Prediction of preeclampsia using combination of biomarkers at 18-23 weeks of gestation: A nested case-control study

Circulating extracellular vesicles in healthy and pathological pregnancies: A scoping review of methodology, rigour and results

Extracellular vesicles (EVs) play a crucial role in pregnancy, revealed by the presence of placental-derived EVs in maternal blood, their in vitro functionality, and their altered cargo in pregnancy pathologies. These EVs are thought to be involved in the development of pregnancy pathologies, such as pre-eclampsia, pre-term birth, and fetal growth restriction, and have been suggested as a source of biomarkers for gestational diseases. However, to accurately interpret their function and biomarker potential, it is necessary to critically evaluate the EV isolation and characterization methodologies used in pregnant cohorts. In this systematic scoping review, we collated the results from 152 studies that have investigated EVs in the blood of pregnant women, and provide a detailed analysis of the EV isolation and characterization methodologies used. Our findings indicate an overall increase in EV concentrations in pregnant compared to non-pregnant individuals, an increased EV count as gestation progresses, and an increased EV count in some pregnancy pathologies. We highlight the need for improved standardization of methodology, greater focus on gestational changes in EV concentrations, and further investigations into the functionality of EVs. Our review suggests that EVs hold great promise as diagnostic and translational tools for gestational diseases. However, to fully realize their potential, it is crucial to improve the standardization and reliability of EV isolation and characterization methodologies, and to gain a better understanding of their functional roles in pregnancy pathologies.

Selective Serotonin Reuptake Inhibitor Use in Pregnancy and Protective Mechanisms in Preeclampsia

Depression and preeclampsia share risk factors and are bi-directionally associated with increased risk for each other. Despite epidemiological evidence linking selective serotonin reuptake inhibitors (SSRIs) in pregnancy to preeclampsia, serotonin (5-HT) and vasopressin (AVP) secretion mechanisms suggest that SSRIs may attenuate preeclampsia risk. However, there is a need to clarify the relationship between SSRIs and preeclampsia in humans to determine therapeutic potential. This retrospective cohort study included clinical data from 9558 SSRI-untreated and 9046 SSRI-treated pregnancies. In a subcohort of 233 pregnancies, early pregnancy (< 20 weeks) maternal plasma copeptin, an inert and stable AVP prosegment secreted 1:1 with AVP, was measured by enzyme-linked immunosorbent assay. Diagnoses and depression symptoms (Patient Health Questionnaire-9 [PHQ-9]) were identified via medical records review. Descriptive, univariate, and multivariate regression analyses were conducted (α = 0.05). SSRI use was associated with decreased preeclampsia after controlling for clinical confounders (depression severity, chronic hypertension, diabetes, body mass index, age) (OR = 0.9 [0.7-1.0], p = 0.05). Moderate-to-severe depression symptoms were associated with significantly higher copeptin secretion than mild-to-no depression symptoms (240 ± 29 vs. 142 ± 10 ng/mL, p < 0.001). SSRIs significantly attenuated first trimester plasma copeptin (78 ± 22 users vs. 240 ± 29 ng/ml non-users, p < 0.001). In preeclampsia, SSRI treatment was associated with significantly lower copeptin levels (657 ± 164 vs. 175 ± 134 ng/mL, p = 0.04). Interaction between SSRI treatment and preeclampsia was also significant (p = 0.04). SSRIs may modulate preeclampsia risk and mechanisms, although further studies are needed to investigate the relationships between 5-HT and AVP in depression and preeclampsia.

Association between serum copeptin levels and preeclampsia risk: A meta-analysis

The role of vasopressin in preeclampsia pathogenesis has been recently supported by experimental studies. This meta-analysis aims to accumulate literature evidence and evaluate whether serum copeptin levels differ among preeclamptic and healthy pregnant women. Medline, Scopus, CENTRAL, Web of Science and Google Scholar databases were systematically searched from inception. All observational studies reporting serum copeptin values among preeclamptic and healthy pregnant women were deemed eligible. Sixteen studies were included, comprising 2105 women. Preeclampsia was linked to significantly higher copeptin levels during the 1st (Standardized Mean Difference-SMD: 2.25, 95% Confidence Intervals-CI: 0.86-3.67), 2nd (SMD: 1.73, 95% CI: 0.31-3.14) and 3rd (SMD: 1.74, 95% CI: 0.96-2.53) trimester. This association was present for severe, non-severe, early and late-onset preeclampsia. Women with the severe form of the disease displayed significantly elevated copeptin levels (SMD: 1.47, 95% CI: 1.10-1.84) compared to those with the non-severe one, while no difference was evident between early and late-onset preeclampsia (SMD: -0.30, 95% CI: -0.91 to 0.31). In conclusion, the present meta-analysis suggests that preeclampsia is associated with significantly increased serum copeptin levels in all pregnancy trimesters, irrespective of disease severity and onset. Future large-scale cohort studies should confirm these findings and introduce cut-off values in order to clarify the exact accuracy of copeptin for the prediction of preeclampsia early in the course of pregnancy.