Pre-eclampsia

Mendelian randomization analysis of blood uric acid and risk of preeclampsia: based on GWAS and eQTL data

BACKGROUND

The causal association between blood uric acid and preeclampsia (Preeclampsia, PE) has not been conclusively established based on the literature reviewed to date. This bi-directional Mendelian randomization study aimed to investigate the bi-directional causal association between blood uric acid concentration and PE at different genetic levels.

METHODS

Pooled data on preeclampsia (sample size = 82,085) and blood uric acid (sample size = 129,405) were conducted based on publicly available genome-wide association analysis (Genome-Wide Association Study, GWAS) on the East Asian populations regarding preeclampsia and blood uric acid, respectively. We assessed blood uric acid and PE associations using two-sample Mendelian randomization (TSMR) analyses based on GWAS pooled statistics using inverse variance weighted (Inverse variance weighted), MR-Egger, and Weighted median (Weighted median) to examine the association between blood uric acid and pre-eclampsia. Causal relationship between blood uric acid and pre-eclampsia.Cochran's Q statistic was used to quantify the heterogeneity of instrumental variables among other methods. Subsequently, we extracted the expression quantitative trait loci (eQCTL, Expression quantitative trait loci) data corresponding to each gene as the instrumental variables using the genes corresponding to the intersecting instrumental variables of the exposure and the outcome in the respective analyses of the forward and backward TSMR respectively, so as to analyze the genetic causality of the genes with the different forward and backward TSMR methods further. Inverse variance weighted (IVW) was used to analyze the genetic causality of genes with different positive and negative outcomes.

RESULTS

Genetically determined blood uric acid level IVW method, ratio (OR) 1.30, 95% confidence interval (CI): [0.6, 2.83], p = 0.51 was not risk associated with PE. In addition according to the inverse MR analysis, we found an OR of 0.99, 95% CI [0.99, 1.0], p = 0.999) for PE on blood uric acid level IVW method and no significant heterogeneity in instrumental variables or level polytropy was found. (ii) Although GWAS data suggested no risk association between PE and uric acid, gene association analysis of eQTL data at blood uric acid levels with PE suggested a risk effect of the TP53INP1 gene for PE (IVW, OR = 11.476, 95% CI 2.511-52.452, p = 1.648 × 10-3) and a protective effect of CTSZ (IVW, OR = 0.011, 95% CI 0.001-0.189, p = 1.804 × 10-3), while a risk effect of ETV7 on hyperuricemia was suggested in a genetic association analysis of PE eQTL data with blood uric acid levels (OR = 1.018, 95% CI 1.007-1.029, p = 1.289 × 10-3).

CONCLUSION

Our MR (Mendelian Randomization) study based on the GWAS database did not support a bidirectional causal effect between blood uric acid levels and PE, whereas MR based on quantitative trait loci suggested that TP53INP1, which affects uric acid levels, has a risk association for PE, whereas CTSZ is protective against preeclampsia. Among the genes affecting PE the ETV7 gene may play a positive role in elevating uric acid levels.

Role of B7H4 and Fas in regulation of trophoblast cells and development of pre-eclampsia: a cross-sectional study

BACKGROUND

This study aimed to investigate the role of B7H4 and Fas in pre-eclampsia (PE) occurrence and development and reveal its potential mechanisms.

METHODS

Thirty healthy individuals and 60 patients with PE were enrolled in the study. In addition, the clinical characteristics of all participants were collected, including age, gestational weeks at delivery, gestational time, number of births, systolic blood pressure, diastolic blood pressure and foetal weight. The chi-square test was used to evaluate differences in clinical characteristics between the high- and low-expression groups. The expression levels of B7H4 and Fas were analysed using western blotting and real-time quantitative polymerase chain reaction (RT-qPCR). The upstream regulators of B7H4 in trophoblasts were predicted and estimated using a luciferase reporter assay. The proliferation and motility of trophoblasts were assessed using CCK8 and transwell assays, respectively.

RESULTS

B7H4 and Fas were upregulated in PE (p < 0.05) and showed diagnostic potential with insufficient sensitivity and specificity [B7H4: area under curve (AUC) = 0.790, sensitivity = 65%, specificity = 83.33%; Fas: AUC = 0.717, sensitivity = 68.34%, specificity = 73.33%]. B7H4 and Fas were closely associated with increased blood pressure in patients with PE (p < 0.05), and the combination of B7H4 and Fas increased the diagnostic efficacy (AUC = 0.864), sensitivity (73.33%) and specificity (86.67%). In trophoblast cells, miR-4319 negatively regulated B7H4 and Fas expression as well as cell proliferation, migration and invasion (p < 0.05). Overexpression of B7H4 alleviated the inhibitory effects of miR-4319, which were reversed by Fas knockdown (p < 0.05).

CONCLUSIONS

miR-4319 mediates the progression of trophoblast progression by negatively regulating the expression of B7H4 and Fas. Therefore, B7H4 and Fas may serve as potential biomarkers for the prediction and treatment of PE.

Homodyned K-Distribution Temporal-Based Characterization of Rat Placenta Microstructure Using the Reduced Uterine Perfusion Pressure Model of Preeclampsia

OBJECTIVE

We characterize rat placenta microstructure in the context of the reduced uterine perfusion pressure (RUPP) model of preeclampsia using the homodyned K-distribution to parameterize envelope-detected signals of ultrasound radiofrequency echo frames obtained in vivo. Preeclampsia is a life-threatening pregnancy syndrome related to abnormal placental tissue microstructure which motivated the quantitative ultrasound-based tissue characterization approach used in this study.

METHODS

Ultrasound radiofrequency echo frames against time (or videos) were obtained on 30 and 38 in vivo placentae at gestation day (GD) 14 and 18 respectively, using 9 Sprague-Dawley rats. Preeclampsia-like effects were induced by surgical modification (post GD 14) following the RUPP model, giving a total of 20 RUPP and 18 control placentae at GD 18. The homodyned K-distribution was fit to value distributions of envelope-detected signals of ultrasound radiofrequency echo frames against time, yielding temporal α (scatterer number per resolution cell) and κ (ratio of coherent to diffuse signal power) parameters used to characterize the placental tissue microstructure.

RESULTS

Visualization of GD 18 α values as a color overlay on B-mode ultrasound video suggested higher values of control compared with RUPP. The mean kurtosis for RUPP was 4.07 ± 0.71 in comparison to 5.08 ± 1.28 for the control using placenta-level kurtosis values (p = 0.0044). There were no significant differences observed in GD 14 placentae, consistent with expectations. Further, we visualized and quantified temporal changes in GD 18 α values with frame-level statistics that support earlier findings.

CONCLUSIONS

This study quantitatively characterizes rat placenta microstructure using the homodyned K-distribution and temporal α and κ parameters.

SIRT2 alleviates pre-eclampsia via prompting mitochondrial biogenesis and function

AIMS

Pre-eclampsia (PE) globally impacts 2-8 % of pregnancies and is a leading cause of neonatal and maternal morbidity and mortality. Recent studies found the association between mitochondrial dysfunction and deficient motility of trophoblast cells in PE. Lower expressions of mitochondrial biogenesis related proteins (i.e. PGC1α, NRF1 and TFAM) and SIRT2 have recently been found. However, the regulative role of SIRT2 on the protein expression and acetylation of PGC1α and its influence on trophoblast migration and invasion in PE have never been investigated.

MATERIALS AND METHODS

The alterations in protein expressions of SIRT2 and PGC1α/NRF1/TFAM were examined in the placenta from pregnant women with and without PE. The role of SIRT2 on mitochondrial biogenesis and mitochondrial morphology/function was explored in trophoblast cell, and the findings were confirmed in the LPS-induced PE mice with adeno-associated virus transfection system.

KEY FINDINGS

We demonstrated the lower protein expressions of SIRT2 and PGC1α/NRF1/TFAM and mitochondrial dysfunction in PE patients and mice compared with counterparts. Moreover, overexpression of SIRT2 enhanced the protein expressions of PGC1α and deacetylated PGC1α, and further facilitating mitochondrial function and motility of trophoblast cells. In vivo, overexpression of SIRT2 attenuated the PE-like symptoms and adverse pregnancy outcomes in LPS-induced PE mice via promoting mitochondrial biogenesis.

SIGNIFICANCE

Above findings suggest that SIRT2 might be a potential interventive target against PE via improving deacetylation of PGC1α and mitochondrial biogenesis and function.

Optimizing pre-eclampsia prevention: Embracing low-dose calcium in sub-Saharan Africa

Pre-eclampsia remains a significant health challenge in sub-Saharan Africa, contributing substantially to maternal and neonatal mortality rates. This paper explores the potential of low-dose calcium supplementation as an alternative strategy to the conventional high-dose regimen in preventing pre-eclampsia. A consistent association between low serum calcium levels and an increased risk of pre-eclampsia is established based on studies spanning Ghana, Nigeria, and Ethiopia. The challenges associated with implementing high-dose calcium supplementation, including cost, logistics, limited information, and adherence issues, underscore the need for a paradigm shift. The evidence presented advocates for integrating low-dose calcium supplementation into sub-Saharan African prenatal care programs. The paper emphasizes the role of healthcare providers in educating women about the benefits and safety of low-dose calcium supplements. Future research and implementation initiatives are urged to refine and tailor these approaches to the region's diverse needs, advancing the collective goal of enhancing maternal and newborn health. This exploration of creative and context-specific solutions underscores the potential of low-dose calcium to significantly contribute to reducing the prevalence of hypertensive disorders in pregnancy, particularly pre-eclampsia, ultimately contributing to healthier and thriving communities in sub-Saharan Africa.

Polyphenols for the Prevention or Management of Preeclampsia: A Systematic Review and Meta-Analysis

OBJECTIVES

To evaluate the effects of polyphenol-containing products during pregnancy on preeclampsia-related maternal and neonatal outcomes.

DESIGN

Systematic review and meta-analysis.

SETTING

Nine databases and one trial registry, from inception to August 11th, 2023.

POPULATION/SAMPLE

Randomised controlled trials where women received polyphenolic-containing products (as standardised extracts or dietary supplements) compared to placebo or standard care.

METHODS

All review stages were conducted by two independent reviewers. Random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman method using a framework for studies with few events.

MAIN OUTCOME MEASURES

Clinical outcomes combining the core outcome set for preeclampsia and WHO's priority outcomes.

RESULTS

Fourteen trials investigating six candidates were included. In women with preeclampsia, the addition of epigallocatechin gallate (EGCG) to nifedipine may reduce the time needed to achieve blood pressure control (mean difference (MD) = -14.10 min, 95% CI -18.46 to -9.74) and increase the time to the next hypertensive crisis (MD = 3.10 h, 95% CI 2.35 to 3.85) compared to nifedipine alone (1 trial, 349 women; low certainty). Similarly, the addition of resveratrol to nifedipine may reduce the time needed to achieve blood pressure control (MD = -15.50 min, 95% CI -19.83 to -11.17) and increase the time to the next hypertensive crisis (MD = 2.50 h, 95% CI 2.09 to 2.91) (1 trial, 349 women; low certainty). No differences were observed for other outcomes or candidates (Salvia miltiorrhiza, Bryophyllum pinnatum , raspberry and cranberry extracts).

