: 03/17/2023] [Indexed: 05/11/2023]
Abstract
In the first trimester of pregnancy, accurately predicting the occurrence of pregnancy-induced hypertension (PIH) is important for both identifying high-risk women and adopting early intervention. In this study, we used four machine-learning models (LASSO logistic regression, random forest, backpropagation neural network, and support vector machines) to predict the occurrence of PIH in a prospective cohort. Candidate features for predicting the occurrence of middle and late PIH were acquired using a LASSO algorithm. The performance of predictive models was assessed using receiver operating characteristic analysis. Finally, a nomogram was established with the model scores, age, and nulliparity. Calibration, clinical usefulness, and internal validation were used to assess the performance of the nomogram. In the training set (2258 pregnant women), eleven candidate factors in the first trimester were significantly associated with the occurrence of PIH (P < 0.001 in the training set). Four models showed AUCs from 0.780 to 0.816 in the training set. For the validation set (939 pregnant women), AUCs varied from 0.516 to 0.795. The nomogram showed good discrimination, with an AUC of 0.847 (95% CI: 0.805-0.889) in the training set and 0.753 (95% CI: 0.653-0.853) in the validation set. Decision curve analysis suggested that the model was clinically useful. The model developed using LASSO logistic regression achieved the best performance in predicting the occurrence of PIH. The derived nomogram, which incorporates the model score and maternal risk factors, can be used to predict PIH in clinical practice. We develop a model with good performance for clinical prediction of PIH in the first trimester.
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Affiliation(s)
- Yequn Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Xiru Huang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
- Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Shiwan Wu
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Pi Guo
- Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Ju Huang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Li Zhou
- Cancer Hospital Of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Xuerui Tan
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China.
- Shantou University Medical College, Shantou, Guangdong, 515041, China.
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Freire VAF, Melo AD, Santos HL, Barros-Pinheiro M. Evaluation of oxidative stress markers in subtypes of preeclampsia: A systematic review and meta-analysis. Placenta 2023; 132:55-67. [PMID: 36669343 DOI: 10.1016/j.placenta.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
Studies about oxidative stress biomarkers revealed different phenotypes between early and late preeclampsia (PE). Despite that, there is extensive evidence of oxidative stress in investigations that combinate forms different of preeclampsia. This study reviews the oxidative stress profile in the PE subtypes and evaluates which markers are altered in the blood and placental tissue. A search was conducted in databases such as MEDLINE, EMBASE, LILACS, and Web of Science without restricting the year and language of publication. The quality of the studies was evaluated by the Newcastle-Ottawa scale and Joanna Briggs Institute for analytical Cross-Sectional Studies. After 13,319 screened records, 65 were included in the systematic review. The markers of stress oxidative of damage and reactive species were those selected, such as malondialdehyde (MDA), lipid peroxide, advanced protein oxidation products, carbonyl protein, 8-hydroxy-2'-deoxyguanosine, total oxidant status, hydrogen peroxide, nitric oxide (NO). We described the antioxidant activity, including the superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione-S-transferase, free glutathione, and total antioxidant capacity (TAC). We results demonstrated that oxidative stress is related to pathophysiology of PE, there were increased lipid peroxidation in the blood and placenta, and in blood a reduction of NO levels and of TAC, like lower enzymatic activity of GPx, CAT in PE, and SOD in mild PE. In addition, altered levels of MDA in the placenta and blood show that placental changes have repercussions on the clinical syndrome and are related to the severity of the disease.
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Chen L, Yan J, Zhang H, Xu J, Chen X. CircSTAM inhibits migration and invasion of trophoblast cells by regulating miR-148a-5p/PTEN axis. J Assist Reprod Genet 2023; 40:201-210. [PMID: 36471201 PMCID: PMC9840740 DOI: 10.1007/s10815-022-02660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The mechanisms underlying the pathogenesis of preeclampsia (PE) remains unclear. Exploring the molecular players in PE progression can provide insights into targeted therapy. METHODS The expression levels of circSTAM in placental chorionic tissues of PE patients and normal pregnant women were compared by RT-qPCR. CircSTAM was knocked down by small interfering RNA to investigate its role in migration, invasion and epithelial-mesenchymal transformation (EMT) of trophoblast HTR-8/SVneo cells. The downstream target of circSTAM was predicted using online bioinformatics resources, and their molecular interaction was examined by luciferase reporter assay. RESULTS CircSTAM was upregulated in PE placenta tissues in comparison to normal placental tissues. CircSTAM knockdown significantly enhanced cellular invasion, migration, as well as EMT. Mir-148a-5p was identified as a target of circSTAM to regulate cell migration and invasion. Mir-148a-5p negatively regulated PTEN expression in trophoblast HTR-8 /SVneo cells. CONCLUSION In summary, circSTAM upregulation in PE trophoblasts promoted the invasion, migration and EMT. CircSTAM may modulate trophoblast phenotype by impinging on mir-148a-5p/PTEN axis. These data provided novel insights into the pathogenesis of PE.
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Affiliation(s)
- Lingfeng Chen
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, No. 333, Chuan'an South Road, Chengxi Street, Wenling City, 317500, Zhejiang Province, China
| | - Jinyu Yan
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, No. 333, Chuan'an South Road, Chengxi Street, Wenling City, 317500, Zhejiang Province, China
| | - Haiyan Zhang
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, No. 333, Chuan'an South Road, Chengxi Street, Wenling City, 317500, Zhejiang Province, China
| | - Jia Xu
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, No. 333, Chuan'an South Road, Chengxi Street, Wenling City, 317500, Zhejiang Province, China
| | - Xiaopei Chen
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, No. 333, Chuan'an South Road, Chengxi Street, Wenling City, 317500, Zhejiang Province, China.
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Holmquist E, Brantsæter AL, Meltzer HM, Jacobsson B, Barman M, Sengpiel V. Maternal selenium intake and selenium status during pregnancy in relation to preeclampsia and pregnancy-induced hypertension in a large Norwegian Pregnancy Cohort Study. Sci Total Environ 2021; 798:149271. [PMID: 34333435 DOI: 10.1016/j.scitotenv.2021.149271] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Pregnancy-induced hypertensive disorders (PIHD), including preeclampsia, cause maternal and perinatal morbidity and mortality worldwide. Several studies have linked selenium supplementation and selenium status to the risk of preeclampsia, but there are no published prospective population-based studies examining associations between dietary selenium intake and preeclampsia. AIM To examine associations between selenium intake from diet and supplements and selenium blood status and PIHD incidence, with sub-analyses for pregnancy-induced hypertension (PIH) and preeclampsia, in a large pregnancy cohort. METHOD The study is based on 69,972 singleton pregnancies from the Norwegian Mother, Father and Child Cohort Study. Maternal dietary selenium intake was assessed with a validated, semi-quantitative food frequency questionnaire at about gestational week 22. Maternal selenium concentrations were measured in whole blood collected around gestational week 18 in a subset of 2572 women. Preeclampsia and PIH diagnosges were obtained from the Medical Birth Registry of Norway. RESULTS Participants had a median dietary selenium intake of 53 μg/day (IQR 44-62). Dietary selenium intake was not significantly associated with PIHD (adjusted (a) OR 1.03, 95% CI 0.98, 1.08 per SD of selenium intake), preeclampsia or PIH. Threshold analyses for deciles of dietary selenium intake did not show any significant associations. Neither inorganic (aOR 1.01, 95% CI 0.98, 1.05) or organic selenium supplement intake (aOR 0.98, 95% CI 0.95, 1.02) or selenium blood status was significantly associated with PIHD (aOR 1.03, 95% CI 0.86, 1.22) or PIHD subgroups. CONCLUSION No significant associations were found between reported selenium intake from diet, or dietary supplements or whole-blood selenium status and PIHD in general or preeclampsia specifically. Hence, the results of this large population-based study, with selenium intake close to the recommended daily intake, do not support previous findings indicating a possible protective effect of selenium supplementation or selenium status with regard to preeclampsia incidence.
