The association between pre pregnancy body mass index and risk of preeclampsia: a registry based study from Tanzania

Short-Chain Fatty Acids and Preeclampsia: A Scoping Review

BACKGROUND

Preeclampsia (PE) is a pregnancy-associated hypertension disorder with high morbidity and mortality. Short-chain fatty acids (SCFAs)-molecules produced by gut microbes-have been associated with hypertension, yet their relation to PE remains uncertain.

OBJECTIVES

The aim was to review existing human studies that examined associations of the major SCFAs (acetate, propionate, butyrate) in pregnancy with PE development.

METHODS

Two reviewers independently searched online databases (EMBASE, PubMed, Web of Science, and Cochrane Database of Systematic Reviews) in January 2024 using the following terms: "short-chain fatty acids," "acetic acid," "butyric acid," "propionic acid," and "preeclampsia." The final set of included studies had to report associations of SCFAs with PE, be peer-reviewed, be written in English, and be conducted in humans.

RESULTS

The abstracts of 907 studies were screened; 43 underwent full-text screening and 11 (1318 total participants, 352 with PE) were included in the final review. All studies used a case-control design. SCFAs were measured in a range of biospecimens (eg, serum, plasma, feces, placentas, and amniotic fluid) that were collected at distinct time points in pregnancy. All 7 studies that investigated butyrate found that it was lower in PE cases than in controls, with 6 of these showing statistical significance (P < .05). Five studies showed that acetate was significantly lower in individuals with PE compared with healthy individuals, while 1 study found that acetate was significantly higher in PE cases. One study reported significantly higher propionate among PE cases vs controls, while 2 studies reported significantly lower propionate levels in PE cases. The nuance in results for acetate and propionate may owe to reasons such as differences in distributions of population characteristics associated with SCFA level and PE or type of PE (early vs late).

CONCLUSION

Current epidemiologic evidence, which derives only from case-control studies, suggests that SCFAs, particularly butyrate (protective), in pregnancy are related to the development of PE. Large-cohort studies are warranted to investigate the temporality and potential causality of these associations.

Associations of Preconception Body Weight, Body Mass Index, and Hypertension with Preeclampsia

Objective: Maximizing preconception health is an important strategy to prevent preeclampsia in pregnancy. Preeclampsia remains a significant cause of maternal and fetal morbidity and mortality. We examined the associations between preconception maternal body weight, body mass index (BMI), and blood pressure with preeclampsia and its related outcomes. Materials and Methods: We performed a retrospective review of 11,214 live births from 6 months preconception during 2009-2018 in the University of Washington medical system. Outcomes were analyzed using chi-square, analysis of variance, and t-tests. Binary logistic regression was performed to examine associations. Results: Of 11,214 births, 1,539 (13.7%) were complicated by preeclampsia. Individuals with preeclampsia weighed more and had higher blood pressure from 6 months preconception to at least 6 months of pregnancy compared with those without preeclampsia (p < 0.001). Persons with prepregnancy systolic blood pressure (SBP) ≥130 mmHg were 3.2 times more likely to develop preeclampsia than those with SBP <130 mmHg (adjusted odds ratio [aOR] = 3.24, 95% confidence interval [CI] = 2.37-4.43). Women with prepregnancy BMI ≥30 kg/m2 were 2.3 times more likely to develop preeclampsia (aOR = 2.31, 95% CI = 1.72-3.10) than those with BMI <30 kg/m2. Mothers with preeclampsia were more likely to deliver preterm (29% vs. 13.8%, p < 0.001) and have neonates with 5-minute Apgar scores <8 (22.1% vs. 12.1%, p = 0.02) and lower preterm birthweights (1,909 g, 95% CI = 1,813-2,004 g vs. 2,057 g, 95% CI = 1,989-2,123 g). Conclusions: Maternal obesity and elevated blood pressure from 6 months preconception to 6 months of pregnancy were associated with preeclampsia, resulting in maternal and fetal complications.

Preeclampsia and its determinants in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Preeclampsia is a serious condition that is linked to poor perinatal outcomes. In Ethiopia, the overall prevalence of preeclampsia and its associated factors is uncertain. Therefore, the purpose of this review was to find the prevalence of pre-eclampsia and its determinants in Ethiopia.

METHODS

To find primary studies, PubMed, Google Scholar, HINAR, Scopus, the Web of Sciences, and grey literature searches were used between January 1, 2013, and January 1, 2023, in Ethiopia. A Microsoft Excel sheet was used to extract data. The pooled prevalence of pre-eclampsia was predicted using a random-effect model.