CONCLUSIONS

ECGC and resveratrol supplements have been investigated for potential effects in managing clinical signs and symptoms of preeclampsia; however, evidence on the clinical and adverse effects of polyphenols is limited and uncertain.

Stress and Pregnancy Outcomes: A Review of the Literature

The human body has the ability to adapt to changing circumstances, and mobilizes various biological systems in order to do so. When exposed to stressful conditions, the endocrine, nervous, and immune systems come together to aid in maintaining homeostasis; however, during periods of chronic stress, these systems can become maladaptive and lead to long-term detrimental health outcomes. Amongst the lingering effects associated with chronic stress exposure, increasingly, studies are identifying a link to adverse pregnancy and neonatal outcomes. This review explores what has been uncovered in the field to date, and examines the effects of stress on fertility and gestation. Establishing additional factors which put women at risk for adverse pregnancy outcomes can aid in identifying a vulnerable population who could benefit from early stress-reducing interventions.

Effect of aspirin on biomarker profile in women at high risk for preeclampsia

BACKGROUND

There is limited evidence in the literature regarding the temporal changes of preeclampsia-related biomarkers during pregnancy in high-risk women who develop preeclampsia despite the administration of aspirin prophylaxis.

OBJECTIVE

This study aimed to compare the temporal changes in mean arterial pressure, uterine artery pulsatility index, placental growth factor, and soluble fms-like tyrosine kinase-1 across gestation in women identified as having high risk for preterm preeclampsia receiving aspirin prophylaxis and low-risk women without aspirin treatment.

STUDY DESIGN

This was a prospective longitudinal nested case-control study of 2007 women with singleton pregnancies who participated in the first-trimester screen-and-prevent program for preeclampsia at the Prince of Wales Hospital, Hong Kong Special Administrative Region, China, between January 2020 and May 2023. The risk of developing preterm preeclampsia was determined using the Fetal Medicine Foundation triple test (maternal factors, mean arterial pressure, uterine artery pulsatility index, and placental growth factor). High-risk women (adjusted risk ≥1:100) were administered a daily dose of aspirin at either 100 or 160 mg according to maternal weight, starting before 16 weeks until 36 weeks or until delivery or the onset of preeclampsia before 36 weeks. Low-risk women were matched according to maternal age, weight, and the date of the scan. The participants were followed up at 12 to 15+6, 20 to 24+6, and 30 to 37+6 weeks to measure mean arterial pressure, uterine artery pulsatility index, placental growth factor, and soluble fms-like tyrosine kinase-1 at each visit. The level of biomarker was expressed as multiple of the median. Log10 transformation was applied to fit the data to a Gaussian distribution before statistical analysis. A linear mixed-effects analysis was performed to compare the longitudinal changes of these biomarkers across gestation between the study groups.

RESULTS

Our study involved 403 low-risk women without preeclampsia, 1471 high-risk women without preeclampsia, and 133 high-risk women who developed preeclampsia. The low-risk group had significantly lower estimated marginal mean log10 mean arterial pressure multiple of the median, log10 uterine artery pulsatility index multiple of the median, and log10 soluble fms-like tyrosine kinase-1 multiple of the median, and higher estimated marginal mean log10 placental growth factor multiple of the median across gestation compared with the high-risk groups (P<.001). Among high-risk women, those who developed preeclampsia exhibited a significantly higher estimated marginal mean log10 mean arterial pressure multiple of the median (0.06378 vs 0.02985; P<.001), log10 uterine artery pulsatility index multiple of the median (0.08651 vs 0.02226; P<.001), and log10 soluble fms-like tyrosine kinase-1 multiple of the median (0.13204 vs 0.01234; P<.001), and lower estimated marginal mean log10 placental growth factor multiple of the median (-0.33504 vs -0.16388; P<.001) across gestation compared with those without preeclampsia. In the individual gestational time point analysis, compared with high-risk women without preeclampsia, those who developed preeclampsia exhibited higher log10 mean arterial pressure multiple of the median in all 3 trimesters, higher log10 uterine artery pulsatility index multiple of the median and lower log10 placental growth factor multiple of the median in the second and third trimesters, and higher log10 soluble fms-like tyrosine kinase-1 multiple of the median in the third trimester.

CONCLUSION

This study demonstrated that high-risk women who developed preeclampsia consistently exhibited high mean arterial pressure levels from the first trimester that remained unchanged during pregnancy, high uterine artery pulsatility index levels and low placental growth factor levels starting from the second trimester, and high soluble fms-like tyrosine kinase-1 levels in the third trimester compared with those who did not develop preeclampsia despite the administration of low-dose aspirin. These findings underscore the role of these biomarkers in further risk stratification for the development of preeclampsia among high-risk women following aspirin administration.

Investigation of TIGIT, PVRIG, CD112 and CD155 expression in early and late onset preeclampsia

Preeclampsia is characterized by hypertension and proteinuria after the 20th week of pregnancy. The disease is divided into early and late onset according to the time of diagnosis. Early onset preeclampsia (EOP) develops after the 20th week of pregnancy. The late-onset form usually occurs after the 34th week of pregnancy. TIGIT and PVRIG are immune checkpoint inhibitor receptors. PVRIG binds only to the PVRL2 (nectin-2, CD112). TIGIT binds to both CD112 and CD155. In our study, the control group consisted of placentas from healthy pregnant women, the early onset preeclampsia group (EOP) consisted of patients diagnosed before the 34th week, and the late-onset preeclampsia group (LOP) consisted of placentas from patients diagnosed at or after the 34th week. TIGIT, PVRIG, CD155, and CD112 expression in placental materials was evaluated both immunohistochemically and by RT-PCR. As a result of H scoring of immunohistochemical expression, it was observed that CD112 and CD155 expression decreased and PVRIG expression increased when the EOP and LOP groups were compared with the control group. In the early onset preeclampsia group, CD112, CD155, TIGIT, and PVRIG gene expression increased twofold compared to that in the control group. In the late-onset preeclampsia group, the expression of all the genes decreased to one-third. The results of our study revealed that these genes may serve as biomarkers for early- and late-onset preeclampsia. Detailed studies are required to determine the use of these receptors in the diagnosis and treatment of the disease.

Development and validation of a preeclampsia prediction model for the first and second trimester pregnancy based on medical history

OBJECTIVE

The study aimed to identify the risk factors of preeclampsia (PE) and establish a novel prediction model.

STUDY DESIGN

A retrospective, single-center analysis was conducted using clinical data from 5099 pregnant women who gave birth at Peking University People's Hospital between June 2015 and December 2020 who had placental growth factor (PIGF) levels records at 13-20 + 6 gestation weeks. The participants were randomly divided into a training set (70%, n = 3569) and a validation set (30%, n = 1030), between which the consistency was checked, and the analysis was performed according to whether PE occurred during pregnancy. Factors with univariate logistic analysis outcome of p < 0.2 were incorporated into the multivariate logistic regression analysis model, then variable selection by stepwise regression with AIC as the criterion was executed to finally identify the variables used for modeling. The model's discriminative ability was assessed using the receiver operating characteristic (ROC) curve, and its calibration was evaluated through calibration curves and Hosmer-Lemesow test. In addition, decision curve analysis (DCA) was used for clinical net benefit appraisal.

RESULTS

Logistic regression analysis identified nine risk factors for PE, including: maternal age (OR = 1.072, 95%CI = 1.025-1.120), parity(OR = 0.718,95%CI = 0.470-1.060), pre-pregnancy BMI (OR = 2.842,95%CI = 1.957-4.106), family hypertension history (OR = 3.604,95%CI = 2.433-5.264), pregestational diabetes mellitus(PGDM) (OR = 8.399, 95%CI = 4.138-15.883), pregnancy complicating nephropathy (OR = 7.931, 95% CI = 2.584-20.258),pregnancy complicating immune system disorders (OR = 3.134, 95% CI = 1.624-5.525), mean arterial pressure(MAP) at 11-13 + 6 gestational weeks (OR = 1.098, 95% CI = 1.078-1.119) and PIGF (OR = 0.647, 95% CI = 0.448-0.927) at 13-20 + 6 gestational weeks (P < 0.05). The restricted spline regression analysis (RCS) analysis results showed that PIGF and the risk of PE presented an approximately "L-shaped" relationship, with the risk of PE rising sharply with the decrease of PIGF when PIGF < 90 pg/ml, and little change with the increase of PIGF when PIGF > 90 pg/ml. A risk prediction model for PE during the first and second trimester was constructed based on the above selected 11 factors. The area under the ROC curve (AUC) for the model was 0.781(95%CI = 0.709-0.853), and the sensitivity and specificity at the optimal cut-off value (threshold probability) were 0.571 and 0.879 respectively. Chi-square of 9.616 and P value of 0.293 from Hosmer-Lemeshow test indicated that the model was well calibrated. Finally, the model showed good clinical net benefits in the threshold range of 0.03-0.3.

CONCLUSION

The incidence of PE was associated with maternal age, pre-pregnancy weight and BMI, family hypertension history, PGDM, pregnancy complicating nephropathy, gestational complicating immune system disorders, blood pressure (systolic, diastolic, mean arterial pressure) at 11-13 + 6 gestational weeks, and PIGF at 13-20 + 6 gestational weeks. When PIGF < 90 pg/ml at 13-20 + 6 gestational week, the risk of PE increased significantly with the reduction of PIGF. The nomogram based on the above results was simpler and more practical in clinical application for PE predicting during the first and second trimester, and may provide an important reference for doctors and patients.

Hyperlipidemia Triggers Trophoblast Cell Dysfunction and Preeclampsia via the AMPK/GATA3/FTL Pathway

BACKGROUND

Preeclampsia, a severe pregnancy complication with an incompletely deciphered cause, is strongly associated with hyperlipidemia. Our previous studies demonstrated that FTL (ferritin light chain) expression was diminished in preeclampsia placentas and that FTL downregulation inhibited trophoblast invasiveness and migration while promoting apoptosis, contributing to preeclampsia development. However, the potential interplay between hyperlipidemia and FTL in the pathogenesis of preeclampsia, as well as the regulatory mechanism involved, remains to be elucidated.

METHODS

We conducted Spearman correlation analysis, used a high-fat diet-fed mice model, cell culture, and molecular biology assays, including immunohistochemistry, chromatin immunoprecipitation, and dual-luciferase reporter gene assays, to explore the impact of hyperlipidemia on the development of preeclampsia and to elucidate the molecular mechanisms involved.

RESULTS

Pregnant women with preeclampsia presented elevated serum total cholesterol, triglycerides, and low-density lipoprotein, with reduced high-density lipoprotein. Similarly, high-fat diet-fed mice exhibited dyslipidemia and preeclampsia-like characteristics. FTL expression was reduced in the placentas of patients with preeclampsia and high-fat diet-fed pregnant mice. In vitro, palmitic acid treatment reduced FTL expression, increased oxidative stress, and impaired trophoblast migration and invasion. GATA3 (GATA binding protein 3) was predicted to be an upstream transcription factor for FTL, with its knockdown reducing and its overexpression increasing FTL levels. Further analysis indicated that palmitic acid suppressed FTL expression by inhibiting GATA3 nuclear translocation and that AMPK (AMP-activated protein kinase) activation rescued FTL expression and restored trophoblast function.