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Affiliation(s)
- Ebba Holmquist
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynaecology, Gothenburg, Sweden
| | - Anne Lise Brantsæter
- Division of Infection Control, Environment and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control, Environment and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Bo Jacobsson
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynaecology, Gothenburg, Sweden; Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway; Department of Obstetrics and Gynaecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Malin Barman
- Department of Biology and Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Verena Sengpiel
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynaecology, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
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Panyarath P, Goldscher N, Pamidi S, Daskalopoulou SS, Gagnon R, Dayan N, Raiche K, Olha A, Benedetti A, Kimoff RJ. Effect of Maternal Obstructive Sleep Apnea-Hypopnea on 24-Hour Blood Pressure, Nocturnal Blood Pressure Dipping and Arterial Stiffness in Hypertensive Disorders of Pregnancy. Front Physiol 2021; 12:747106. [PMID: 34733178 PMCID: PMC8558510 DOI: 10.3389/fphys.2021.747106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022] Open
Abstract
Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). Attenuation of the normal nocturnal blood pressure (BP) decline (non-dipping) is associated with adverse pregnancy outcomes. OSAH is associated with nocturnal non-dipping in the general population, but this has not been studied in pregnancy. We therefore analyzed baseline data from an ongoing RCT (NCT03309826) assessing the impact of OSAH treatment on HDP outcomes, to evaluate the relationship of OSAH to 24-h BP profile, in particular nocturnal BP dipping, and measures of arterial stiffness. Methods: Women with a singleton pregnancy and HDP underwent level II polysomnography. Patients with OSAH (apnea-hypopnea index (AHI) ≥ 5 events/h) then underwent 24-h ambulatory BP monitoring and arterial stiffness measurements (applanation tonometry, SphygmoCor). Positive dipping was defined as nocturnal systolic blood pressure (SBP) dip ≥ 10%. The relationships between measures of OSAH severity, measures of BP and arterial stiffness were evaluated using linear regression analyses. Results: We studied 51 HDP participants (36.5 ± 4.9 years, BMI 36.9 ± 8.6 kg/m2) with OSAH with mean AHI 27.7 ± 26.4 events/h at 25.0 ± 4.9 weeks’ gestation. We found no significant relationships between AHI or other OSA severity measures and mean 24-h BP values, although BP was generally well-controlled. Most women were SBP non-dippers (78.4%). AHI showed a significant inverse correlation with % SBP dipping following adjustment for age, BMI, parity, gestational age, and BP medications (β = −0.11, p = 0.02). Significant inverse correlations were also observed between AHI and DBP (β = −0.16, p = 0.01) and MAP (β = −0.13, p = 0.02) % dipping. Oxygen desaturation index and sleep time below SaO2 90% were also inversely correlated with % dipping. Moreover, a significant positive correlation was observed between carotid-femoral pulse wave velocity (cfPWV) and REM AHI (β = 0.02, p = 0.04) in unadjusted but not adjusted analysis. Conclusion: Blood pressure non-dipping was observed in a majority of women with HDP and OSAH. There were significant inverse relationships between OSAH severity measures and nocturnal % dipping. Increased arterial stiffness was associated with increasing severity of OSAH during REM sleep in unadjusted although not adjusted analysis. These findings suggest that OSAH may represent a therapeutic target to improve BP profile and vascular risk in HDP.
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Affiliation(s)
- Pattaraporn Panyarath
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada.,Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Noa Goldscher
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Sushmita Pamidi
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada.,Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada
| | - Stella S Daskalopoulou
- Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada.,Division of Internal Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Robert Gagnon
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Natalie Dayan
- Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada.,Division of Internal Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Kathleen Raiche
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Allen Olha
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Andrea Benedetti
- Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology and Biostatistics, McGill University Health Centre, Montreal, QC, Canada
| | - R John Kimoff
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada.,Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada
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9
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Desplanches T, Morgan AS, Jones P, Diguisto C, Zeitlin J, Martin-Marchand L, Benhammou V, Lecomte B, Rozé JC, Truffert P, Ancel PY, Sagot P, Roussot A, Fresson J, Blondel B. Risk factors for very preterm delivery out of a level III maternity unit: The EPIPAGE-2 cohort study. Paediatr Perinat Epidemiol 2021; 35:694-705. [PMID: 33956996 DOI: 10.1111/ppe.12770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Regionalisation programmes aim to ensure that very preterm infants are born in level III units (inborn) through antenatal referral or transfer. Despite widespread knowledge about better survival without disability for inborn babies, 10%-30% of women deliver outside these units (outborn). OBJECTIVE To investigate risk factors associated with outborn deliveries and to estimate the proportion that were probably or possibly avoidable. METHODS We used a national French population-based cohort including 2205 women who delivered between 24 and 30+6 weeks in 2011. We examined risk factors for outborn delivery related to medical complications, antenatal care, sociodemographic characteristics and living far from a level III unit using multivariable binomial regression. Avoidable outborn deliveries were defined by pregnancy risk (obstetric history, antenatal hospitalisation) and time available for transfer. RESULTS 25.0% of women were initially booked in level III, 9.1% were referred, 49.8% were transferred, and 16.1% had outborn delivery. Risk factors for outborn delivery were gestational age <26 weeks (adjusted relative risk (aRR) 1.37, 95% confidence interval (CI) 1.13, 1.66), inadequate antenatal care (aRR 1.39, 95% CI 1.10, 1.81), placental abruption (aRR 1.66, 95% CI 1.27, 2.17), and increased distance to the closest level III unit ((aRR 2.79, 95% CI 2.00, 3.92) in the 4th versus 1st distance quartile). Among outborn deliveries, 16.7% were probably avoidable, and 25.6% possibly avoidable, which could increase the proportion of inborn deliveries between 85.9% and 92.9%. Avoidable outborn deliveries were mainly associated with gestational age, intrauterine growth restriction, preterm premature rupture of membranes, and haemorrhage, but not distance. CONCLUSIONS Our study identified some modifiable risk factors for outborn delivery; however, when regionalised care relies heavily on antenatal transfer, as it does in France, only some outborn deliveries may be prevented. Earlier referral of high-risk women will be needed to achieve full access to tertiary care.
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Affiliation(s)
- Thomas Desplanches
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,CHRU Dijon, Department of Gynaecology, Obstetrics, Foetal Medicine and Infertility, Dijon, France
| | - Andrei S Morgan
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, UCL, London, UK.,Embrace Yorkshire and Humber Infant and Paediatric Transport Service, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Peter Jones
- SAMU de Paris, AP-HP, Hôpital Necker Enfants Malades, Paris, France.,Réanimation Pédiatrique AP-HP, Hôpital Robert Debré, Paris, France
| | - Caroline Diguisto
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Obstetrics and Gynecology, University Hospital of Tours, Tours University, Tours, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | - Laetitia Martin-Marchand
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | - Valérie Benhammou
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | | | - Jean-Christophe Rozé
- Pediatric Intensive Care Unit, Mothers' and Children's Hospital, Nantes Teaching Hospital, Nantes, France
| | - Patrick Truffert
- Neonatal Intensive Care Unit, Jeanne de Flandre Hospital, CHRU Lille, Lille, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, CHU Cochin Broca Hôtel-Dieu, Paris, France
| | - Paul Sagot
- CHRU Dijon, Department of Gynaecology, Obstetrics, Foetal Medicine and Infertility, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France
| | - Jeanne Fresson
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Medical Information, University Hospital (CHRU) Nancy, Nancy, France
| | - Béatrice Blondel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
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10
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Dong X, Han M, Zeb S, Tong M, Li X, Chen Q. Active Management Reduces the Incidence of Recurrent Pre-eclampsia and Improves Maternal and Fetal Outcomes in Women With Recurrent Pre-eclampsia. Front Med (Lausanne) 2021; 8:658022. [PMID: 33996861 PMCID: PMC8116559 DOI: 10.3389/fmed.2021.658022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Women with previous pre-eclampsia are at an increased risk of developing recurrent pre-eclampsia. Intervention with low dose aspirin had been recommended to reduce the incidence of recurrent pre-eclampsia. However, the association between interventions and maternal and neonatal outcomes in subsequent pregnancies in women with previous pre-eclampsia has not been fully studied. Methods: In this prospective study, a total of 41 patients with previous pre-eclampsia received low dose aspirin and active management (including psychological and physiological intervention), between 10 to 28 weeks until 32 to 34 weeks in our regional referral hospital. The recurrence of pre-eclampsia, and maternal and neonatal outcomes in this pregnancy were analyzed and compared to our previous study which reported a 60% recurrence of pre-eclampsia in our regional referral hospital. Results: Thirteen women with previous pre-eclampsia developed recurrent pre-eclampsia. The time of onset or severity of pre-eclampsia in the previous pregnancy was not associated with the incidence of recurrent pre-eclampsia. The time of onset of previous pre-eclampsia was also not associated with the time of onset in subsequent pre-eclampsia. However, the number of severe recurrent pre-eclampsia was significantly reduced, compared to their first pregnancies. The number of SGA and stillbirth/neonatal death was also significantly reduced in recurrent pre-eclampsia that was actively managed, compared to their first pregnancies. Conclusion: Despite the small sample size included in this study, our study demonstrates that active obstetric management reduces the incidence of recurrent pre-eclampsia, compared to our previous study, and reduces the severity of recurrent pre-eclampsia. It also improves neonatal outcomes in recurrent pre-eclampsia. However, because of no controls in this study, our findings need to confirmed by a case-control or randomized clinical trial study.
