Diabetes and pre-eclampsia affecting pregnancy: a retrospective cross-sectional study

Dymanics of stroke in pregnant women with preeclampsia

INTRODUCTION

Preeclampsia is one of the leading causes of maternal mortality in Kazakhstan, with its prevalence rising in recent years. The condition poses significant risks to both maternal and neonatal health. Identifying prognostic criteria for stroke development among women with preeclampsia is essential for improving outcomes.

METHODS

This study evaluated the diagnostic significance of clinical features and risk factors for stroke in pregnant women with preeclampsia. A retrospective analysis was conducted on 200 pregnant women divided into two groups: 100 women with acute cerebrovascular events associated with preeclampsia (main group) and 100 women with preeclampsia but without stroke (comparison group). Data were collected from 2016 to 2022, focusing on clinical, anamnestic, and laboratory markers.

RESULTS

Significant differences in risk factors were observed between the two groups. Key predictors of stroke in the context of preeclampsia included advanced maternal age (>35 years), obesity, a maternal family history of stroke, and a history of stillbirth. Adverse outcomes such as emergency caesarean sections, maternal death, intrauterine foetal death, and early neonatal death were more frequent in the main group compared to the comparison group.

DISCUSSION

The findings highlight the need for early identification and monitoring of high-risk pregnancies to prevent stroke and improve maternal and neonatal outcomes. Proactive interventions based on these risk factors can help mitigate maternal and perinatal morbidity and mortality in Kazakhstan.

Hyperglycemia-induced endothelial exosomes trigger trophoblast dysregulation and abnormal placentation through PUM2-mediated repression of SOX2

BACKGROUND

Hyperglycemia is closely related to adverse pregnancy outcomes including pre-eclampsia (PE), a life-threatening complication with a substantial morbidity and mortality. However, the pathogenesis of abnormal placentation in gestational diabetes mellitus (GDM)-associated PE remains elusive.

METHOD

Here we isolated exosomes from the human umbilical vein endothelial cells (HUVECs) treated with normal level of glucose (NG) and high levels of glucose (HG). The exosomes were added to HTR-8a/SVneo cells, a trophoblast cell line. High-throughput RNA-sequencing was performed to analyzed the changed RNAs in the exosomes and exosome-treated HTR-8a/SVneo cells. HTR-8a/SVneo cell phenotypes were evaluated from the aspects of cell proliferation, cell invasion and DNA damage.

RESULTS

After treatment with HG, the changed RNAs in exosomes was enriched in RNA stabilization and oxidative stress. The altered RNAs in the HTR-8a/SVneo cells treated with exosomes from HG-induced HUVECs were enriched in pathways related to cell adhesion, migration, DNA damage response and angiogenesis. The HG-induced exosomes impaired the proliferation and invasion of HTR-8a cells and caused the DNA damage. HG up-regulated PUM2 in the exosomes and exosome-treated HTR-8a/SVneo cells. PUM2 interacted with SOX2 mRNA, resulting in the mRNA degradation. Overexpression of SOX2 prevented the damage to HTR-8a/SVneo cells caused by the exosomes from HG-induced HUVECs.

CONCLUSIONS

We demonstrate that high glucose-induced endothelial exosomes mediate abnormal phenotypes of trophoblasts through PUM2-mediated repression of SOX2. Our results reveal a novel regulatory mechanism of hyperglycemia in development of abnormal placentation and provide potential targets for preventing adverse pregnancy outcomes.

A retrospective cohort study on the effects of Down's screening markers and maternal characteristics on pregnancy outcomes in preeclampsia

BACKGROUND

To investigate the effects of down's screening markers and maternal characteristics on preeclampsia (PE) pregnancy outcome during early and middle pregnancy.

METHODS

A retrospective study of a cohort of 246 PE and 18,709 No-PE pregnant women who participated in Down's screening during early and middle pregnancy was performed. Clinical data of pregnancy-related were collected. Multivariate binary logistic regression was used to analyze the adjusted odds ratio (aOR) and 95% confidence interval (CI) of Down's screening markers, maternal characteristics, pregnancy outcome, and other related variables, and to evaluate the influencing factors of each indicator on PE. P < .05 was considered to be statistically significant.

RESULTS

Compared with the non-PE group, the concentration and median multiple (MoM) of pregnancy-associated plasma protein-A (PAPP-A) and free beta subunit of human chorionic gonadotropin (free β-hCG) in PE group were both lower (P < .001). Multivariate binary logistic regression analysis showed that low birth weight, hydronephrosis, premature delivery, fetal growth retardation, cesarean section, live birth, hyperlipemia, infection, decreased free β-hCG and first trimester maternal weight were risk factors for PE (aOR were: 7.552, 6.684, 4.154, 3.762, 3.612, 2.454, 1.757, 1.562, 1.270, and 1.077, respectively), while uterine scar, premature rupture of membranes and elevated PAPP-A were protective factors of PE (aOR were: 0.222, 0.328 and 0.612, respectively).

CONCLUSION

Decreased maternal serum PAPP-A level, increased free β-hCG, hyperlipemia, premature delivery, cesarean section, live birth, hydronephrosis, fetal growth retardation, low birth weight, and infection are risk factors for PE, while uterine scar and premature rupture of membrane are protective factors for PE.