CONCLUSIONS

This study revealed that high lipid levels contribute to preeclampsia by downregulating FTL through the AMPK-GATA3 pathway, highlighting potential therapeutic targets for preeclampsia management.

Effect of Hypertensive Disorders of Pregnancy (HDP) on maternal and perinatal birth outcomes in Eastern Ethiopia: a prospective cohort study

BACKGROUND

Globally, hypertensive disorders of pregnancy are the major causes of maternal and perinatal morbidity and mortality. In low and middle-income countries, including Ethiopia, studies on the effect of hypertensive disorders of pregnancy on maternal and perinatal birth outcomes are limited.

OBJECTIVES

The aim of this study was to examine the effect of hypertensive disorders of pregnancy on maternal and perinatal birth outcomes in Eastern Ethiopia.

METHODS

We employed a prospective cohort study design involving 374 pregnant women, equally divided into hypertensive ((n = 187) and normotensive (n = 187). Data were collected face to face using an interviewer-administered questionnaire as well as by reviewing the medical records of the mothers. Data analysis was done in STATA Version 17. Binary logistic regression was run to produce risk ratios (relative risk) and 95% confidence intervals along with their p-values were calculated in the bivariate and multivariable analyses. Significance was declared at a P-value of less than 0.05.

RESULTS

Compared with normotensive, women with hypertensive disorder had significantly increased risk of developing preterm birth (cRR = 1.8; 95% CI, 1.5, 2.2), stillbirth (cRR = 1.6; 95% CI, 1.3, 2.02), low birth weight (cRR = 1.9; 95% CI, 1.6, 2.3), and early neonatal death (cRR = 1.7; 95% CI, 1.3, 2.3). Women with hypertensive disorders had 2.6 times (aRR = 2.6, 95% CI; 1.2, 5.7) higher risk of perinatal death, and 1.7 (aRR = 1.7; 95%CI, 1.02, 2.90) times higher risk of cesarean section delivery compared with the normotensive women controlling the other variables.

CONCLUSION

Significant risk of cesarean section delivery, perinatal death, stillbirth, low birth weight delivery, and early neonatal death were reported among women with hypertensive disorders of pregnancy. To minimize the burden of the problem, much has to be done by health care professionals and stakeholders focusing on the identification and proper management of mothers with hypertensive disorders.

Maternal exposure to Waste-to-Energy plants and risks of adverse birth outcomes and hypertensive pregnancy disorders in Lazio, Italy

Evidence on the effects of waste incineration on adverse birth outcomes (ABO) and hypertensive disorders of pregnancy (HDP) is limited. We investigated the association between maternal exposure to a waste-to-energy (WTE) plant in Lazio Region and ABO/HDP. Employing a difference-in-differences (DiD) design, we assessed changes related to the plant's deactivation (2017), comparing outcomes to a control WTE plant that remained operational. Mothers with geocoded residential address within 7 km from Colleferro (exposed area) and San Vittore del Lazio (control area) plants who delivered between 2007 and 2023 were enrolled. Information was derived from regional health databases. Outcome-specific multivariate logistic models included interaction terms between a "pre-post" variable (0 for deliveries in the operational period - 1 for deliveries in the post-operational period) and a variable indicating the plant (Colleferro/San Vittore) linked to each delivery. Secondary analyses considered extended buffers around the plants or a control group from a broader area surrounding Colleferro, instead of San Vittore. 25,360 deliveries occurred within 7 km from the two WTE plants. After Colleferro plant's deactivation, pre-eclampsia risk decreased compared to San Vittore (OR = 0.35; 95 % CI: 0.13-0.93). Suggestions of association were noted for ABO, for example preterm birth (OR = 0.83; 95 % CI: 0.62-1.10). Pre-eclampsia risk remained low when using an extended buffer for the delivery selection. Exposure to WTE plant emissions was associated with ABO and HDP. While further research is needed, public health measures should enhance stricter emission monitoring, cleaner waste management, and prevention for pregnant women in affected areas.

Expression and Clinical Significance of Irisin in Serum and Placenta Tissues of Pregnant Women with Severe Preeclampsia

Objective

Preeclampsia (PE) is a serious pregnancy-specific disorder that poses significant risks to maternal and fetal health, with severe preeclampsia (SPE) being a particularly life-threatening complication. The objective of this study is to investigate the effects and clinical significance of irisin in pregnant women with severe preeclampsia (SPE). Irisin levels in the serum and placental tissues of healthy pregnant women and those with early- and late-onset SPE were measured and compared.

Methods

A total of 70 pregnant women treated at our hospital from January to November 2023 were selected for this study. The participants were divided into three groups: 20 women with early-onset severe preeclampsia (ES-PE group), 20 women with late-onset severe preeclampsia (LS-PE group), and 30 healthy pregnant women (control group). Fasting peripheral blood samples (5 mL) were collected from each participant, and placental tissues were obtained after delivery. Irisin levels in serum were measured using enzyme-linked immunosorbent assays (ELISA) with a commercial kit, and irisin expression in placental tissues was assessed by immunohistochemistry (IHC) with a rabbit anti-irisin antibody. The modes of delivery were also recorded.

Results

The concentrations of irisin in both serum and placental tissues were significantly higher among pregnant women in the control group compared to the ES-PE and LS-PE groups. There was a significant difference between the control group and the ES-PE and LS-PE groups in the mode of delivery. Additionally, a significant positive correlation was identified between the serum irisin concentration and its differential expression in placental tissues, while there was a significant negative correlation between irisin levels in both serum and placental tissue and systolic and/or diastolic blood pressure.

Conclusion

Reduced serum and placental irisin levels in pregnant women with SPE were associated with the onset and progression of SPE and may serve as a potential biological marker for SPE screening.

Daily Versus BID Nifedipine GITS in Severe Preeclampsia: Randomized Controlled Trial

BACKGROUND

Optimal dosing of nifedipine gastrointestinal therapeutic system (GITS) in pregnancies complicated by preeclampsia with severe features is unknown. We assessed whether nifedipine GITS 30 mg BID improved blood pressure control when compared with nifedipine GITS 60 mg daily.

METHODS

Unblinded, randomized controlled trial, at a single academic hospital from December 2021 to December 2023. Individuals between 220/7 and 335/7 weeks of gestation diagnosed with preeclampsia with severe features were randomized to nifedipine GITS 60 mg QD or 30 mg BID once the decision to increase the total daily dose was made. The primary outcome was the percentage of suboptimal blood pressures on hours 24 to 48 after randomization, defined as the ratio of systolic ≥150 mm Hg and diastolic ≥100 mm Hg blood pressure episodes divided by the total number of blood pressures taken during the collection time period.

RESULTS

The percentage of suboptimal blood pressure from hours 24 to 48 was similar between groups (60 mg daily: 34.2±29.4% versus 30 mg BID: 32.8±34.0%; P=0.87). The need for any emergent antihypertensive treatment during the blood pressure collection period was higher in the 60 mg daily group (46.2% versus 14.8%; P=0.03). Secondary outcomes including gestational age at delivery and number of increases in long-acting antihypertensive regimen were similar.

CONCLUSIONS

Nifedipine GITS dosed 60 mg daily and 30 mg BID has similar rates of suboptimal blood pressure in individuals with preeclampsia with severe features. However, there is a reduction in the need for emergent antihypertensive treatment for severe range blood pressures with BID dosing, which would favor its use in this population.

Antiretroviral Therapy at Conception Leads to Lower Peripheral CD49a+ NK Cells and Higher SERPINB2

Problem: Antiretroviral therapy (ART) during pregnancy is essential to prevent vertical HIV transmission and preserve the health of the mother and child. However, ART in pregnancy has been associated with adverse birth outcomes linked to poor placental development. Immune dysregulation of placental development is an important factor in the development of preeclampsia (PE), a common hypertension disorder of pregnancy. Some studies found an association between ART use at conception or during the first trimester and PE. However, little is known regarding the impact of timing of ART initiation on the immune environment in pregnancy. Methods: To investigate the immune environment in pregnant persons with HIV (PPWH) on ART at conception (N = 40) compared to PPWH that started ART in the second trimester (N = 40) we analyzed specimens from the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Perinatal Core Protocol, P1025, concluded in 2013. Results: No difference was found in soluble factors in circulation including PlGF and sFLt-1, associated with PE. However, upon analysis of PBMC by high dimension flow cytometry, we detected a lower frequency of circulating CD49a+ NK cells, associated with uterine tissue and pregnancy, in PPWH on ART at conception compared with PPWH who started ART in the second trimester. Moreover, PBMC from PPWH on ART at conception expressed higher levels of SERPINB2 in transcriptomics analyses. Conclusions: Our findings shed new insights into the potential impact of ART at conception and suggest the persistence of a dysregulated inflammatory environment compared to PPWH starting ART after the conclusion of placental development.

Diagnosis of Hypertensive Disorders in Pregnancy: Hypertensive Disorders in Pregnancy

Hypertensive disorders of pregnancy, including chronic hypertension, superimposed preeclampsia, gestational hypertension, and preeclampsia, affect 10-20% of pregnancies and are a significant cause of maternal and perinatal mortality. The incidence of these disorders is rising due to factors such as advanced maternal age, obesity, assisted reproductive technology, and increased rates of preexisting comorbidities. Differentiating pregnancy-associated hypertension from pre-existing chronic hypertension is challenging, as the overlap between the two may be broadening due to the changing demographics of the pregnant population. This review critically evaluated the evidence regarding the current time periods recommended to make a diagnosis of a hypertensive disorder of pregnancy. We noted no evidence to support the arbitrary 4-hour time period or any particular time period for diagnosis of hypertensive disorders in pregnancy. In addition, there is no clear definition of what is considered persistent or sustained blood pressure elevations in blood pressure. Every effort should be made to ensure accurate diagnosis of new onset elevated blood pressures during pregnancy prior to labeling the patient with the diagnosis and thus recommending serial maternal and fetal testing and delivery at or before 37 weeks' gestation.

Predicting complications in hypertensive disorders of pregnancy: external validation of a prognostic model for adverse perinatal outcomes

BACKGROUND

Prediction models can be used as simple evidence-based tools to identify fetuses at risk of perinatal death. Payne et al developed a prognostic model for perinatal death in women with hypertensive disorders of pregnancy, a leading cause of maternal/fetal morbidity and mortality.

OBJECTIVE

This study aimed to externally validate the predictive performance of this model in pregnant women with hypertensive disorders of pregnancy admitted between 26 and 34 weeks of gestation in Ghana.

STUDY DESIGN

The perinatal model was applied in the SPOT (Severe Pre-eclampsia adverse Outcome Triage) study, a cohort of women with hypertensive disorders of pregnancy admitted between 26 and 34 weeks of gestation to referral facilities in Ghana. Predictive performance was assessed by calibration (calibration-in-the-large coefficient and calibration slope) and discrimination (based on the c-statistic).

RESULTS

Of the 543 women included in the validation analysis, 87 (16%) experienced perinatal death from delivery until hospital discharge. Predictive performance of the model was poor. The calibration-in-the-large coefficient was 1.12 (95% confidence interval, 0.87-1.36, 0 for good calibration), calibration slope was 0.08 (95% confidence interval, -0.21 to 0.36, 1 for good calibration), and c-statistic was 0.52 (95% confidence interval, 0.44-0.59).