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Affiliation(s)
- Xin Dong
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Min Han
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shahn Zeb
- School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Mancy Tong
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT, United States
| | - Xuelan Li
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Chen
- Department of Obstetrics & Gynecology, The University of Auckland, Auckland, New Zealand
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11
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Choi HK, Kim HO. [Effect of Lifestyle Intervention Program for Overweight and Obesity Pregnant Women]. J Korean Acad Nurs 2021; 50:459-473. [PMID: 32632078 DOI: 10.4040/jkan.19228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was conducted to identify the effects of a lifestyle intervention program on weight gain, dietary habits, fatigue and pregnancy stress, blood pressure, and neonatal birth weight, using Cox's interaction model of client health behavior for overweight and obese women. METHODS This was a quasi-experimental research with a non-equivalent control group pre-post test design. A total of 52 patients who met the selection criteria, including 25 in the experimental group and 27 in the control group, were the subjects of the study; they comprised overweight and obese pregnant women who were receiving prenatal care at A and B women's hospital in J province. The lifestyle intervention program ran for 12 weeks in total and consisted of interactions involving affective support, health information, and professional/technical competencies. The data collection period was from February 1, 2017 to August 31, 2017. RESULTS This study showed differences in the appropriate weight gain rate (χ²=6.17, p=.013), suppression of an increase in fatigue (t=-2.32, p=.012), and an increase in pregnancy stress (t=-1.87, p=.034). Yet, no differences in physical activity, dietary habits change, blood pressure, and neonatal birth weight (p>.05) were found. CONCLUSION The study findings indicate that this program could be an effective intervention for the control of appropriate weight gain, fatigue, and pregnancy stress. Therefore, a lifestyle intervention program based on Cox's interaction model of client health behavior could be an efficient strategy for a positive health outcome of overweight and obesity pregnant women.
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Affiliation(s)
- Hye Kyung Choi
- College of Nursing, Jeonbuk National University, Jeonju, Korea
| | - Hyeon Ok Kim
- College of Nursing · Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.
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12
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Liu L, Li H, Wang N, Song X, Zhao K, Zhang C. Assessment of plasma cell-free DNA and ST2 as parameters in gestational hypertension and preeclampsia. Hypertens Res 2021; 44:996-1001. [PMID: 33864012 DOI: 10.1038/s41440-021-00650-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/14/2021] [Accepted: 02/14/2021] [Indexed: 11/09/2022]
Abstract
The objective of this study was to evaluate the differences and predictive efficacy of circulating cell-free DNA (cfDNA) and human suppression of tumorigenesis 2 (ST2) among women with uncomplicated pregnancies and patients with gestational hypertension (GH) or preeclampsia (PE). This study included patients with GH (n = 41), patients with PE (n = 62), and women with uncomplicated pregnancies (n = 148). The cfDNA concentration was determined by qPCR, and the ST2 levels were measured by ELISA. A receiver operating characteristic curve was employed to measure the diagnostic performance of cfDNA and ST2. Our results showed that ST2 but not cfDNA was increased in the middle and third trimesters of normal pregnancy; ST2 and cfDNA were increased in GH and PE patients compared to women with uncomplicated pregnancies. More importantly, plasma cfDNA and ST2 served as diagnostic biomarkers for GH and PE, and the AUCs were 0.883 and 0.734 for GH and 0.838 and 0.816 for PE, respectively. Moreover, their combination significantly elevated the diagnostic efficiency for GH and PE, with AUCs of 0.906 and 0.916, respectively. Plasma cfDNA and ST2 could be used as parameters for GH and PE.
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Affiliation(s)
- Lisheng Liu
- Key Laboratory of Animal Resistance Research, College of Life Science, Shandong Normal University, Ji'nan, Shandong, China.,Department of Clinical Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji'nan, Shandong, China
| | - Hua Li
- Department of Gynecology and Obstetrics, Ji'nan Maternity and Child Care Hospital, Ji'nan, Shandong, China
| | - Ning Wang
- Department of Clinical Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji'nan, Shandong, China
| | - Xingguo Song
- Department of Clinical Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji'nan, Shandong, China
| | - Ke Zhao
- Department of Clinical Laboratory, Ji'nan Maternity and Child Care Hospital, Ji'nan, Shandong, China
| | - Cong Zhang
- Key Laboratory of Animal Resistance Research, College of Life Science, Shandong Normal University, Ji'nan, Shandong, China. .,Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China.
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13
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Li Z, Zhou X, Gao W, Sun M, Chen H, Meng T. Circular RNA VRK1 facilitates pre-eclampsia progression via sponging miR-221-3P to regulate PTEN/Akt. J Cell Mol Med 2021; 26:1826-1841. [PMID: 33738906 PMCID: PMC8918405 DOI: 10.1111/jcmm.16454] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 12/19/2022] Open
Abstract
Pre‐eclampsia (PE) is a worldwide pregnancy‐related disorder. It is mainly characterized by defect migration and invasion of trophoblast cells. Recently, circular RNAs (circRNAs) have been believed to play a vital role in PE. The expression patterns and the biological functions of circRNAs in PE remain elusive. Here, we performed a circRNA microarray to identify putative PE‐related circRNAs. Bioinformatics analyses were used to screen the circRNAs which have potential relationships with pre‐eclampsia, and we identified a novel circRNA (circVRK1) that was up‐regulated in PE placenta tissues. By using HTR‐8/SVneo cells, circVRK1 knockdown significantly enhanced cell migration and invasion abilities, as well as epithelial‐mesenchymal transition (EMT). Mechanistically, we found that circVRK1 and PTEN could function as the ceRNAs to miR‐221‐3p. Overexpression of miR‐221‐3p promoted cell migration, invasion and EMT via regulating PTEN. The cotransfection of miR‐221‐3p inhibitor or PTEN reversed the effect from circVRK1 knockdown. Moreover, the circVRK1/miR‐221‐3p/PTEN axis greatly regulated Akt phosphorylation. In general, circVRK1 suppresses trophoblast cell migration, invasion and EMT, by acting as a ceRNA to miR‐221‐3p to regulate PTEN, and further inhibit PI3K/Akt activation. The purpose of this paper is to open wide insights to investigate the onset of PE and provide new potential therapeutic targets in PE.
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Affiliation(s)
- Ziwei Li
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China.,China Medical University, Shenyang, China
| | - Xinyi Zhou
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China.,China Medical University, Shenyang, China
| | - Wenyan Gao
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Manni Sun
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Haiying Chen
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Tao Meng
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China
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14
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Rath W, Tsikouras P, Schlembach D. [Ambulatory and Home Blood Pressure Measurement in Hypertensive Pregnant Women]. Z Geburtshilfe Neonatol 2020; 224:333-338. [PMID: 33276403 DOI: 10.1055/a-1266-7401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The prevalence of hypertensive disorders in pregnancy (HDP) is 6-8%. Blood pressure measurement (BPM) remains the cornerstone of diagnosis and should be performed in a standardised manner using automated devices. Office BPM represents only a spotty reading in an "artificial" environment failing to diagnose white coat hypertension (WCH). Ambulatory and home blood pressure measurement (ABPM/HBPM) are recommended for the diagnosis and differentiation of hypertension as well as for blood pressure and therapy control in women with HDP. Patient compliance is crucial for the use of both methods. ABPM is an appropriate method for the early identification of WCH and masked hypertension as well as for differentiating WCH from chronic hypertension < 20 week's gestation. HBPM has been shown to reduce the number of antenatal visits and hospital admissions compared to office blood pressure measurement without compromising maternal and fetal outcomes; it also avoids unnecessary antihypertensive medications and reduces the rate of labour inductions and false diagnosis of "preeclampsia". Problems associated with ABPM are its limited availability and inconvenience to patients due to sleep disturbances. Disadvantages of HBPM are the need for patient training, potential measurement errors, and the lack of evidence-based BP thresholds. The widespread use especially of HBPM may contribute to a reduction in workload of obstetric staff in the hospital and may save hospital expense.
