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Zhu T, Tang L, Qin M, Wang WW, Chen L. Prediction of Gestational Diabetes Mellitus (GDM) risk in early pregnancy based on clinical data and ultrasound information: a nomogram. BMC Med Inform Decis Mak 2025; 25:138. [PMID: 40102801 PMCID: PMC11916998 DOI: 10.1186/s12911-025-02962-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Accepted: 03/06/2025] [Indexed: 03/20/2025] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy and has been on a continuous increase in recent years. This study aimed to establish a combined prediction model for the risk of GDM and to provide more reliable reference information for non-invasive assessment of GDM in clinical practice. METHODS This study retrospectively collected clinical data and ultrasound information of 122 pregnant women who underwent fetal nuchal translucency screening, which divided into 36 cases of the GDM group and 86 cases of the non-gestational diabetes mellitus(NGDM) group. The collected clinical data and ultrasound information were analyzed using Student's t-test and Wilcoxon W test for univariate analysis. Independent risk factors for patients with GDM were screened through binary logistic regression analysis. A model was established based on the screened results, and the diagnostic performance of different models was evaluated by drawing the receiver operating characteristic curve(ROC). The optimal prediction model was selected, and the calibration curve and clinical decision curve were drawn to evaluate the goodness of fit and clinical application efficiency of the model. RESULTS Univariate results showed that age, body mass index(BMI), number of abortions, gravidity, placental volume(PV), vascularization index(VI), flow index(FI), and vascularization flow index(VFI) all had statistically significant differences between the GDM and NGDM groups(p < 0.05). Binary logistic regression analysis showed that BMI, number of abortions, PV, VI, and FI were independent risk factors for the development of GDM in pregnant women (p < 0.05). Based on these results, five prediction models were established in this study. Their area under the ROC curve(AUC) were 0.67, 0.80, 0.80, 0.87, and 0.85, respectively. The model combining clinical data with 30° ultrasound data had the highest AUC, so we constructed a nomogram for this model. The results of its calibration curve showed that the model had a good fit, and the results of the clinical decision curve showed that the model had good clinical application efficiency. CONCLUSION The nomogram model combining clinical data with 30° ultrasound data has good accuracy and clinical application value for predicting the risk of GDM.
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Affiliation(s)
- Tong Zhu
- Department of Ultrasound Medicine, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang Province, China
| | - Lin Tang
- Department of Ultrasound Medicine, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang Province, China
| | - Man Qin
- Department of Ultrasound Medicine, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang Province, China
| | - Wen-Wen Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang Province, China
| | - Ling Chen
- Department of Ultrasound Medicine, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang Province, China.
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Papastefanou I, Mesaric V, Gomes Castello R, Nicolaides KH, Charakida M. At mid-gestation, markers of placental function rather than maternal cardiac function are stronger determinants of birthweight. Am J Obstet Gynecol 2025:S0002-9378(25)00040-7. [PMID: 39855589 DOI: 10.1016/j.ajog.2025.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 12/24/2024] [Accepted: 01/10/2025] [Indexed: 01/27/2025]
Abstract
BACKGROUND The role of maternal cardiac and hemodynamic assessment during normal and complicated pregnancies has gained attention during the last few years. Some researchers suggested that the manifestation of complications in pregnancy suffering from impaired placentation is mainly driven by preexisting cardiac changes, identifiable at an early stage by echocardiographic and hemodynamic assessment. It is therefore of great importance to determine the link between placental perfusion and maternal cardiac function and hemodynamics. Also, the impact of maternal cardiac function on birth weight has not been thoroughly studied. OBJECTIVE To elucidate the possible association of maternal cardiovascular indices with placental perfusion at mid-gestation and birthweight. STUDY DESIGN Prospective study on women with singleton pregnancies attending Kings' College Hospital, London, UK for a routine hospital visit at 19 to 24 weeks of gestation. We recorded maternal characteristics and medical history, measured mean arterial pressure, heart rate, uterine artery pulsatility index, umbilical artery pulsatility index, middle cerebral artery pulsatility index, and serum placental growth factor. We also performed maternal echocardiogram to assess cardiac output and peripheral vascular resistance as well as indices of diastolic and systolic cardiac function. Multivariable regression modeling was used. RESULTS Our cohort included 4006 women. Higher uterine artery pulsatility index values were associated with lower mean arterial pressure, heart rate, and left ventricular systolic function, after adjustment for maternal characteristics and subsequent development of hypertensive disorders of pregnancy and gestational diabetes mellitus. In a multivariable approach that explained 17.9% of the variance of the birthweight, we found that some cardiovascular indices provided small but significant contribution to the model after accounting for maternal factors and development of hypertensive disorders of pregnancy and gestational diabetes mellitus, uterine artery pulsatility index, and placental growth factor. CONCLUSION The findings of our study indicate a weak but significant association between maternal cardiovascular indices with placental perfusion at mid-gestation and birthweight. Our data would not support routine maternal cardiovascular assessment for predicting birthweight.