CONCLUSION

This perinatal prediction model performed poorly in this cohort in Ghana. Possible reasons include differences in case mix, clinical management strategies, or data collection procedures between development and validation settings; suboptimal modeling strategies at development; or omission of important predictors. Given the burden of perinatal mortality and importance of risk stratification, new prediction model development and validation is recommended.

Mechanism of microRNA-152 Regulating Decidual Natural Killer Cell Viability and Affecting Trophoblast Cell Invasiveness via the HLA-G/KIR2DL4 Axis

Trophoblast cells are specialized placental epithelial cells essential for pregnancy maintenance. miR-152 is implicated in trophoblast cell regulation and pregnancy failure. This study explores the role of miR-152 in decidual natural killer (dNK) cell viability and trophoblast cell invasion. HTR-8/SVneo cells were transfected with miR-152-mimics/inhibitor or their respective controls, followed by co-culture with dNK cells. RT-qPCR assessed transfection efficiency, while cytokine secretion (IL-8, IP-10, VEGF), cell viability, apoptosis, and invasion were evaluated via ELISA, CCK-8, flow cytometry, Western blot, and Transwell assays. The interaction between miR-152 and HLA-G was examined via dual-luciferase reporter assay, and HLA-G/sHLA-G levels were measured. Co-cultures of dNK cells and miR-152/HLA-G-overexpressing HTR-8/SVneo cells were established, and anti-KIR2DL4/IgG1 was used to block HLA-G/KIR2DL4 binding. Co-immunoprecipitation confirmed protein interactions. miR-152 overexpression suppressed dNK cell cytokine secretion, reduced HTR-8/SVneo cell viability and invasion, and promoted apoptosis. miR-152 inhibition had the opposite effect. miR-152 directly targeted HLA-G, and HLA-G overexpression rescued dNK function and trophoblast invasion. Blocking the HLA-G/KIR2DL4 binding counteracted the effects of miR-152. miR-152 inhibits dNK cell function and trophoblast invasion by targeting HLA-G, reducing HLA-G/KIR2DL4 interaction. These findings highlight a potential regulatory mechanism in pregnancy maintenance.

Endothelial damage and complement dysregulation in fetuses from pregnancies complicated by preeclampsia

INTRODUCTION

Our objective was to evaluate the endothelial function profile and complement system in fetuses from preeclamptic pregnancies using ex vivo and in vitro approaches.

MATERIAL AND METHODS

A total of 66 singleton pregnancies were prospectively recruited comprising 34 cases of preeclampsia and 32 normotensive pregnancies matched for baseline characteristics. In the ex vivo approach, soluble tumor necrosis factor-a receptor 1 (sTNFR1), vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1), Von Willebrand factor (sVWF), terminal complement complex (sC5b-9), Factor H, complement component C3a and Factor Bb were analyzed in fetal cord blood samples. In the in vitro model, vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), Von Willebrand factor (VWF), vascular endothelial cadherin (VE-Cadherin), endothelial nitric oxide synthase (eNOS), reactive oxygen species (ROS) and C5b-9 deposits were evaluated on endothelial cells in culture exposed to fetal sera or plasma.

RESULTS

Increased sVCAM-1, sICAM- l and decreased Factor H and Factor Bb concentrations were detected in preeclampsia fetuses as compared to fetuses from normotensive mothers (509.4 ± 28 vs. 378.4 ± 34.3 ng/mL, 161.1 ± 11.9 vs. 114.8 ± 6.8, 199.6 ± 18.3 vs. 267.1 ± 15.4 ng/mL and 6.6 ± 0.7 vs. 10.3 ± 1.4 μg/mL respectively, p < 0.05) with similar results in sTNFR1, sVWF, sC5b-9 and C3a. Endothelial cells exposed to fetal sera from preeclampsia showed incremented expression of VCAM-1(38.1 ± 1.4% vs. 28.3 ± 1.6%, p < 0.01), ICAM-1 (12 ± 0.9% vs. 8.6 ± 0.6%, p < 0.05), VWF (43.5 ± 2.9% vs. 3.7 ± 0.3%, p < 0.05), and ROS (5 × 1013 ± 1 × 1012 vs. 3.5 × 1013 ± 1.4 × 1012, p < 0.01) with similar expression of VE-Cadherin and eNOS as compared to those exposed to control fetuses. While soluble C5b-9 was similar between the study groups (851.4 ± 177.5 vs. 751.4 ± 132.81 ng/mL, p > 0.05), significantly less C5b-9 deposits on endothelial cells were induced by fetal plasma from preeclamptic compared to normotensive mothers (fold change 0.08 ± 0.02 vs. 0.48 ± 0.13, p < 0.01).

CONCLUSIONS

High levels of endothelial adhesion molecules and oxidative stress products suggest endothelial damage and reduced in vitro deposition of C5b-9 indicates complement dysregulation in preeclampsia fetuses. More research is necessary to study the impact of preeclampsia on fetal vascular health and innate immunity.

Prevention of Pre-Eclampsia: Modern Strategies and the Role of Early Screening

Background: Pre-eclampsia (PE) remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Early detection and risk stratification are critical for improving pregnancy outcomes. This review aims to summarize current advancements in PE screening, including clinical risk factors, biomarkers, imaging techniques, and predictive models. Methods: A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar to identify relevant studies on PE screening and prediction. Peer-reviewed original studies, systematic reviews, and meta-analyses published in English were included, while case reports and conference abstracts were excluded. Results: Traditional screening methods rely on maternal history and clinical risk factors, while emerging approaches incorporate biochemical markers and ultrasound parameters to enhance predictive accuracy. Machine learning models and artificial intelligence (AI)-driven algorithms are being explored for improved risk stratification. However, challenges such as data heterogeneity, lack of external validation, and integration into clinical practice remain. Conclusions: Advances in PE screening hold promise for early identification and targeted prevention strategies. Future research should focus on validating predictive models in diverse populations, integrating AI with traditional screening methods, and developing personalized approaches to reduce PE-associated complications.

Persistence of hypertension after pregnancy-related hypertensive disorders in women with polycystic ovary syndrome

OBJECTIVE

To assess whether polycystic ovary syndrome (PCOS) increases the risk of persistent hypertension in women with a history of pregnancy-related hypertensive disorder (PHD).

DESIGN

A single-center, prospective cohort study.

SUBJECTS

A total of 124 patients with PHD were enrolled. Pregnancy-related hypertensive disorder was diagnosed on the basis of the presence of pregnancy-induced hypertension or preeclampsia. All patients with PHD were screened for PCOS diagnosis, which was confirmed or excluded on the basis of patient history and clinical reports. Sixty-two patients diagnosed with PCOS (n = 62 cases) were included as the study group. After 1-to-1 matching process on the basis of age, body mass index, and infertility treatment, 62 control patients without PCOS were also included.

EXPOSURE

Polycystic ovary syndrome diagnosis according to the national and international criteria.

MAIN OUTCOME MEASURES

The primary outcome was the persistence of hypertension 12 months after delivery. The secondary outcomes included persistence of hypertension at 3 and 6 months from delivery, pregnancy complications, and data on antihypertensive treatment.

RESULTS

After 12 months from delivery, the risk of persistent hypertension was significantly higher in patients with PHD with PCOS than in controls [adjusted odds ratio, 5.01; 95% confidence interval (CI), 1.63-15.94]. At 6 months, that risk was also significantly higher (adjusted odds ratio, 5.01; 95% CI, 1.63-15.94). Additionally, pregnant patients with PCOS had an earlier onset of PHD (30.0 vs. 31.1 weeks), required a higher dose of nifedipine (37.5 mg vs. 30 mg), and were more likely to receive antihypertensive therapy with multiple drugs (24.2% vs. 9.7%) than controls. The incidence of fetal growth restriction (19.4% vs. 6.5%), abnormal Doppler velocimetry (16.1% vs. 4.8%), and cesarean delivery (35.5% vs. 19.4%) was also significantly higher in the PCOS group than in controls.

CONCLUSION

Polycystic ovary syndrome is associated with an increased risk of persistent hypertension in patients with a history of PHD. Preventive interventions before pregnancy, specific pregnancy surveillance, and long-term follow-up should be recommended for women with PCOS.

Mitochondrial Oxidative Phosphorylation Alterations in Placental Tissues from Early- and Late-Onset Preeclampsia

Preeclampsia (PE), a pregnancy complication characterized by high blood pressure and organ damage, has been suggested to be associated with mitochondrial dysfunction, although evidence remains limited. This study aimed to investigate the activity of oxidative phosphorylation (OXPHOS) enzymes and the expression of related proteins in placental tissues from women diagnosed with early-onset preeclampsia (eoPE, <34 weeks of gestation), late-onset preeclampsia (loPE, ≥34 weeks of gestation), and normotensive controls. Placental samples were analyzed using immunohistochemistry, western blotting, and enzymatic activity assays to assess the activity and expression of OXPHOS complexes. Complex I activity was increased by 80% in eoPE and 56% in loPE, with positive correlations between normalized complex I expression, gestational age at delivery (r = 0.85, p = 0.01), and birth weight (r = 0.88, p = 0.004) in loPE. Relative complex II expression in loPE showed positive correlations with pregnancy duration (r = 0.76, p = 0.03) and birth weight (r = 0.77, p = 0.03), while in controls, complex II expression correlated with pregnancy duration (r = 0.64, p = 0.03). Additionally, complex IV enzyme activity in eoPE was negatively correlated with maternal age at birth (r = -0.69, p = 0.03). The observed correlations highlight mitochondrial metabolism as a promising biomarker for predicting disease progression and guiding therapeutic interventions in preeclampsia. Unraveling its precise role in PE pathogenesis is critical to advancing diagnostic precision and improving maternal-fetal outcomes.

Maternal and Neonatal Outcomes in Gestational Hypertension for Delivery at 37 versus 38 to 40 Weeks

This study aimed to compare neonatal and maternal outcomes for mothers with gestational hypertension delivered at 37 weeks' gestation compared with 38 to 40 weeks.Single-center, retrospective chart review of women with gestational hypertension delivered between 370/7 and 406/7 weeks' gestation over a 29-month period.A total of 337 mother-infant dyads with gestational hypertension were included: 194 delivered at 37 weeks' gestation (cohort 1) and 143 delivered at 38 to 40 weeks' gestation (cohort 2). Preeclampsia developed in 12% of cohort 1 and 8% of cohort 2 (p = 0.242). No significant differences in severe hypertensive-related complications were found between the cohorts. Neonatal outcomes including neonatal intensive care unit admission, respiratory support, phototherapy, and length of stay were all more frequent in cohort 1.For women with gestational hypertension, delivery at 38 to 40 weeks was not associated with increased maternal complications but was associated with fewer neonatal complications when compared with delivery at 37 weeks. · Gestational hypertension is a common complication of pregnancy.. · Mothers with gestational hypertension are often induced early.. · Neonatal adverse outcomes increase with early delivery.. · Optimal timing of delivery for pregnancies complicated by gestational hypertension is unknown..