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Affiliation(s)
- Werner Rath
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Komotini, Greece
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15
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Sá CPND, Jiménez MF, Rosa MW, Arlindo EM, Ayub ACK, Cardoso RB, Kreitchmann R, El Beitune P. Evaluation of Angiogenic Factors (PlGF and sFlt-1) in Pre-eclampsia Diagnosis. Rev Bras Ginecol Obstet 2020; 42:697-704. [PMID: 33254263 PMCID: PMC10309227 DOI: 10.1055/s-0040-1713916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Recent observations support the hypothesis that an imbalance between angiogenic factors has a fundamental role in the pathogenesis of pre-eclampsia and is responsible for the clinical manifestations of the disease. The goal of the present study was to evaluate the sensitivity, specificity, and the best accuracy level of Soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and sFlt-1/PlGF ratio in maternal serum and protein/creatinine ratio in urine sample to define the best cutoff point of these tests to discriminate between the patients with gestational hypertension and the patients with pre-eclampsia, to evaluate the possibility of using them as diagnostic methods. METHODS A prospective longitudinal study was performed, and blood samples were collected from 95 pregnant patients with hypertension to measure serum concentrations of biomarkers sFlt-1 and PlGF. Urine samples were collected for protein screening. Significance was set as p < 0.05. RESULTS The sFlt-1/PlGF ratio demonstrated a sensitivity of 57.5% and a specificity of 60% using 50.4 as a cutoff point. The test that showed the best accuracy in the diagnosis of pre-eclampsia was protein/creatinine ratio, with a sensitivity of 78.9% and a specificity of 70% using 0.4 as a cutoff point and showing an area under the receiver operating characteristic curve of 0.80 (p < 0.001). CONCLUSION No studied laboratory test proved to be fairly accurate for the diagnosis of pre-eclampsia, except for the protein/creatinine ratio. The evidence is insufficient to recommend biomarkers sFlt-1 and PlGF to be used for the diagnosis of pre-eclampsia.
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Affiliation(s)
- Catherine Primo Nogueira de Sá
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil.,Obstetrics Service, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Mirela Foresti Jiménez
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | | | - Ellen Machado Arlindo
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil.,Obstetrics Service, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Antonio Celso Koehler Ayub
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Rodrigo Bernardes Cardoso
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Régis Kreitchmann
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Patrícia El Beitune
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
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16
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Tura AK, Scherjon S, Stekelenburg J, van Roosmalen J, van den Akker T, Zwart J. Severe Hypertensive Disorders of Pregnancy in Eastern Ethiopia: Comparing the Original WHO and Adapted sub-Saharan African Maternal Near-Miss Criteria. Int J Womens Health 2020; 12:255-263. [PMID: 32308499 PMCID: PMC7152537 DOI: 10.2147/ijwh.s240355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/21/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To assess life-threatening complications among women admitted with severe hypertensive disorders of pregnancy and compare applicability of World Health Organization (WHO) maternal near-miss (MNM) criteria and the recently adapted sub-Saharan African (SSA) MNM criteria in eastern Ethiopia. METHODS Of 1,054 women admitted with potentially life-threatening conditions between January 2016 and April 2017, 562 (53.3%) had severe preeclampsia/eclampsia. We applied the definition of MNM according to the WHO MNM criteria and the SSA MNM criteria. Logistic regression was performed to identify factors associated with severe maternal outcomes (MNMs and maternal deaths). RESULTS The SSA MNM criteria identified 285 cases of severe maternal outcomes: 271 MNMs and 14 maternal deaths (mortality index 4.9%). The WHO criteria identified 50 cases of severe maternal outcomes: 36 MNMs and 14 maternal deaths (mortality index 28%). The MNM ratio was 36.6 per 1,000 livebirths according to the SSA MNM criteria and 4.9 according to the WHO criteria. More than 80% of women in both groups had MNM events on arrival or within 12 hours after admission. Women without antenatal care, from rural areas, referred from other facilities, and with concomitant hemorrhage more often developed severe maternal outcomes. CONCLUSION Regarding hypertensive disorders of pregnancy, the SSA tool is more inclusive than the WHO tool, while still maintaining a considerably high mortality index indicating severity of included cases. This may enable more robust audits. Strengthening the referral system and improving prevention and management of obstetric hemorrhage in women with hypertensive disorders of pregnancy are required to avert severe maternal outcomes.
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Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sicco Scherjon
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Jos van Roosmalen
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, Deventer, The Netherlands
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Kirk K, Warren C. "What's in a name?": Exploring inconsistent and contradictory definitions and clinical guidelines for hypertensive disorders of pregnancy from published literature from Nigeria and Bangladesh. J Glob Health 2020; 10:010306. [PMID: 32257134 PMCID: PMC7100861 DOI: 10.7189/jogh.10.010306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Karen Kirk
- Population Council, New York, New York, USA
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18
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Krishnan V, Makris A, Hennessy A, Hollis B, Lee G. Blood pressure assessments of pregnant women in a Day Assessment Unit - A prospective observational study. Obstet Med 2019; 14:26-30. [PMID: 33995569 DOI: 10.1177/1753495x19881848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/20/2019] [Indexed: 11/15/2022] Open
Abstract
Aim We investigated the optimum time and number of observations for assessing women in the Day Assessment Unit. Methods A single centre prospective observational study was undertaken. Women referred for blood pressure assessment in the Day Assessment Unit were recruited. Results The blood pressure of women who subsequently developed preeclampsia was noted to change differently over the time of observation compared to women with other hypertensive disorders, most notably in the first and third hour (p = 0.042), although the averages at each hour did not differ between these two groups. Conclusions Mean blood pressure measured over four hours did not significantly differ compared to blood pressure measured over one hour. Women who subsequently developed preeclampsia had a different pattern of blood pressure change whilst in the Day Assessment Unit.
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Affiliation(s)
- Vidhu Krishnan
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, Australia
| | - Angela Makris
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
| | | | - Brian Hollis
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, Australia
| | - Gaksoo Lee
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, Australia.,Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
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Uzun Cilingir I, Varol F, Gurkan H, Sutcu H, Atli E, Eker D, Inan C, Erzincan S, Sayin C. Placental and serum levels of human Klotho in severe preeclampsia: A potential sensitive biomarker. Placenta 2019; 85:49-55. [DOI: 10.1016/j.placenta.2019.08.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 01/08/2023]
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Baykus Y, Ustebay S, Deniz R, Ugur K, Yavuzkir Ş, Aydin S. Direct laboratory evidence that pregnancy-induced hypertension might be associated with increased catecholamines and decreased renalase concentrations in the umbilical cord and mother’s blood. J LAB MED 2019; 43:77-85. [DOI: 10.1515/labmed-2018-0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Abstract
Background
Renalase (RNL) is a controversial enzyme as to whether it oxidizes catecholamines (CAs) (as is generally accepted) in the blood or not. CAs (dopamine [DPMN], epinephrine [EPI] and norepinephrine [NEPI]) are associated with hypertension, including pregnancy-induced hypertension, which occurs in 8–10% of all pregnancies. Therefore, the aim of the study was to compare CAs and renalase concentration in (i) normotensive controls (C), (ii) patients with preeclampsia (PE) and (iii) patients with severe preeclampsia (SPE), which is one of the well-known symptoms of hypertension.
Methods
This case-control study involved 90 women divided into three groups – 30 C, 30 PE and 30 SPE – whose age and body mass indexes (BMIs) were similar. A total of 270 blood samples (90 maternal samples, 90 umbilical cord artery samples and 90 umbilical cord vein samples) were obtained. CAs and RNL concentrations of the biological samples were measured by enzyme-linked immunosorbent assay (ELISA).
Results
Comparing the amounts of CAs, RNL and systolic blood pressure (SBP)/diastolic blood pressure (DBP) between healthy control pregnant women and pregnant women with PE and SPE (SBP/DBP was 120/80 mm Hg for C, above 140/90 mm Hg for PE and above 160/110 mm Hg for SPE), the levels of CAs were significantly increased whereas RNL was reduced. The correlation between SBP/DBP and the amount of RNL in pregnant women with PE and SPE was negative.
Conclusions
These novel results are evidence that hypertension seen in PE and SPE is directly related to increased levels of CAs and reduced RNL concentrations. The use of RNL preparations may be preferred in future to prevent maternal and perinatal morbidity and mortality due to pregnancy-induced hypertension.
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Wallace K, Bean C, Bowles T, Spencer SK, Randle W, Kyle PB, Shaffery J. Hypertension, Anxiety, and Blood-Brain Barrier Permeability Are Increased in Postpartum Severe Preeclampsia/Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome Rats. Hypertension 2019; 72:946-954. [PMID: 30354708 DOI: 10.1161/hypertensionaha.118.11770] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hypertension and inflammation during pregnancy are suggested to contribute to the development of postpartum depression and anxiety. Using a rat model of severe preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome, which displays both hypertension and inflammation during pregnancy, we evaluated whether rats were prone to develop depression or anxiety in the postpartum period. On gestational day 12, miniosmotic pumps infusing sFlt-1 (soluble fms-like tyrosine kinase-1) and sEng (soluble endoglin) were placed into rats, a subset of these rats was infused with 2 mg/kg of Orencia (abatacept) the following day to determine whether immune suppression via T-cell depletion prevented any changes in maternal depression or anxiety-like behavior. All rats, including normal pregnant (NP) controls, delivered between gestational days 21 and 22. Postpartum severe preeclamptic rats buried significantly more marbles compared with NP rats ( P=0.002) and Orencia-treated rats ( P=0.05). Severe preeclamptic rats spent significantly more time in closed arms of the elevated plus maze compared with NP rats ( P=0.009) and Orencia-treated rats ( P=0.05). Severe preeclamptic rats were hypertensive compared with NP ( P=0.03) and Orencia-treated rats ( P=0.01). Finally, severe preeclamptic rats had increased blood-brain barrier permeability compared with NP rats ( P=0.03), which was reversed in Orencia-treated rats ( P=0.008). These results suggest that severe preeclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome during pregnancy contributes to an increase in anxiety-like behavior, blood-brain barrier permeability, and hypertension in the postpartum. The current results suggest that T-cell suppression during pregnancy can also help prevent chronic hypertension and increased anxiety in the postpartum period.