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Affiliation(s)
- Ioannis Papastefanou
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Vita Mesaric
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Renata Gomes Castello
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Kypros H Nicolaides
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK; Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK.
| | - Marietta Charakida
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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van Zundert SKM, Broekhuizen M, Mirzaian M, van Rossem L, Danser AHJ, Willemsen SP, Griffioen PH, Koning AHJ, Mulders AGMGJ, van Schaik RHN, Steegers-Theunissen RPM. First-trimester maternal tryptophan metabolites, utero-placental (vascular)development and hypertensive disorders of pregnancy: The Rotterdam periconceptional cohort. Placenta 2024; 158:105-112. [PMID: 39426350 DOI: 10.1016/j.placenta.2024.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 09/06/2024] [Accepted: 10/13/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal and perinatal mortality and morbidity. Knowledge on the placenta-related pathophysiology of HDP is increasing. Since maternal tryptophan metabolites are involved in placentation, we investigated associations between first-trimester tryptophan metabolites and utero-placental (vascular) development, and the occurrence of HDP. METHODS 911 women were included from a prospective tertiary hospital cohort. Serum tryptophan metabolites were determined at 8.1 ± 1.4 weeks gestation. Placental volume (PV) and utero-placental vascular volume (uPVV) were determined at 7, 9 and 11 weeks gestation. HDP, including hypertension in early pregnancy, gestational hypertension, and preeclampsia, were retrieved from medical records. Associations with PV- and uPVV-trajectories were assessed using mixed models, and HDP risks were estimated by logistic regression models, adjusted for confounders. A mediation analysis was performed to evaluate whether blood pressure was a mediator in the associations with utero-placental (vascular) development. RESULTS A negative association between kynurenine and PV-trajectories was found (β = -0.129, 95%CI = -0.220 to -0.039), which was not mediated by blood pressure. No significant associations between other tryptophan metabolites and PV- and uPVV-trajectories were observed. Higher 5-hydroxytryptophan was associated with hypertension in early pregnancy (OR = 1.405, 95%CI = 1.210-1.681), and with an increased risk of preeclampsia in these women. No associations between tryptophan metabolites and other HDP were found. CONCLUSIONS Higher first-trimester kynurenine concentrations were associated with impaired utero-placental (vascular) development. Higher first-trimester 5-hydroxytryptophan concentrations were associated with early pregnancy hypertension, and an increased risk of preeclampsia, indicating its clinical potential as biomarker for future prediction, prevention and treatment of HDP.
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Affiliation(s)
- Sofie K M van Zundert
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands; Department of Clinical Chemistry, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Michelle Broekhuizen
- Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Erasmus MC, University Medical Centre Rotterdam, the Netherlands; Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Mina Mirzaian
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Lenie van Rossem
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - A H Jan Danser
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Pieter H Griffioen
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Anton H J Koning
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
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Carbillon L. Commentary: AI-based preeclampsia detection and prediction with electrocardiogram data. Front Cardiovasc Med 2024; 11:1437369. [PMID: 39139750 PMCID: PMC11319159 DOI: 10.3389/fcvm.2024.1437369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 06/25/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
- Lionel Carbillon
- Department of Obstetrics and Gynecology, Hôpital Jean Verdier, Assistance Publique—Hôpitaux de Paris, Bondy, France
- Sorbonne North Paris University, Bobigny, France
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Jia L, Huang X, Peng H, Jia Y, Zhang R, Wei Y, Wei M, Wang R, Li H, He Q, Wang K. Pregnancy-specific beta-1-glycoprotein 1-enriched exosomes are involved in the regulation of vascular endothelial cell function during pregnancy. Placenta 2023; 139:138-147. [PMID: 37392715 DOI: 10.1016/j.placenta.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/29/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Pregnancy is a dynamic time period associated with significant physiological changes in the cardiovascular system. It is well known that during pregnancy, the placenta secretes a variety of molecular signals, including exosomes, into the maternal circulation to adapt to increased blood volume and maintain blood pressure at normotensive levels. METHODS In the present study, we compared the effects of exosomes derived from the peripheral blood serum of nonpregnant women (NP-Exo) and pregnant women with uncomplicated pregnancy (P-Exo) on endothelial cell function. We also analyzed the proteomic profiles of these two groups of exosomes and the molecular mechanisms underlying the effect of exosome cargoes on vascular endothelial cell function. RESULTS We found that P-Exo were positively involved in regulating the function of human umbilical vein endothelial cell (HUVEC) and promoting the release of nitric oxide (NO). Furthermore, we revealed that trophoblast-derived pregnancy-specific beta-1-glycoprotein 1 (PSG1)-enriched exosomes treatment induced the promotion of HUVEC proliferation and migration as well as the release of NO. In addition, we found that P-Exo maintained blood pressure at normal levels in mice. DISCUSSION These results suggested that PSG1-enriched exosomes derived from maternal peripheral blood regulate the function of vascular endothelial cells and play an important role in maintaining maternal blood pressure during pregnancy.
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Affiliation(s)
- Linyan Jia
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China; Clinical and Translational Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaojie Huang
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China; Clinical and Translational Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hao Peng
- Clinical and Translational Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuanhui Jia
- Clinical and Translational Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruonan Zhang
- Clinical and Translational Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingying Wei
- Clinical and Translational Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mengtian Wei
- Clinical and Translational Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruixue Wang
- Clinical and Translational Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Han Li
- Clinical and Translational Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qizhi He
- Department of Pathology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Kai Wang
- Clinical and Translational Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
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