Hypertensive disorders of pregnancy trends in the United States post aspirin recommendation guidelines

OBJECTIVE

To evaluate changes in the rates of hypertensive disorders of pregnancy (HDP) in the US after the publication of aspirin (ASA) recommendation guidelines by the USPSTF and ACOG.

METHODS

A population-based retrospective cohort study was performed using the US Natality database. The pre-ASA group included births between 2010-2014. The post-ASA group were births between 2016-2021. Births in 2015 were excluded. Outcomes were rates of HDP. Univariate and multivariate analyses were performed. Using the 2010-2014 HDP trend, a projected trend was calculated and compared to the actual trend across the entire cohort.

RESULTS

There were 12,127,659 births in the pre-ASA group and 17,665,217 births in the post-ASA group. The post-ASA group had a significantly higher rate of overall HDP than the pre-ASA group (7.7 % vs 4.9 %; aOR 1.58, 95 % CI [1.57-1.59]). When stratified by gestational age at delivery, the post-ASA group had a significantly lower rate of preterm HDP prior to 37 weeks (21.6 % vs 23.7 %; aOR 0.90, 95 % CI [0.89-0.91]) and preterm HDP prior to 34 weeks (6.0 % vs 7.5 %; aOR 0.79, 95 % CI [0.78-0.81]). The actual HDP trend post-ASA recommendation was higher than projected for overall HDP and preterm HDP < 37 weeks but was not different for preterm HPD < 34 weeks.

CONCLUSION

While overall HDP is increasing, the rate of preterm births complicated by HDP has been decreasing. The actual trend for the overall HDP category and the two preterm HDP categories, however, remains either higher or no different compared to the projected trend post aspirin recommendation guidelines.

Giant intracardiac thrombus-in-transit in a woman with sudden respiratory-haemodynamic compromise following cesarean section for eclampsia: a case report

Background

Intracardiac thrombus-in-transit is a potentially fatal condition, seldom detected in real time.

Case summary

We present a case of a 30-year-old pregnant woman with thalassemia intermedia and asplenia, who experienced a combined respiratory-haemodynamic collapse following an emergent caesarean section performed for eclampsia, and in whom a large mass transversing a patent foramen ovale was observed on bedside echocardiography. In view of the patient's unstable condition, mass' size and location as well as accompanying inter-atrial communication-all of which contributed to an imminent threat to cerebral circulation-and temporal proximity to abdominal surgery and epidural anaesthesia, an immediate open-heart surgery was decided upon that included mass excision and patent foramen ovale closure, and after which the patient quickly and fully recovered. Histopathologic examination of the mass revealed a mixture of thrombotic and amniotic fluid elements. Acute pulmonary embolism was eventually confirmed by computed tomography performed on post-operative day 2.

Discussion

Early echocardiography and surgical intervention, as dictated by a multidisciplinary collaboration, allowed for a favourable outcome in our patient, emphasizing their pivotal role in the management of a life-threatening presentation of an intracardiac thrombus-in-transit.

Low molecular weight heparins promote migration and invasion of trophoblast cells through regulating the PI3K/AKT signaling pathway

Pregnant women confront a high risk of mortality due to preeclampsia (PE), which also results in severe challenges for newborns. Due to their efficient properties and minimal side effects, low molecular weight heparins (LMWHs) are extensively utilized by optimizing their molecular size. Nevertheless, there have been no reports regarding the alleviating effect of LMWHs on PE and the molecular mechanism underlying it. To examine the therapeutic impact of LMWHs on PE, we initially created a PE rat model and assessed the advantages of LMWHs on PE through Western blot, immunofluorescence, TUNEL, 24-h proteinuria determination, and other techniques. Furthermore, we examined the in vitro molecular mechanism of LMWHs therapy on PE using CCK-8, Transwell, Flow cytometry, Wound healing assay, and other techniques. LMWHs, when used in vivo, reduced the rise in blood pressure and 24-h proteinuria in rat models of PE. Additionally, they prevented trophoblast cell apoptosis in these rat models. In vitro, LMWHs demonstrated a significant ability to enhance the migration and invasion of HTR-8 and JEG-3 cells. Mechanistically, LMWHs mitigate the development of PE by activating the PI3K/AKT signaling pathway. According to our findings, the activation of the PI3K/AKT signaling pathway by LMWHs appears to provide relief for PE. Therefore, we have compelling evidence supporting the use of LMWHs as an efficient treatment for PE.

Role of serum high-sensitive C-reactive protein to predict severity of pre-eclampsia in a high-population resource-poor country: a prospective observational study

Objective

To determine the role of high-sensitive C-reactive protein (hsCRP) in predicting the severity of preeclampsia in a high-population, resource-poor country.

Patients and Methods

This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology of Calcutta National Medical College, India, from March 2021 to September 2022. A total of 180 participants were divided into three equal groups: patients with severe preeclampsia and non-severe preeclampsia and healthy pregnant women.

Results

The levels of the biomarkers hsCRP and uric acid differed significantly between women with preeclampsia and healthy women, with cutoff levels of 3.72 mg/L and 5.15mg/dL, respectively, as determined using receiver operating characteristic (ROC) curve analysis. HsCRP was also able to differentiate severe preeclampsia from non-severe preeclampsia at a cutoff level ≥8.75 mg/L (high Youden index >0.6). However, uric acid levels failed to discriminate between pregnant women with severe and non-severe preeclampsia. Elevated hsCRP levels were strongly associated with low birth weight of newborns in pregnant women with preeclampsia and healthy control groups (P=0.001) and with disease severity (P<0.001), respectively.

Conclusions

HsCRP can be used as an important diagnostic tool to exclude and evaluate the severity of preeclampsia.

Alternative splicing of CADM1 is associated with endothelial progenitor cell dysfunction in preeclampsia

Preeclampsia is a pregnancy-specific hypertensive disorder and is associated with an increased postpartum risk of cardiovascular morbidity for both women and their offspring. Previous studies have indicated that cord blood endothelial colony-forming cells (ECFCs) are dysfunctional in preeclampsia. The specific mechanisms are not yet fully understood, but dysregulation of alternative splicing has been proposed as one of the pathogenic pathways. To identify specific targets of alternative splicing in fetal ECFCs, we performed transcriptome-wide differential splicing analyses between cord blood ECFCs from preeclamptic (n = 16) and normal pregnancies (n = 13). Selected splicing events were validated using fragment length analysis and Sanger sequencing. In silico transcriptome-wide differential splicing analysis identified a significantly increased abundance of the CADM1 isoform ENST00000542447 in the preeclamptic cohort (P = 0.002), which was confirmed by wet-lab validation. The deleted exon 8 harbors glycosylation sites known to mediate cell-cell adhesion. To investigate the functional impact of alternative splice variants, we induced an in vitro splice switch using antisense morpholino treatment and then monitored cellular effects using migration and angiogenesis assays in ECFCs from six normal pregnancies. The CADM1 exon 8 skipping converted the normal ECFCs to a preeclampsia-like state characterized by a decreased migration ability (PANOVA = 0.005) and decreased tubule length (PANOVA = 0.02). We propose aberrant splicing of CADM1 and the resulting changes in the adherence properties of ECFCs as a potential contributor to cardiovascular sequelae in the offspring of preeclamptic pregnancies.NEW & NOTEWORTHY We investigated differential splicing between normal and preeclamptic pregnancies in endothelial colony-forming cells (ECFCs) from cord blood. Transcriptome-wide analysis identified exon 8 skipping of CADM1 mRNA to be upregulated in ECFCs from women with preeclampsia. In vitro splice switching studies indicated that induction of this isoform decreases the cell migration and tubule formation abilities of fetal ECFCs. Our findings link a specific splice isoform of CADM1 to preeclampsia, with potential implications for vascular health in the offspring.

Proteinuria is associated with worse outcomes in babies born to mothers with preeclampsia: A retrospective cohort study at a tertiary referral hospital in Brazil

To evaluate whether the presence of proteinuria, although no longer mandatory in the revised diagnostic criteria, results in worse maternal and fetal outcomes in preeclampsia (PE). A retrospective cohort study was conducted, analyzing data from pregnant patients diagnosed with PE between January 2015 and December 2019 at a tertiary care center in Brazil. Ethical approval was obtained, and the patient records were reviewed to assess maternal and perinatal outcomes based on the revised diagnostic criteria by the College of Obstetricians and Gynecologists, focusing on the presence or absence of proteinuria. The study included 816 pregnant patients with PE, of whom 685 (83.9%) were diagnosed based on proteinuria. The revised criteria, which include indicators of organ damage, identified an additional 131 cases (16.4%). Analysis showed no significant differences in maternal outcomes between proteinuria and non-proteinuria groups, including intensive care unit (ICU) admission, acute pulmonary edema (APE), HELLP syndrome, eclampsia, or C-section rates. However, babies born to mothers with proteinuria PE experienced worse outcomes, including fetal growth restriction, low birth weight, ICU admission, and higher rates of preterm birth. Relative risk analysis demonstrated a high risk of babies being born with low birth weight, ICU admission, and being born preterm and very preterm in cases where proteinuria was present in mothers with PE. The presence of proteinuria is associated with significantly worse outcomes in babies born to mothers with preeclampsia, while no significant differences were observed in maternal outcomes.

Potential role of Hematopoietic PBX-Interacting Protein (HPIP) in trophoblast fusion and invasion: Implications in pre-eclampsia pathogenesis

Pre-eclampsia is a known hypertensive disorder of pregnancy. While abnormal placentation and poor trophoblast invasion into maternal endometrium during blastocyst implantation are primary causes of pre-eclampsia, the underlying mechanisms remain elusive. Hematopoietic PBX-Interacting protein (HPIP) is an estrogen receptor (ER) interacting protein that plays a pivotal role in cell proliferation, migration, and differentiation; however, its role in trophoblast functions is largely unknown. In this study, we used BeWo cells as a model system to investigate trophoblast fusion and syncytialization, focusing on the role of HPIP in regulating these critical aspects of trophoblast functions. Herein, we report that HPIP expression declines during forskolin-induced trophoblast fusion in BeWo cells. In support of these observations, HPIP depletion enhanced forskolin-induced human chorionic gonadotropin-β (β-hCG), ERVWE1, and GCM1 expression, markers for trophoblast fusion. Furthermore, silencing of HPIP decreased cell invasion and epithelial to mesenchymal transition (EMT), a prerequisite for syncytialization in BeWo cells. Functional genomic studies further revealed a regulatory role for HPIP in a subset of gene networks involved in trophoblast fusion and EMT. We also uncovered that HPIP is a proteolytic substrate of furin, which is known to promote trophoblast cell fusion. Clinical data further indicated a significantly lower expression level of HPIP in pre-eclampsia subjects than in normal subjects. These findings imply that HPIP inhibits trophoblast fusion while promoting invasion and EMT, and its downregulation in trophoblasts might have implications for pre-eclampsia development.

Per- and polyfluoroalkyl substances (PFAS) in drinking water, gestational diabetes mellitus, hypertension and preeclampsia: A nation-wide register-based study on PFAS in drinking water

BACKGROUND

There is inconclusive evidence of associations between exposure to per- and polyfluoroalkyl substances (PFAS) and diabetes and hypertensive disorders during pregnancy.