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Affiliation(s)
- Kedra Wallace
- From the Department of Obstetrics and Gynecology (K.W., C.B., T.B., S.-K.S., W.R.), University of Mississippi Medical Center, Jackson
| | - Cynthia Bean
- From the Department of Obstetrics and Gynecology (K.W., C.B., T.B., S.-K.S., W.R.), University of Mississippi Medical Center, Jackson
| | - Teylor Bowles
- From the Department of Obstetrics and Gynecology (K.W., C.B., T.B., S.-K.S., W.R.), University of Mississippi Medical Center, Jackson
| | - Shauna-Kay Spencer
- From the Department of Obstetrics and Gynecology (K.W., C.B., T.B., S.-K.S., W.R.), University of Mississippi Medical Center, Jackson
| | - Wisdom Randle
- From the Department of Obstetrics and Gynecology (K.W., C.B., T.B., S.-K.S., W.R.), University of Mississippi Medical Center, Jackson
| | - Patrick B Kyle
- Department of Pathology (P.B.K.), University of Mississippi Medical Center, Jackson
| | - James Shaffery
- Department of Psychiatry, Center of Psychiatric Neuroscience (J.S.), University of Mississippi Medical Center, Jackson
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Affiliation(s)
- Shiliang Liu
- From the Maternal, Child and Youth Health Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON (S.L.)
| | - Wee-Shian Chan
- Departments of Medicine and Obstetrics and Gynaecology, University of British Columbia, the Children’s and Women’s Hospital of British Columbia, Vancouver, BC (W.-S.C.)
| | - Joel G. Ray
- Departments of Medicine, Health Policy Management and Evaluation and Obstetrics and Gynecology, St Michael’s Hospital, University of Toronto, ON (J.G.R.)
| | - Michael S. Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC (M.S.K.)
| | - K.S. Joseph
- Department of Obstetrics and Gynaecology, the School of Population and Public Health, University of British Columbia and the Children’s and Women’s Hospital of British Columbia, Vancouver, BC, Canada (K.S.J.)
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Chaudhari S, Cushen SC, Osikoya O, Jaini PA, Posey R, Mathis KW, Goulopoulou S. Mechanisms of Sex Disparities in Cardiovascular Function and Remodeling. Compr Physiol 2018; 9:375-411. [PMID: 30549017 DOI: 10.1002/cphy.c180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies demonstrate disparities between men and women in cardiovascular disease prevalence, clinical symptoms, treatments, and outcomes. Enrollment of women in clinical trials is lower than men, and experimental studies investigating molecular mechanisms and efficacy of certain therapeutics in cardiovascular disease have been primarily conducted in male animals. These practices bias data interpretation and limit the implication of research findings in female clinical populations. This review will focus on the biological origins of sex differences in cardiovascular physiology, health, and disease, with an emphasis on the sex hormones, estrogen and testosterone. First, we will briefly discuss epidemiological evidence of sex disparities in cardiovascular disease prevalence and clinical manifestation. Second, we will describe studies suggesting sexual dimorphism in normal cardiovascular function from fetal life to older age. Third, we will summarize and critically discuss the current literature regarding the molecular mechanisms underlying the effects of estrogens and androgens on cardiac and vascular physiology and the contribution of these hormones to sex differences in cardiovascular disease. Fourth, we will present cardiovascular disease risk factors that are positively associated with the female sex, and thus, contributing to increased cardiovascular risk in women. We conclude that inclusion of both men and women in the investigation of the role of estrogens and androgens in cardiovascular physiology will advance our understanding of the mechanisms underlying sex differences in cardiovascular disease. In addition, investigating the role of sex-specific factors in the development of cardiovascular disease will reduce sex and gender disparities in the treatment and diagnosis of cardiovascular disease. © 2019 American Physiological Society. Compr Physiol 9:375-411, 2019.
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Affiliation(s)
- Sarika Chaudhari
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Paresh A Jaini
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rachel Posey
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Piccoli GB, Zakharova E, Attini R, Ibarra Hernandez M, Covella B, Alrukhaimi M, Liu ZH, Ashuntantang G, Orozco Guillen A, Cabiddu G, Li PKT, Garcia-Garcia G, Levin A. Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases. J Clin Med 2018; 7:jcm7100318. [PMID: 30275392 PMCID: PMC6210235 DOI: 10.3390/jcm7100318] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/14/2022] Open
Abstract
Pregnancy-related acute kidney injury (pAKI), preeclampsia (PE), and the hypertensive disorders of pregnancy are closely related conditions, which are, in turn, frequently linked to pre-existing and often non-diagnosed chronic kidney disease (CKD). The current literature and research mainly underline the effects of pregnancy complications on the offspring; this review strongly emphasizes the maternal health as well. These conditions not only negatively affect pregnancy outcomes, but have a relevant effect on the future health of affected mothers and their children. Therefore, dedicated diagnostic and follow-up programs are needed, for optimizing materno-foetal health and reducing the impact of pregnancy-related problems in the mothers and in the new generations. This narrative review, performed on the occasion of the 2018 World Kidney Day dedicated to women’s health, focuses on three aspects of the problem. Firstly, the risk of AKI in the hypertensive disorders of pregnancy (the risk is the highest in developing countries; however PE is the main cause of pregnancy related AKI worldwide). Secondly, the effect of AKI and the hypertensive disorders of pregnancy on the development of CKD in the mother and offspring: long-term risks are increased; the entity and the trajectories are still unknown. Thirdly, the role of CKD in the pathogenesis of AKI and the hypertensive disorders of pregnancy: CKD is a major risk factor and the most important element in the differential diagnosis; pregnancy is a precious occasion for early diagnosis of CKD. Higher awareness on the importance of AKI in pregnancy is needed to improve short and long term outcomes in mothers and children.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy.
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, 101000 Moscow, Russia.
- Nephrology, Moscow State University of Medicine and Dentistry, 101000 Moscow, Russia.
- Nephrology, Russian Medical Academy of Continuous Professional Education, 101000 Moscow, Russia.
| | - Rossella Attini
- Obstetrics, Department of Surgery, University of Torino, 10100 Torino, Italy.
| | - Margarita Ibarra Hernandez
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, 44100 Guadalajara Jal, Mexico.
| | - Bianca Covella
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, P.O. Box 20170, Dubai, UAE.
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210000, China. zhihong--
| | - Gloria Ashuntantang
- Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, P.O. Box 337, Yaounde, Cameroon.
| | | | | | - Philip Kam Tao Li
- Prince of Wales Hospital, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong.
| | - Gulliermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, 44100 Guadalajara Jal, Mexico.
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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Strapasson MR, Ferreira CF, Ramos JGL. Associations between postpartum depression and hypertensive disorders of pregnancy. Int J Gynaecol Obstet 2018; 143:367-373. [PMID: 30194695 DOI: 10.1002/ijgo.12665] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 07/25/2018] [Accepted: 09/06/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify possible relationships between postpartum depression and hypertensive disorders of pregnancy (HDP), as well as the associated risk factors for developing postpartum depression. METHODS The present prospective descriptive cross-sectional study was conducted among postpartum women who attended a public maternity hospital in Brazil between January 15, 2015, and January 15, 2017. The diagnosis and severity of HDP were based on blood pressure measurements (systolic ≥140 mm Hg or diastolic ≥90 mm Hg), proteinuria, clinical findings, and laboratory findings. A group of normotensive women was also included. The Edinburgh Postnatal Depression Scale was used to assess the risk of postpartum depression. RESULTS Of 168 participants (42 with HDP and 126 normotensive), 40 (23.8%) women displayed depressive symptoms (25 normotensive and 15 with HDP). The probability of postpartum depression correlated with a diagnosis of HDP (Spearman correlation coefficient [rS ] 0.219; P=0.004); premonitory signs of eclampsia (rS 0.171; P=0.027); magnesium sulfate therapy (rS 0.199; P=0.010); diastolic blood pressure (rS 0.165; P=0.033); and use of milk formula during hospitalization (rS 0.152; P=0.048). CONCLUSION Women diagnosed with HDP were more likely to have depressive symptoms than their normotensive counterparts.
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Affiliation(s)
- Márcia R Strapasson
- Post Graduation Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Health School, University of Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Charles F Ferreira
- Post Graduation Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Climacteric and Menopause Research Group, Faculty of Medicine, Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - José G L Ramos
- Post Graduation Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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26
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Pfeffer TJ, Hilfiker-Kleiner D. Pregnancy and Heart Disease: Pregnancy-Associated Hypertension and Peripartum Cardiomyopathy. Curr Probl Cardiol 2018; 43:364-388. [DOI: 10.1016/j.cpcardiol.2017.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Jirakittidul P, Sirichotiyakul S, Ruengorn C, Techatraisak K, Wiriyasirivaj B. Effect of iron supplementation during early pregnancy on the development of gestational hypertension and pre-eclampsia. Arch Gynecol Obstet 2018; 298:545-550. [DOI: 10.1007/s00404-018-4821-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/13/2018] [Indexed: 12/27/2022]
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28
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Salvig CD, Storkholm MH, Salvig JD, Uldbjerg N. Reducing the number of obstetrical beds by challenging traditions. Acta Obstet Gynecol Scand 2018; 97:1157-1161. [PMID: 29777635 DOI: 10.1111/aogs.13382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
The aim of this commentary is to describe changes in women's care at an obstetric department that made it possible to reduce the number of beds from 40 to 29. Patient pathways were reviewed and revised using lean methodology. The mean length of stay was reduced from 70 to 59 h and the mean numbers of hospitalizations per woman from 1.26 to 1.20. At the organizational level, we introduced a Family Department, home management of newborns, home monitoring of the women with cardiotocography and blood samples, and intrapartum Group B Streptococcus-PCR. Additionally, an After Birth Clinic and network meetings for vulnerable women were established. In patient pathway, we reduced the hospitalization indicated by preterm premature rupture of membranes, preeclampsia and observation after birth laceration. According to National Patient Satisfaction surveys, there was no decrease in women's satisfaction after reducing the number of beds.
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Affiliation(s)
- Camilla D Salvig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Marie H Storkholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jannie D Salvig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
In pregnancy, there are numerous changes which occur to accommodate the needs of both the fetus and placenta. These changes present us with a unique set of clinical challenges particularly in the setting of any disease processes occurring during pregnancy. It is essential to understand that the systems profoundly affected are the cardiovascular and renal systems. The most predominant disease process occurring in pregnancy affecting both the cardiovascular and renal system is the spectrum of hypertensive disorders specifically pre-eclampsia. Due to its high incidence worldwide, it is considered as the most common cause of infant and maternal morbidity and mortality. While the international definition, classification scheme and diagnostic criteria for Hypertensive Disorders of Pregnancy still must be agreed upon, hypertension has been the mandatory feature for all established guidelines. Pre-eclampsia particularly the severe form which is recognized as HELLP (Hemolysis, Elevated Liver enzymes and Low Platelet count) syndrome is the primary cause of acute kidney injury in pregnancy. In this review, we would primarily discuss the hemodynamic and vascular changes, anatomical and physiologic renal adaptations occurring during normal pregnancy and the complications which arise in the setting of hypertensive diseases. Mainly focusing on the pre-eclampsia spectrum, since knowledge of these is of clinical importance not only in understanding its role in the disease process but more so its implications for prevention, screening, diagnosis, and management.
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Ziganshina MM, Amiraslanov EY, Yarotskaya EL, Dolgushina NV, Sergunina OA, Nikolaeva MA, Kan NE, Tyutyunnik VL, Mantrova DA, Loginova NS, Konradi AO, Sukhikh GT. Autoantibodies to endothelial cells in patients with hypertensive disorders during pregnancy. Pregnancy Hypertens 2018; 12:65-70. [PMID: 29674202 DOI: 10.1016/j.preghy.2018.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Marina M Ziganshina
- Laboratory of Clinical Immunology, Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation", Moscow, Russian Federation.
| | - Elrad Y Amiraslanov
- Observational Department, Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation"
| | - Ekaterina L Yarotskaya
- Department of International Cooperation, Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation"
| | - Nataliya V Dolgushina
- R&D Department, Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation"
| | - Olga A Sergunina
- Observational Department, Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation"
| | - Marina A Nikolaeva
- Laboratory of Clinical Immunology, Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation", Moscow, Russian Federation
| | - Natalia E Kan
- Observational Department, Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation"
| | - Victor L Tyutyunnik
- Obstetrical Physiologic Department, Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation"
| | - Diana A Mantrova
- Observational Department, Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation"
| | - Natalya S Loginova
- Laboratory of Clinical Immunology, Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation", Moscow, Russian Federation
| | | | - Gennady T Sukhikh
- Federal State Budget Institution "National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation"
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Gainder S, Thakur M, Saha SC, Prakash M. To study the changes in fetal hemodynamics with intravenous labetalol or nifedipine in acute severe hypertension. Pregnancy Hypertens 2018; 15:12-15. [PMID: 30825908 DOI: 10.1016/j.preghy.2018.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/22/2018] [Accepted: 02/24/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare the efficacy of intravenous labetalol or oral nifedipine in treatment of acute maternal hypertension and study the fetal hemodynamic changes using color Doppler ultrasound that follows treatment. STUDY DESIGN Thirty women with severe preeclampsia having acute hypertension (more than or equal to 160/105 mmHg) were randomized in 2 groups to receive intravenous labetalol or oral nifedipine until blood pressure was lowered to less than or equal to 140/90 mmHg. Doppler vascular indices namely pulsatility index, resistance index, S/D ratio of umbilical (UA) and middle cerebral artery (MCA) were measured baseline at the time of acute severe hypertension and repeated after control of blood pressure, to assess the changes in fetal hemodynamics if any with labetalol or nifedipine. RESULTS Both nifedipine and labetalol were found to be effective when used for rapid control of blood pressure. Mean age of women in both groups and mean gestational age was statistically comparable. No change in fetal heart rate before and after treatment was observed in both groups. Doppler vascular indices of UA and MCA showed no significant changes as compared to baseline values in both groups. CONCLUSION The use of labetalol and nifedipine were not related to any significant changes in fetal Doppler, which is reassuring about the safety of these drugs when treating acute severe hypertension in pregnancy. Choice between these two drugs should be based on cost, availability respective contraindications, and clinician's experience.
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Affiliation(s)
- Shalini Gainder
- Department of Obstetrics & Gynaecology, PGIMER Chandigarh, India.
| | - Monika Thakur
- Department of Obstetrics & Gynaecology, PGIMER Chandigarh, India.
| | - S C Saha
- Department of Obstetrics & Gynaecology, PGIMER Chandigarh, India
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Ukah UV, Payne B, Hutcheon JA, Ansermino JM, Ganzevoort W, Thangaratinam S, Magee LA, von Dadelszen P. Assessment of the fullPIERS Risk Prediction Model in Women With Early-Onset Preeclampsia. Hypertension 2018; 71:659-665. [PMID: 29440330 PMCID: PMC5865495 DOI: 10.1161/hypertensionaha.117.10318] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 09/30/2017] [Accepted: 01/18/2018] [Indexed: 12/22/2022]
Abstract
Supplemental Digital Content is available in the text. Early-onset preeclampsia is associated with severe maternal and perinatal complications. The fullPIERS model (Preeclampsia Integrated Estimate of Risk) showed both internal and external validities for predicting adverse maternal outcomes within 48 hours for women admitted with preeclampsia at any gestational age. This ability to recognize women at the highest risk of complications earlier could aid in preventing these adverse outcomes through improved management. Because the majority (≈70%) of the women in the model development had late-onset preeclampsia, we assessed the performance of the fullPIERS model in women with early-onset preeclampsia to determine whether it will be useful in this subgroup of women with preeclampsia. Three cohorts of women admitted with early-onset preeclampsia between 2012 and 2016, from tertiary hospitals in Canada, the Netherlands, and United Kingdom, were used. Using the published model equation, the probability of experiencing an adverse maternal outcome was calculated for each woman, and model performance was evaluated based on discrimination, calibration, and stratification. The total data set included 1388 women, with an adverse maternal outcome rate of 7.3% within 48 hours of admission. The model had good discrimination, with an area under the receiver operating characteristic curve of 0.80 (95% confidence interval, 0.75–0.86), and a calibration slope of 0.68. The estimated likelihood ratio at the predicted probability of ≥30% was 23.4 (95% confidence interval, 14.83–36.79), suggesting a strong evidence to rule in adverse maternal outcomes. The fullPIERS model will aid in identifying women admitted with early-onset preeclampsia in similar settings who are at the highest risk of adverse outcomes, thereby allowing timely and effective interventions.