OBJECTIVES

We conducted a nation-wide register-based cohort study to assess the associations of the estimated maternal drinking water exposure to the sum of four major PFAS (PFAS4; perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA) and perfluorohexanoate (PFHxS)) with gestational diabetes mellitus (GDM), hypertension and preeclampsia.

MATERIALS AND METHODS

We included nulliparous women giving birth in Sweden during 2012-2018 in large localities served by municipal drinking water where PFAS were measured in raw and drinking water. Using a one-compartment toxicokinetic model, we estimated cumulative maternal blood levels of PFAS4 during pregnancy considering residential history, municipal PFAS water concentration and year-specific maternal PFAS background serum levels. The outcomes and individual covariates were ascertained via register linkage. Mean values and 95% Confidence Intervals (CI) of Odds Ratios (OR) were estimated by logistic regression.

RESULTS

Among the 109,031 nulliparous women included, with an estimated average 7.8 ng PFAS4/mL serum (standard deviation: 2.0 ng/mL), there were indications of a non-monotonic inverse association for PFAS4 and GDM, corresponding to multivariable-adjusted OR 0.72 (95 % CI: 0.61-0.84) when comparing extreme quartiles. An inverse association were also seen for each PFAS individually. No clear associations were seen for hypertension or preeclampsia, although individual PFAS indicated significant associations, both inverse (PFAS and PFHxS) and direct (PFOS and PFNA) for hypertension.

CONCLUSION

In the present study, we observed indications of inverse, non-monotonic associations for PFAS4 and GDM. Some individual PFAS were also associated with hypertension, both direct and inverse. The limitations linked to the exposure assessment still require caution in the interpretation.

Preeclampsia risk prediction from prenatal cell-free DNA screening

Preeclampsia is characterized by placental dysfunction and results in significant morbidity, but reliable early prediction remains challenging. We investigated whether clinically obtained prenatal cell-free DNA (cfDNA) screening (PDNAS) using whole-genome sequencing (WGS) data can be leveraged to predict preeclampsia risk early in pregnancy (≤16 weeks). Using 1,854 routinely collected clinical PDNAS samples (median, 12.1 weeks) with low-coverage (0.5×) WGS data, we developed a framework to quantify maternal and fetal tissue signatures using nucleosome accessibility, revealing early placental and endothelial dysfunction. These signatures informed a prediction model for preeclampsia risk, which achieved a validation performance of 0.85 area under the receiver operating characteristic curve (AUC) (81% sensitivity at 80% specificity) for preterm phenotypes several months prior to disease onset in a separate cohort of 831 consecutively collected samples, and subsequently confirmed in an external cohort of 141 samples (AUC 0.84, 79% sensitivity). We demonstrate that assessment of cfDNA nucleosome accessibility from early-pregnancy cfDNA sequence data enables the detection of early placental and endothelial-tissue aberrations and may aid in the determination of preeclampsia risk.

Exploring new predictors for hypertensive disorders of pregnancy

The best performing predicting Bayesian algorithm for preeclampsia, endorsed by FIGO, identifies high-risk women at first trimester screening who benefits of a closer monitoring and possibly preventive measures. Unfortunately, the most frequent late term and term preeclampsia are less efficiently predicted. This algorithm is based on statistical assumptions at odds with the physiopathology: preeclampsia is a disease and not a syndrome, as we know it is, and the contingent time-based criteria according to which all pregnancies if not terminated by nature should develop this "disease". In addition to this, we know that gestational hypertension might cause in fifty percent of cases severe outcome, comparable to preeclampsia. The very definition of preeclampsia as proteinuric hypertension is now extended to hypertension associated with other end-organ damage, including fetal growth restriction (FGR), this latter condition proceeding, in early onset cases, hypertension. Predicting phenotypes of hypertensive Disorders of pregnancy (HDP) could better help clinical practice. This study reports exploratory observations in women resulted at high and low risk at first trimester screening followed up at second and third trimester, to term. The co-variates interrogated were sFlt1/PlGF ratio, the uterine arteries PI, the systemic vascular resistances (SVR), maternal total body water and visceral fat. Women were classified as HDP-AGA, HDP-FGR, normotensive-FGR and uneventful pregnancies (controls). We performed a longitudinal Bayesian multivariate mixed-effects model corrected both for pre-gestational BMI and trimester of analysis. The sFlt-1/PlGF ratio and SVR confirmed their significant difference in HDP-AGA, in normotensive FGR, and HDP-FGR along the three trimesters from controls, but with different strength along the three trimesters. The bioimpedance analysis of total body water and visceral fat confirmed the association of these co-factors with women who will develop HDP-AGA. The strength of longitudinal changes observed, even on a limited number of cases, provide evidence that Bayesian algorithms applied at screening tests at different gestational ages, should be based on co-variates significantly associated either with HDP-FGR or with HDP-AGA provided that the main causative co-factors involved are adopted by predictive models aimed at these distinct diseases.

Correlation of the umbilical cord coiling pattern and fetal outcome: A single-center observational analytical study

INTRODUCTION

The umbilical cord (UC) anatomically embodies the feto-placental bridge with a major role in fetal development due to the vascular structures embedded in Wharthon's jelly. The helical coiling of the umbilical cord may be counterclockwise, viewed from the fetus, defined as sinistral coiling, while the opposite as dextral coiling. This study aimed to determine any associations between UC coiling patterns and medical disorders of pregnancy.

MATERIAL AND METHODS

An observational analytical study was conducted at the Clinical Emergency Hospital of Targu-Mures, Romania between January 2023-December 2023. Consecutive singleton placentas with attached UC submitted to the Pathology Department for various feto-maternal conditions were considered for appropriate measurements. The coiling number and direction (sinistral or dextral) of the umbilical cord were assessed per first 10 cm measured at the placental end.

RESULTS

Of 187 cases this study included, 57.21 % (97) had sinistral and 42.79 % (90) had dextral UC coiling. The minimum and maximum maternal age group was 12-44 years old. Sinistral UC coiling was associated with an increased risk of spontaneous abortion and stillbirth (25.77 %, p = 0.028). Sinistral coiling was also associated with extreme prematurity (p = 0.013), smaller birth weight (p = 0.040) and lower placental weight (p = 0.029). A lower 1 min (p = 0.045) and 5 min Apgar score (p = 0.017) were associated with sinistral coiling. No relevant risk of premature rupture of membranes (PROM) was observed (p = 0.324). No significant association of sinistral coiling and metabolic or blood-related maternal diseases was observed (p = 0.385 and p = 0.725).

CONCLUSION

According to the literature approximately 25 % of all pregnancies have a dextral UC coiling direction. In contrast, in our study a significantly higher percentage was found (slightly higher than 42 %) to have dextral coiling of the UC. Data from our selected group indicated that certain neonatal pathologies (extreme prematurity, stillbirth, smaller birth weight, and lower Apgar score) were more associated with sinistral coiling as compared to dextral. More extensive studies are necessary to ascertain the clinical relevance of these data, particularly concerning high-risk pregnancies.

Formative research to optimize pre-eclampsia risk-screening and prevention (PEARLS): study protocol

BACKGROUND

Pre-eclampsia is a leading cause of maternal and neonatal mortality, affecting nearly 5% of pregnant women worldwide. Accurate and timely risk-screening of pregnant women is essential to start preventive therapies as early as possible, including low-dose aspirin and calcium supplementation. In the formative phase for the "Preventing pre-eclampsia: Evaluating AspiRin Low-dose regimens following risk Screening" (PEARLS) trial, we aim to validate and implement a pre-eclampsia risk-screening algorithm, and validate an artificial intelligence (AI) ultrasound for gestational age estimation. In the trial phase, we will compare different daily aspirin doses (75 mg v 150 mg) for pre-eclampsia prevention and postpartum bleeding. This study protocol outlines the mixed-methods formative phase of PEARLS, which will identify challenges and the feasibility of implementing these activities in participating facilities in Ghana, Kenya, and South Africa.

METHODS

We will employ qualitative and quantitative methods to identify factors that may influence trial implementation. In-depth interviews and focus group discussions with policy stakeholders, research midwives, health workers, and pregnant women will explore the barriers, facilitators, and acceptability of pre-eclampsia risk screening, AI ultrasound, and aspirin uptake. A cross-sectional survey of antenatal care and maternity health workers will assess current clinical practices around pre-eclampsia and willingness to participate in the trial activities. Data will be analyzed using thematic analysis and triangulated across sources and participant groups. The findings will inform trial design and help optimize implementation.

DISCUSSION

The research will provide critical insights into the feasibility of pre-eclampsia risk screening and AI ultrasound for gestational age estimation in resource-limited settings. By identifying factors that can influence implementation of pre-eclampsia prevention and care pathways, the findings will inform successful execution of the PEARLS trial, and post-research scale-up activities. This, in turn, can help reduce the prevalence of pre-eclampsia, and improve maternal and newborn outcomes in high-burden settings.

TRIAL REGISTRATION

PACTR202403785563823 || pactr.samrc.ac.za (Date of registration: 12 March 2024).

Neutralization of Marinobufagenin Demonstrates Efficacy In Vitro and In Vivo in Models of Pre-Eclampsia

Background/Objectives: Marinobufagenin (MBG) is a biomarker that is found to be high in pre-eclampsia (preE), and thus is relevant in the pathogenesis of obstetric complications. MBG is thought to possibly be implicated in harmful signaling within cytotrophoblasts (CTBs) of the placenta. In this study, we evaluated how anti-MBG human monoclonal antibody can alter cellular signaling in CTBs and in a rat model of preE. Methods: CTB cell proliferation, migration, and invasion as a result of MBG, both with and without anti-MBG present, were monitored via cell-based studies. Pro-angiogenic and anti-angiogenic factors in response to MBG with and without antibody were measured. Finally, we evaluated the lead anti-MBG antibody in comparison with the parent murine antibody in a rat model of preE. Results: CTB cells exposed to ≥1 nM MBG showed decreased (p < 0.05) proliferation, migration, and invasion, decreased secretion of VEGF and PIGF, and increased secretion of sFlt-1 and sEng. Pretreatment with anti-MBG significantly (p < 0.05) attenuated MBG-induced CTB dysfunction and modulation of VEGF, PIGF, sFlt-1, and sEng expression. In the rat model, anti-MBG treatment normalized blood pressure, reduced proteinuria, and eliminated fetal effects. Conclusions: MBG is a potential causative agent for preE, as it causes dysfunction in CTBs due to anti-angiogenic milieu. Our study suggests that anti-MBG antibody binds to MBG, neutralizing it and preventing downstream signaling in vitro. In a rat model of preE, treatment with anti-MBG antibody was effective at normalizing blood pressure, kidney function, and fetal birth weights. These data suggest that a human monoclonal antibody with high specificity and affinity for MBG has potential as a therapeutic agent for preE.

A systematic review and meta-analysis of the association between endothelial nitric oxide synthase (eNOS) rs2070744 polymorphism and preeclampsia

OBJECTIVE

Preeclampsia, characterized by hypertension and proteinuria, is a medical condition associated with maternal and fetal morbidity and mortality. Previous studies reported conflicting correlations between the eNOS rs2070744 variant and the occurrence of preeclampsia. Due to inconsistencies in findings, the purpose of the present meta-analysis was to explore the precise link between the eNOS rs2070744 variant and the development of preeclampsia.