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Affiliation(s)
- U Vivian Ukah
- From the Departments of Obstetrics and Gynaecology (U.V.U., J.A.H.) and Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., B.P., J.A.H., J.M.A.); Departments of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands (W.G.); Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (S.T.); and School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M., P.v.D.).
| | - Beth Payne
- From the Departments of Obstetrics and Gynaecology (U.V.U., J.A.H.) and Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., B.P., J.A.H., J.M.A.); Departments of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands (W.G.); Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (S.T.); and School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Jennifer A Hutcheon
- From the Departments of Obstetrics and Gynaecology (U.V.U., J.A.H.) and Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., B.P., J.A.H., J.M.A.); Departments of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands (W.G.); Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (S.T.); and School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - J Mark Ansermino
- From the Departments of Obstetrics and Gynaecology (U.V.U., J.A.H.) and Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., B.P., J.A.H., J.M.A.); Departments of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands (W.G.); Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (S.T.); and School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Wessel Ganzevoort
- From the Departments of Obstetrics and Gynaecology (U.V.U., J.A.H.) and Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., B.P., J.A.H., J.M.A.); Departments of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands (W.G.); Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (S.T.); and School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Shakila Thangaratinam
- From the Departments of Obstetrics and Gynaecology (U.V.U., J.A.H.) and Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., B.P., J.A.H., J.M.A.); Departments of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands (W.G.); Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (S.T.); and School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Laura A Magee
- From the Departments of Obstetrics and Gynaecology (U.V.U., J.A.H.) and Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., B.P., J.A.H., J.M.A.); Departments of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands (W.G.); Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (S.T.); and School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Peter von Dadelszen
- From the Departments of Obstetrics and Gynaecology (U.V.U., J.A.H.) and Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., B.P., J.A.H., J.M.A.); Departments of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands (W.G.); Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (S.T.); and School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M., P.v.D.)
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Ukah UV, De Silva DA, Payne B, Magee LA, Hutcheon JA, Brown H, Ansermino JM, Lee T, von Dadelszen P. Prediction of adverse maternal outcomes from pre-eclampsia and other hypertensive disorders of pregnancy: A systematic review. Pregnancy Hypertens 2017; 11:115-123. [PMID: 29198742 DOI: 10.1016/j.preghy.2017.11.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND The hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity. The ability to predict these complications using simple tests could aid in management and improve outcomes. We aimed to systematically review studies that reported on potential predictors of adverse maternal outcomes among women with a hypertensive disorder of pregnancy. METHODS We searched MEDLINE, Embase and CINAHL (inception - December 2016) for studies of predictors of severe maternal complications among women with a hypertensive disorder of pregnancy. Studies were selected in a two-stage process by two independent reviewers, excluding those reporting only on adverse fetal outcomes. We extracted data on study and test(s) characteristics and outcomes. Accuracy of prediction was assessed using sensitivity, specificity, likelihood ratios and area under the receiver operating curve (AUROC). Strong evidence of prediction was taken to be a positive likelihood ratio >10 or a negative likelihood ratio <0.1, and for multivariable models, an AUROC ≥0.70. Bivariate random effects models were used to summarise performance when possible. RESULTS Of 32 studies included, 28 presented only model development and four examined external validation. Tests included symptoms and signs, laboratory tests and biomarkers. No single test was a strong independent predictor of outcome. The most promising prediction was with multivariable models, especially when oxygen saturation, or chest pain/dyspnea were included. CONCLUSION Future studies should investigate combinations of tests in multivariable models (rather than single predictors) to improve identification of women at high risk of adverse outcomes in the setting of the hypertensive disorders of pregnancy.
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Affiliation(s)
- U Vivian Ukah
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Healthy Starts Theme, BC Children's Hospital Research, Vancouver, BC, Canada.
| | - Dane A De Silva
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Beth Payne
- Healthy Starts Theme, BC Children's Hospital Research, Vancouver, BC, Canada; Department of Anaesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Laura A Magee
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Helen Brown
- Woodward Library, University of British Columbia, Vancouver, BC, Canada
| | - J Mark Ansermino
- Healthy Starts Theme, BC Children's Hospital Research, Vancouver, BC, Canada
| | - Tang Lee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Healthy Starts Theme, BC Children's Hospital Research, Vancouver, BC, Canada
| | - Peter von Dadelszen
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Eche S, Mackraj I, Moodley J. Circulating fetal and total cell-free DNA, and sHLA-G in black South African women with gestational hypertension and pre-eclampsia. Hypertens Pregnancy 2017; 36:295-301. [PMID: 29115889 DOI: 10.1080/10641955.2017.1385794] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Quantification of circulating fetal and total cell-free DNA (cfDNA) and soluble human leucocyte antigen (HLAG) in gestational hypertension and pre-eclampsia. METHODS Serum cfDNA were quantified in controls, pre-eclamptics, and gestational hypertensive patients using real-time qPCR. Soluble HLAG was measured by enzyme-linked immune-sorbent assay. RESULTS Serum fetal and total cfDNA levels were higher in pre-eclampsia compared with the controls and gestational hypertensives (p < 0.001), more so in severe compared with mild-to-moderate pre-eclampsia (p < 0.05). Soluble HLAG levels were lower in pre-eclamptics than controls and gestational hypertension (p < 0.05). CONCLUSION Circulating fetal and total cfDNA were increased, while soluble HLAG was decreased in pre-eclampsia.
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Affiliation(s)
- Simeon Eche
- a Discipline of Human Physiology , University of KwaZulu-Natal , Durban , South Africa
| | - Irene Mackraj
- a Discipline of Human Physiology , University of KwaZulu-Natal , Durban , South Africa
| | - Jagidesa Moodley
- b Discipline of Obstetrics and Gynecology and Women's Health and HIV Research Group , Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban , South Africa
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Eltounali SA, Moodley J, Naicker T. Role of kidney biomarkers [Kidney injury molecule-1, Calbindin, Interleukin-18 and Monocyte chemoattractant protein-1] in HIV associated pre-eclampsia. Hypertens Pregnancy 2017; 36:288-294. [PMID: 29039974 DOI: 10.1080/10641955.2017.1385793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Both HIV infection and pre-eclampsia (PE) are associated with considerable maternal mortality in South Africa. This study was designed to compare the urinary levels of kidney injury molecule-1 (KIM-1), calbindin, interleukin-18 (IL-18), and monocyte chemoattractant protein-1 (MCP-1) in HIV associated normotensive and preeclamptic pregnancies. METHODS Following ethical approval and written consent, urine samples were collected from HIV negative (HIV -ve) normotensive pregnant (n = 19), HIV positive (HIV +ve) normotensive pregnant (n = 19), HIV -ve pre-eclamptic (n = 19) and HIV +ve pre-eclamptic (n = 19) women. The concentrations of KIM-1, calbindin, IL-18 and MCP-1 were assessed using the Bioplex technology. RESULTS In contrast to IL-18 (p > 0.05) and MCP-1 (p > 0.05), the concentrations of KIM-1 (p = 0.02) and calbindin (p = 0.02) were significantly higher in PE compared to normotensive pregnancies, irrespective of HIV status. Based on HIV status, all 4 analytes were similar between HIV+ve and HIV-ve groups. Urinary KIM-1 levels in the HIV -ve pre-eclamptics were significantly higher than those in the HIV -ve women with normal pregnancies (p = 0.007). The maternal hypertension and/or HIV profile has no marked impact on the fetal weight. CONCLUSION Our results demonstrate an increase in the urinary level of kidney injury molecule-1 and calbindin in PE, implicating their possible value as biomarkers of kidney injury. We observed no differences in the levels of KIM-1, IL-18, MCP-1 and calbindin based on HIV status. We propose that studies with larger sample sizes using these markers be conducted to establish their use as markers of diagnosing kidney injury in PE.
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Affiliation(s)
- Soumaya Abdullatif Eltounali
- a Optics and Imaging Centre, Nelson R. Mandela School of Medicine, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Jagidesa Moodley
- b Women's Health and HIV Research Unit, Nelson R. Mandela School of Medicine, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Thajasvarie Naicker
- a Optics and Imaging Centre, Nelson R. Mandela School of Medicine, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa
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Goldstein KM, Callegari LS. Should a history of assisted reproductive technology be another consideration when assessing cardiovascular risk? J Clin Hypertens (Greenwich) 2017; 19:170-172. [PMID: 28194918 DOI: 10.1111/jch.12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karen M Goldstein
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Lisa S Callegari
- Health Services Research and Development, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, WA, USA.,Departments of Obstetrics & Gynecology and Health Services, University of Washington, Seattle, WA, USA
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Weiner E, Mizrachi Y, Grinstein E, Feldstein O, Rymer-Haskel N, Juravel E, Schreiber L, Bar J, Kovo M. The role of placental histopathological lesions in predicting recurrence of preeclampsia. Prenat Diagn 2016; 36:953-960. [PMID: 27568920 DOI: 10.1002/pd.4918] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/10/2016] [Accepted: 08/24/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We aimed to study the role of placental pathology in the prediction of preeclampsia (PE) recurrence. METHODS The medical records and pathological placental reports of all women diagnosed with PE, during 2008-2015, were reviewed. The study population was divided according to the outcome of their subsequent pregnancy: those who did (recurrence group) or did not (no-recurrence group) develop recurrent PE. Data regarding maternal characteristics and placental maternal/fetal vascular malperfusion lesions, of the initial pregnancies, were compared. Two prediction models were generated for PE recurrence. RESULTS Compared to the no-recurrence group (n = 130), the recurrence group (n = 96) was characterized by lower gestational age (p < 0.001), longer inter-pregnancy interval (p = 0.012), and higher rate of severe features (p < 0.001). By logistic regression analysis composite maternal (aOR = 3.05, 95%CI 1.39-6.71, p = 0.005), fetal (aOR = 9.31, 95%CI 3.9-22.1, p < 0.001), and concurrent maternal + fetal (aOR = 13.94, 95%CI 5.08-38.21, p < 0.001), vascular malperfusion lesions were found to be independently associated with recurrence. A clinical prediction model accounted for 20.8% of PE recurrence (R2 = 0.208, AUC = 0.732), while a clinical-pathological model accounted for 34.2% of recurrence (R2 = 0.342, AUC = 0.80). CONCLUSION Placental maternal and fetal vascular malperfusion lesions are independently associated with increased risk for PE recurrence. A clinical-pathological prediction model for recurrence of PE is superior to a prediction model based merely on clinical factors. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Eran Weiner
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yossi Mizrachi
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grinstein
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Feldstein
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Rymer-Haskel
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Juravel
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics and Gynecology and Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Siddiqui MF, Nandi P, Girish GV, Nygard K, Eastabrook G, de Vrijer B, Han VK, Lala PK. Decorin over-expression by decidual cells in preeclampsia: a potential blood biomarker. Am J Obstet Gynecol 2016; 215:361.e1-361.e15. [PMID: 27001218 DOI: 10.1016/j.ajog.2016.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Decorin, a leucine-rich proteoglycan that is produced by decidual cells, limits invasion and endovascular differentiation of extravillous trophoblast cells during early placentation by binding to multiple tyrosine kinase receptors, in particular, vascular endothelial growth factor receptor-2. OBJECTIVE Because many studies have reported an association between poor trophoblast invasion and endovascular differentiation with preeclampsia, the studies reported here tested (1) whether decorin over-expression in the chorionic villi and/or basal decidua is associated with preeclampsia and, if so, (2) whether this association results in a hypoinvasive placenta, and (3) whether elevated plasma decorin concentration in the second trimester is a predictive biomarker for preeclampsia. STUDY DESIGN Decorin messenger RNA expression was measured with quantitative polymerase chain reaction at the tissue level and with in situ hybridization at the cellular level using (35)S-labeled antisense complimentary RNA probe in placentas from healthy control subjects and subjects with preeclampsia (14 each, 23-40 weeks of gestation). Tissue sections of the same placentas were also immunostained for decorin protein. A decorin over-expressing human endometrial stromal cell line was tested for invasion-regulatory effects on an invasive first-trimester extravillous trophoblast cell line HTR-8/SVneo plated in cocultures that were separated by a semipermeable membrane. Furthermore, we conducted retrospective measurements of plasma decorin levels during the second trimester (15-18 weeks of gestation) in a cohort of 28 body mass index-matched pairs of control subjects and subjects with preeclampsia before the onset of clinical disease. RESULTS First, decorin messenger RNA expression at the cellular level measured with in situ hybridization exhibited profoundly higher expression levels in basal plate decidual cells within the placentas from preeclamptic subjects than those from control subjects at all gestational ages, whereas no difference between the 2 subject groups was noted in villus mesenchymal cells. Similarly decorin messenger RNA expression at the tissue level in chorionic villi (primarily resulting from fetally derived mesenchymal cells) did not differ significantly between control and preeclampsia placentas. These findings were validated with immunostaining for decorin protein. Second, knocking down decorin gene in a decorin over-expressing endometrial cell line (used as an in vitro surrogate of decorin over-expressing decidual cells) in cocultures with extravillous trophoblast cells abrogated its invasion-restraining actions on trophoblast cells, which indicated paracrine contribution of decorin over-expressing decidua to the poor trophoblast invasiveness in situ. Finally, retrospective measurement of plasma decorin levels during the second trimester in 28 body mass index-matched pairs of control subjects and subjects with preeclampsia revealed elevated plasma decorin levels in all subjects with preeclampsia in all body mass index groups. A receiver operating characteristic curve analysis revealed strong diagnostic performance of plasma decorin in the prediction of preeclampsia status. Although there was no significant gestational age-related change in decorin levels during the second trimester in control or subjects with preeclampsia, we found that plasma decorin had a significant inverse relationship with body mass index or bodyweight. CONCLUSION We conclude that decorin over-expression by basal decidual cells is associated with hypoinvasive phenotype and poor endovascular differentiation of trophoblast cells in preeclampsia and that elevated plasma decorin concentration is a potential predictive biomarker for preeclampsia before the onset of clinical signs.
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Abstract
Preeclampsia is one of the most challenging diseases of pregnancy, with unclear etiology, no specific marker for prediction, and no precise treatment besides delivery of the placenta. Many risk factors have been identified, and diagnostic and management tools have improved in recent years. However, this disease remains one of the leading causes of maternal morbidity and mortality worldwide, especially in under-resourced settings. A history of previous preeclampsia is a known risk factor for a new event in a future pregnancy, with recurrence rates varying from less than 10% to 65%, depending on the population or methodology considered. A recent review that performed an individual participant data meta-analysis on the recurrence of hypertensive disorders of pregnancy in over 99 000 women showed an overall recurrence rate of 20.7%; when specifically considering preeclampsia, it was 13.8%, with milder disease upon recurrence. Prevention of recurrent preeclampsia has been attempted by changes in lifestyle, dietary supplementation, antihypertensive drugs, antithrombotic agents, and others, with much uncertainty about benefit. It is always challenging to treat and counsel a woman with a previous history of preeclampsia; this review will be based on hypothetical clinical cases, using common scenarios in obstetrical practice to consider the available evidence on how to counsel each woman during pre-conception and prenatal consultations.
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Affiliation(s)
- Maria Laura Costa
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Campinas, São Paulo, Brazil
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Zheng Q, Deng Y, Zhong S, Shi Y. Human chorionic gonadotropin, fetal sex and risk of hypertensive disorders of pregnancy: A nested case-control study. Pregnancy Hypertens 2016; 6:17-21. [PMID: 26955766 DOI: 10.1016/j.preghy.2016.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/12/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To assess whether human chorionic gonadotropin (HCG) and fetal sex are two independent risk factors for hypertensive pregnancy in the early second-trimester of pregnancy. METHODS This was a retrospective nested case-control study based on a cohort of 2521 singleton pregnancies, among whom we recruited 98 hypertensive pregnancies (subdivided into severe preeclampsia, n=34; mild preeclampsia, n=29 and gestational hypertension, n=35) and 196 normotensive pregnancies. Maternal serum HCG levels were measured at 15-20 weeks of gestation and fetal sex was determined from the neonatal record. Mann-Whitney U and chi-square tests were performed to assess differences of HCG levels and fetal sex between groups. Logistic regressions were performed to evaluate the effect of HCG and fetal sex on hypertensive pregnancy. RESULTS There were 35 male and 63 female fetuses in the hypertensive group, and 102 male and 94 female fetuses in the normotensive group (p=0.008). HCG (MoM) levels were significantly higher in only severe preeclamptic pregnancies (n=34) (p=0.013). There were no significant differences of the HCG (MoM) levels between male and female fetuses in each sub-group. aOR for increased maternal HCG levels and female fetus were 2.4 (95% CI: 1.434-3.954) and 2.9 (95% CI: 1.227-6.661) respectively in severe preeclamptic pregnancies compared with normotensive pregnancies. CONCLUSIONS There is a female preponderance in hypertensive pregnancies. Increased HCG levels and female fetus are two independent risk factors for severe preeclampsia in the early second-trimester of pregnancy.
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Affiliation(s)
- Qizhen Zheng
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, China; Shantou University Medical College, Shantou 515041, China
| | - Yuqing Deng
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, China; Shenzhen Key Laboratory of Gynaecology Diagnostic Technology Research, Shenzhen, China.
| | - Shilin Zhong
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Yu Shi
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, China
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