METHODS

The articles were retrieved from various online sources, including Cochrane Library, Google Scholar, EMBASE, PubMed, and Web of Science databases up to February 2024. Data were analyzed by Review Manager (RevMan) 5.4. We adhered to the PRISMA 2020 guidelines to conduct this meta-analysis.

RESULTS

A total of 26 articles containing 3741 cases and 4920 controls were included for qualitative and quantitative data synthesis. In the overall population, we found a strong correlation between the eNOS rs2070744 variant and higher preeclampsia risk in recessive (CC vs. CT + TT: OR = 1.31, p = 0.017) dominant (CC + CT vs. TT: OR = 1.14, p = 0.051), co-dominant 2 (CC vs. TT: OR = 1.37, p = 0.011) and allelic (C vs. T: OR = 1.14, p = 0.022) models. Our study also explored similar outcomes among the Caucasian population in dominant (CC + CT vs. TT: OR = 1.16, p = 0.048), recessive (CC vs. CT + TT: OR = 1.46, p = 0.027), allele (C vs. T: OR = 1.18, p = 0.044), co-dominant 2 (CC vs. TT: OR = 1.53, p = 0.027), and co-dominant 3 (CC vs. CT: OR = 1.46, p = 0.002) models. Besides, a significant risk of preeclampsia in the African population was observed in co-dominant 2 (CC vs. TT: OR = 2.11, p = 0.009), dominant (CC + CT vs. TT: OR = 1.58, p = 0.002) and allelic (C vs. T: OR = 1.45, p = 0.001) models. However, no association of this polymorphism with preeclampsia risk was reported in Asian and mixed populations.

CONCLUSION

This study suggests a significant correlation between eNOS rs2070744 polymorphism and preeclampsia. However, more research on various ethnic groups is necessary to confirm the association.

An elevated triglyceride-glucose index in the first-trimester predicts adverse pregnancy outcomes: a retrospective cohort study

BACKGROUND

The relationship of the first-trimester triglyceride-glucose (TyG) index with GDM (gestational diabetes mellitus) and other adverse pregnancy outcomes has yet to be fully understood. This study aims to investigate the relationship between the first-trimester TyG index and the risk of adverse pregnancy outcomes in pregnant women.

METHODS

The data for the retrospective cohort study were derived from the Maternal and Child Health Hospital of Longgang District, Shenzhen, China. To calculate the TyG index, health indicators were measured in the early pregnancy period (<14 gestational weeks), including triglycerides and fasting blood glucose levels in pregnant women. Multivariable regression analysis and subgroup analysis were used to ascertain the independent association between the TyG index and the possibility of adverse pregnancy outcomes. Interaction analysis was performed to assess the potential heterogeneity of associations among subgroups. Nonlinear associations and the predictive value of the TyG index were explored using restricted cubic splines and receiver operating characteristic (ROC) curves. The discrimination and accuracy of the fully adjusted model were evaluated using calibration curves, Brier scores, and decision curve analysis (DCA). Mediation analysis was conducted to assess the impact of GDM (gestational diabetes mellitus) and PE (preeclampsia) as intermediaries on the risk of Preterm delivery.

RESULTS

The study included a cohort of 11,942 pregnant women, with an average TyG index of 8.36 ± 0.41. Logistic regression analysis showed that after adjusting for covariates, for each 1-unit increase in the TyG index, the risk of GDM increased by 2.21-fold, and this result was significantly different across all quartiles. Compared to the lowest quartile group, the highest TyG index group had the highest risk of PE (OR: 2.89; 95% CI 1.39 ~ 6.50), GH (gestational hypertension) (OR: 1.47; 95% CI 1.07 ~ 2.02), and Preterm delivery (OR: 1.75; 95% CI 1.21 ~ 2.56).The analysis of data stratification and interaction confirmed the validity of our study results. However, the analysis found no statistically significant association between the TyG index and low birth weight and macrosomia. GDM and PE were identified as partial mediating factors between TyG and the risk of preterm delivery, with variance contributions of 7.23% and 20.33%. The TyG index demonstrated the highest area under the curve (AUC) values in the ROC curves for GDM, PE, GH, and preterm delivery, with values of 0.61, 0.67, 0.58, and 0.56, respectively. The combination of the TyG index, maternal age, and pre-pregnancy body mass index predicted outcomes better than the TyG index alone (p < 0.01).After adjustment for confounders, the model showed good accuracy and net benefit in predicting adverse pregnancy outcomes, as supported by calibration curves, Brier scores, and decision curve analysis.

CONCLUSION

An elevated first-trimester TyG index correlates with a heightened risk of GDM, PE, GH and Preterm delivery.The TyG index presents a promising tool for more effectively identifying populations at early risk for adverse pregnancy outcomes.

Mechanisms underlying changes in intestinal permeability during pregnancy and their implications for maternal and infant health

Proper regulation of intestinal permeability is essential for maintaining the integrity of the intestinal mucosal barrier. An abnormal increase in permeability can significantly contribute to the onset and progression of various diseases, including autoimmune disorders, metabolic conditions, allergies, and inflammatory bowel diseases. The potential connection between intestinal permeability and maternal health during pregnancy is increasingly recognized, yet a comprehensive review remains lacking. Pregnancy triggers a series of physiological structural adaptations and significant hormonal fluctuations that collectively contribute to an increase in intestinal permeability. Although an increase in intestinal permeability is typically a normal physiological response during pregnancy, an abnormal rise is associated with immune dysregulation, metabolic disorders, and various pregnancy-related complications, such as recurrent pregnancy loss, gestational diabetes mellitus, overweight and obesity during pregnancy, intrahepatic cholestasis of pregnancy, and preeclampsia. This paper discusses the components of the intestinal mucosal barrier, the concept of intestinal permeability and its measurement methods, and the mechanisms and physiological significance of increased intestinal permeability during pregnancy. It thoroughly explores the association between abnormal intestinal permeability during pregnancy and maternal diseases, aiming to provide evidence for the pathophysiology of disease development in pregnant women. Additionally, the paper examines intervention methods, such as gut microbiota modulation and nutritional interventions, to regulate intestinal permeability during pregnancy, improve immune and metabolic states, and offer feasible strategies for the prevention and adjuvant treatment of clinical pregnancy complications.

Smaller decrease in late second trimester blood pressure is associated with gestational hypertensive disease development

OBJECTIVES

We investigated whether a smaller reduction in 2nd trimester blood pressure (BP) is associated with the development of gestational hypertensive disease.

STUDY DESIGN

We conducted a retrospective cohort study utilizing a clinical database at an urban safety-net hospital. Individuals ages 18-40 with a singleton gestation and 1st trimester prenatal care were included. Those with chronic hypertension were excluded. Systolic BP (SBP), diastolic BP (DBP), & mean arterial pressure (MAP) decrease were calculated. The outcome variable, gestational hypertensive disease (GHDP) included gestational hypertension and preeclampsia with and without severe features.

RESULTS

Of N = 3,355 individuals that met inclusion criteria, 18 % had GHDP. The mean gestational age of 1st trimester and 2nd trimester BP values were 9.8 ± 2.1 and 23.5 ± 2.3 weeks. Those with GHDP compared to those without GHDP had a significantly higher mean 1st trimester SBP (p < 0.01), DBP (p < 0.01), and MAP (p < 0.01). Those with GHDP compared to those without GHDP had a significantly smaller decrease between 1st and 2nd trimester SBP (-1.7 ± 12.3 vs -2.9 ± 11.8, p < 0.001) and MAP (-2.1 ± 8.4 vs -2.7 ± 7.9, p = 0.01). Those with GHDP compared to those without GHDP had a smaller DBP decrease but it was not statistically significant (-2.3 ± 8.7 vs -2.7 ± 8.2, p = 0.19).

CONCLUSIONS

Pregnant individuals who experienced a smaller decrease in SBP and MAP were more likely to develop GHDP. A reduced physiologic drop in 2nd trimester BP may suggest underlying vascular dysregulation. Future studies investigating biological mechanisms driving diminished 2nd trimester BP decline, utilizing non-invasive hemodynamic monitoring, are necessary.

Evaluating oxidative stress targeting treatments in in vitro models of placental stress relevant to preeclampsia

Background

Preeclampsia is a complex pregnancy disorder characterized by the new onset of hypertension and organ dysfunction, often leading to significant maternal and fetal morbidity and mortality. Placental dysfunction is a hallmark feature of preeclampsia, which is often caused by inappropriate trophoblast cell function in association with oxidative stress, inflammation and/or pathological hypoxia. This study explores the role of oxidative stress in trophoblast cell-based models mimicking the preeclamptic placenta and evaluates potential therapeutic strategies targeting these mechanisms.

Methods

Uric acid (UA) and malondialdehyde (MDA) concentrations were measured in human plasma from women with preeclampsia (n = 24) or normotensive controls (n = 14) using colorimetric assays. Custom-made first trimester trophoblast cell line, ACH-3P, was exposed to various preeclampsia-like stimuli including hypoxia mimetic (dimethyloxalylglycine or DMOG, 1 mM), inflammation (tumour necrosis factor or TNF-α, 10 ng/mL) or mitochondria dysfunction agent, (Rhodamine-6G or Rho-6G, 1 μg/mL), ± aspirin (0.5 mM), metformin (0.5 mM), AD-01 (100 nM) or resveratrol (15 µM), for 48 h. Following treatments, UA/MDA, proliferation (MTT), wound scratch and cytometric bead, assays, were performed.

Results

Overall, MDA plasma concentration was increased in the preeclampsia group compared to healthy controls (p < 0.001) whereas UA showed a trend towards an increase (p = 0.06); when adjusted for differences in gestational age at blood sampling, MDA remained (p < 0.001) whereas UA became (p = 0.03) significantly correlated with preeclampsia. Our 2D first trimester trophoblast cell-based in vitro model of placental stress as observed in preeclampsia, mimicked the increase in UA concentration following treatment with DMOG (p < 0.0001), TNF-α (p < 0.05) or Rho-6G (p < 0.001) whereas MDA cell concentration increased only in the presence of DMOG (p < 0.0001) or Rho-6G (p < 0.001). Metformin was able to abrogate DMOG- (p < 0.01), Rho-6G- (p < 0.0001) or TNF-α- (p < 0.01) induced increase in UA, or DMOG- (p < 0.0001) or TNF-α- (p < 0.05)induced increase in MDA. AD-01 abrogated UA or MDA increase in the presence of TNF-α (p < 0.001) or Rho-6G (p < 0.001)/DMOG (p < 0.0001), respectively. The preeclampsia-like stimuli also mimicked adverse impact on trophoblast cell proliferation, migration and inflammation, most of which were restored with either aspirin, metformin, resveratrol, or AD-01 (p < 0.05).

Conclusion

Our 2D in vitro models recapitulate the response of the first trimester trophoblast cells to preeclampsia-like stresses, modelling inappropriate placental development, and demonstrate therapeutic potential of repurposed treatments.

Occupational noise exposure and maternal pregnancy complications: register-based cohort from urban areas in four Nordic countries

OBJECTIVE

To assess the role of occupational noise exposure on pregnancy complications in urban Nordic populations.

METHODS

A study population covering five metropolitan areas in Denmark, Finland, Norway and Sweden was generated using national birth registries linked with occupational and residential environmental exposures and sociodemographic variables. The data covered all pregnancies during 5-11 year periods in 2004‒2016, resulting in 373 184 pregnancies. Occupational noise exposure was based on a Swedish-developed job-exposure-matrix, containing measured A-weighted annual 8 hour noise levels (LAeq8h), and linked with person-specific job-history. Outcomes included diagnosed gestational diabetes, gestational hypertension, mild pre-eclampsia and severe pre-eclampsia. The data were analysed with logistic regression models separately in each country, adjusting for maternal (age, parity, birth year, education and marital status) and residential environmental factors (low neighbourhood income, NO2 and green and blue space). The results were combined by meta-analysis.

RESULTS

Occupational noise exceeding 80 dB, compared with less than 70 dB, was associated with an increased odds of gestational diabetes in all countries, with a combined OR of 1.26 (95% CI 1.04 to 1.51), and mild pre-eclampsia in all countries except Finland, resulting in a combined OR of 1.22 (95% CI 0.99 to 1.51). Further adjustment by maternal body-mass index attenuated these associations. No association with gestational hypertension or severe pre-eclampsia was found.

CONCLUSIONS

Register data from four nationalities show that gestational diabetes and, tentatively, mild pre-eclampsia was increased among pregnant workers working in occupations where noise levels exceed 80 dB LAeq8h but not in occupations with lower noise levels.

Prevalence, risk factors, and adverse perinatal outcomes in Chinese women with preeclampsia: a large retrospective cohort study

BACKGROUND

Preeclampsia (PE) is the primary cause of maternal and neonatal morbidity and mortality. However, comprehensive studies on the related risk factors with PE and its effects on adverse perinatal outcomes are limited. This study aimed to evaluate the prevalence, risk factors, and adverse perinatal outcomes in Chinese women with preeclampsia.

METHODS

We conducted a retrospective cohort study from January 1, 2018, to December 31, 2019, which enrolled 38,496 women without preeclampsia (non-PE) and 1130 women with PE. Univariate and multivariate logistic regression models were used to determine the risk factors and adverse perinatal outcomes of PE.

RESULTS

Multivariate logistic regression models showed that maternal age > 35 years, pp-BMI overweight/obesity, excessive gestational weight gain, multiparity, twin pregnancy, IVF, cesarean section history, times of abortion history ≥ 2, GDM, and ICP were significantly associated with the risk of PE (all P < 0.05). Women with PE in singleton pregnancies were associated with an increased risk of maternal outcomes of cesarean section, and preterm birth, and a higher risk of neonatal outcomes of stillbirth, low birth weight, fetal distress, neonatal asphyxia, and neonatal unit admission, which were also observed in women with PE in twin pregnancies, except for stillbirth and neonatal asphyxia.

CONCLUSION

This study identified the risk factors and associated adverse perinatal outcomes of PE, which providing comprehensive evidence for clinicians to manage women at risk of PE.

Peripartum Respiratory Failure in a Patient With Severe Preeclampsia

Preeclampsia is a major hypertensive disorder of pregnancy associated with increased maternal, fetal, and neonatal risks. Acute respiratory failure, though rare, is a severe complication that may arise due to preeclampsia or unrelated medical conditions. We present a case of a 23-year-old primiparous woman admitted to our Emergency Department with gestational hypertension during her third trimester. She was hospitalized for blood pressure regulation and preeclampsia screening, which included urine protein analysis, blood tests for liver and kidney function, and fetal monitoring through cardiotocography. Laboratory tests revealed albuminuria but no indicators of severe preeclampsia. On the fourth day of hospitalization, despite antihypertensive treatment, the patient's blood pressure remained elevated, and she developed severe headaches. An emergency caesarean section was performed. During the procedure, she experienced severe bronchospasm, causing transient oxygen desaturation. Despite initial improvement, persistent hypoxemia required increased oxygen administration. Imaging and cardiological evaluations ruled out major complications, and she was admitted to the intensive care unit for eight days. Following a 14-day hospitalization, the patient was discharged in stable hemodynamic and respiratory condition, with follow-up instructions for cardiology and pulmonology assessment. Severe preeclampsia can lead to life-threatening complications, including acute respiratory failure. Prompt differential diagnosis and timely intervention are crucial to improving maternal outcomes.

Serum FoxO1 and SIRT2 concentrations in healthy pregnant women and complicated by preeclampsia

BACKGROUND

Sirtuins and FoxO1 are reported to be important in the pathophysiology of preeclampsia. This study aimed to investigate whether serum FoxO1 and SIRT2 concentrations differ between preeclampsia and normal pregnancy and also to compare these markers in early- and late-onset preeclampsia.

METHODS

This cross-sectional study was conducted on 27 women with early-onset preeclampsia, 27 women with late-onset preeclampsia, and 26 healthy normotensive pregnant controls. Maternal serum levels of FoxO1 and SIRT2 were measured with the use of an enzyme-linked immunosorbent assay kit.

RESULTS

The mean maternal serum FoxO1 levels were significantly lower both in early-onset (9.1 ± 3.8 vs. 29.1 ± 3.2, p < 0.001) and late-onset preeclampsia (2.6 ± 1.6 vs. 29.1 ± 3.2, p < 0.001) than the normotensive pregnancies. The mean maternal serum FoxO1 level of late-onset preeclampsia was significantly lower than the early-onset preeclampsia group (2.6 ± 1.6 vs. 9.1 ± 3.8, p < 0.001). The mean maternal serum SIRT2 levels were significantly lower both in early-onset (4.5 ± 2.1 vs. 6.3 ± 0.9, p < 0.001) and late-onset preeclampsia (2.1 ± 0.6 vs. 6.3 ± 0.9, p < 0.001) than the healthy pregnancies.

CONCLUSIONS

FoxO1 and SIRT2 may be biomarkers for early detection of preeclampsia and potential therapeutic targets in the pathophysiology of preeclampsia.

Point-of-Care Ultrasound (POCUS) Exam Performed by an Anesthesiologist Changes Obstetric Management

Point-of-care ultrasound (POCUS) exams have been shown to impact perioperative patient care. Involvement in antepartum obstetric patients has not been previously described. We report a case of a parturient with chronic hypertension in new-onset respiratory distress. The anesthesiologist performed cardiac and lung POCUS exams that identified new-onset systolic heart failure and contributed to her diagnosis of preeclampsia with severe features. These findings guided the initiation of inotropic therapy and diuresis. The patient ultimately required transfer to a center able to perform more advanced obstetric and cardiac care, including extracorporeal membrane oxygenation (ECMO). The patient delivered via cesarean section under general anesthesia and was weaned off inotropes. This demonstrates how POCUS can guide the management of complex antepartum patients to change obstetric management.

Metabolic profiles of meconium in preeclamptic and normotensive pregnancies

INTRODUCTION

Preeclampsia (PE) is a common vascular pregnancy disorder affecting maternal and fetal metabolism with severe immediate and long-term consequences in mothers and infants. During pregnancy, metabolites in the maternal circulation pass through the placenta to the fetus. Meconium, a first stool of the neonate, offers a view to maternal and fetoplacental unit metabolism and could add to knowledge on the effects of PE on the fetus and newborn.

OBJECTIVES

To compare meconium metabolome of infants from PE and normotensive pregnancies.

METHODS

A cohort of preeclamptic parturients and normotensive controls were recruited in Tampere University Hospital during 2019-2022. Meconium was sampled and its metabolome analyzed using liquid chromatography- mass spectrometry in 48 subjects in each group.

RESULTS

Differences in abundances of 1263 compounds, of which 19 could be annotated, were detected between the two groups. Several acylcarnitines, androsterone sulfate, three bile acids, amino acid derivatives (phenylacetylglutamine, epsilon-(gamma-glutamyl)lysine and N-(phenylacetyl)glutamic acid), as well as caffeine and paraxanthine were lower in the PE group compared to the control group. Urea and progesterone were higher in the PE group.

CONCLUSION

PE is associated with alterations in the meconium metabolome of infants. The differing abundances of several metabolites show alterations in the interaction between the fetoplacental unit and mother in PE, but whether they are a cause or an effect of the disorder remains to be further investigated.

Preeclampsia as a Study Model for Aging: The Klotho Gene Paradigm

Aging and pregnancy are often considered opposites in a woman's biological timeline. Aging is defined by a gradual decline in the functional capabilities of an organism over its lifetime, while pregnancy is characterized by the presence of the transient placenta, which fosters the cellular fitness necessary to support fetal growth. However, in the context of preeclampsia, pregnancy and aging share common hallmarks, including clinical complications, altered cellular phenotypes, and heightened oxidative stress. Furthermore, women with pregnancies complicated by preeclampsia tend to experience age-related disorders earlier than those with healthy pregnancies. Klotho, a gene discovered fortuitously in 1997 by researchers studying aging mechanisms, is primarily expressed in the kidneys but also to a lesser extent in several other tissues, including the placenta. The Klotho protein is a membrane-bound protein that, upon cleavage by ADAM10/17, is released into the circulation as soluble Klotho (sKlotho) where it plays a role in modulating oxidative stress. This review focuses on the involvement of sKlotho in the development of preeclampsia and age-related disorders, as well as the expression of the recently discovered Mytho gene, which has been associated with skeletal muscle atrophy.

Household Air Pollution Exposures Over Pregnancy and Maternal Blood Pressure Trajectories through 8 Years Postpartum: Evidence from the Ghana Randomized Air Pollution and Health Study (GRAPHS)

Background

Household air pollution is a major contributor to cardiovascular disease burden in women in Sub-Saharan Africa. However, little is known about exposures during pregnancy or the effect of clean cooking interventions on postpartum blood pressure trajectories.

Methods

The Ghana Randomized Air Pollution and Health Study (GRAPHS) randomized 1414 non-smoking women in the first and second trimesters to liquefied petroleum gas (LPG) or improved biomass stoves - vs control (traditional three-stone open fire). Personal exposure to carbon monoxide was measured at four prenatal timepoints and three times over the first postpartum year. Participants were prospectively followed with annual resting BP measurements at 2, 4, 5, 6, 7, and 8 years postpartum. We employed linear mixed effects models to determine effect of GRAPHS interventions on postpartum BP, and to examine associations between prenatal and postnatal CO and postpartum BP.

Results

LPG intervention was associated with 3.54mmHg (95% CI -5.55, -1.53) lower change in systolic BP from enrolment through 8 years postpartum, and 2.27mmHg (95% CI -3.61, -0.93) lower change in diastolic BP from enrolment through 8 years postpartum, as compared to control. In exposure-response analysis, average prenatal CO was positively associated with change in systolic BP from enrolment (β=0.71mmHg, 95% CI 0.08, 1.30, per doubling of CO).

Conclusions

LPG cookstove intervention initiated in early pregnancy and maintained through the first postpartum year was associated with lower systolic and diastolic BP trajectories through 8 years postpartum. These findings support the need to integrate clean cooking solutions into existing antenatal care packages.