RESULTS

Twenty-nine studies were included. The pooled prevalence of pre-eclampsia was 11.51% (95% CI: 8.41, 14.61). Age > 35 years old (AOR = 2.34, 95%CI, 1.74-2.94; p-value = 0.64), housewife (AOR = 2.76, 95%CI, 1.2-4.32; p-value = 0.37), previous history of pre-eclampsia (AOR = 4.02, 95%CI, 2.91-5.55; p-value = 0.09), family history of hypertension (OR = 1.84, 95%CI, 1.39-2.3; p-value = 0.4), history of chronic hypertension (AOR = 2.44, 95%CI, 1.8-3.08; p-value = 0.67), history of multiple pregnancies (AOR = 1.45, 95%CI, 1.09-1.8; p-value = 0.38), and alcohol intake during pregnancy (AOR = 1.53, 95%CI, 1.03-2.04; p-value = 0.03) were the determinants of pre-eclampsia.

CONCLUSIONS

When compared to previous studies, the overall pooled prevalence of pre-eclampsia was high. Pre-eclampsia is associated with maternal age >35 years, being a housewife, having a history of preeclampsia, having a history of chronic hypertension, having a family history of hypertension, having diabetes mellitus, drinking alcohol during pregnancy, and having multiple pregnancies.

Double burden of malnutrition and its associated factors among women in low and middle income countries: findings from 52 nationally representative data

BACKGROUND

Double burden of malnutrition (DBM) is an emerging global public health problem. The United Nations member states adopted eradicating all forms of malnutrition as an integral component of the global agenda. However, there is evidence of a high burden of undernutrition among women and rising rates of overweight and obesity, especially in low and middle income countries (LMICs). Therefore, this study aimed to investigate the prevalence and associated factors of underweight, overweight, and obesity among women of reproductive age in LMICs.

METHODS

Data for the study were drawn from a recent 52 Demographic and Health Surveys (DHS) conducted in LMICS. We included a sample of 1,099,187 women of reproductive age. A multilevel multinomial logistic regression model was used to identify factors associated with DBM. Adjusted relative risk ratio (RRR) with a 95% Confidence Interval (CI) was reported to show an association.

RESULTS

The prevalence of underweight, overweight, and obesity in LMICs among women of reproductive age was 15.2% (95% CI: 15.1-15.3), 19.0% (95% CI: 18.9- 19.1), and 9.1% (95% CI: 9.0-9.2), respectively. This study found that women aged 24-34 years, aged ≥ 35 years, with primary, secondary, and above educational level, from wealthy households, using modern contraceptives, exposed to media (radio and television), and with high parity (more than one birth) were more likely to have overweight and obesity and less likely to have underweight. Moreover, the risk of having obesity (RRR = 0.59; 95% CI = 0.58-0.60 and overweight (RRR = 0.78; 95% CI = 0.77-0.79) were lower among rural women, while the risk of being underweight was (RRR = 1.13; 95% CI = 1.11-1.15) higher among rural women compared to urban women.

CONCLUSION

The prevalence of underweight, overweight, and obesity was high among women of reproductive age in LMICs. Underweight, overweight, and obesity are influenced by sociodemographic, socioeconomic, and behavioral-related factors. This study shows that, in order to achieve Sustainable Development Goal 2, a multifaceted intervention approach should be considered to prevent both forms of malnutrition in women of reproductive age. This can be achieved by raising awareness and promoting healthy behaviors such as healthy eating and physical activity, especially among educated women, women from wealthy households, and women exposed to the media.

Quantitative Point of Care Tests for Timely Diagnosis of Early-Onset Preeclampsia with High Sensitivity and Specificity

Preeclampsia is a heterogeneous and multiorgan cardiovascular disorder of pregnancy. Here, we report the development of a novel strip-based lateral flow assay (LFA) using lanthanide-doped upconversion nanoparticles conjugated to antibodies targeting two different biomarkers for detection of preeclampsia. We first measured circulating plasma FKBPL and CD44 protein concentrations from individuals with early-onset preeclampsia (EOPE), using ELISA. We confirmed that the CD44/FKBPL ratio is reduced in EOPE with a good diagnostic potential. Using our rapid LFA prototypes, we achieved an improved lower limit of detection: 10 pg ml-1 for FKBPL and 15 pg ml-1 for CD44, which is more than one order lower than the standard ELISA method. Using clinical samples, a cut-off value of 1.24 for CD44/FKBPL ratio provided positive predictive value of 100 % and the negative predictive value of 91 %. Our LFA shows promise as a rapid and highly sensitive point-of-care test for preeclampsia.

A conceptual framework for nutritional evaluation, screening, and monitoring of pregnant women: Evidence from a Brazilian cohort of nulliparous women

The present review comes from five previous studies of a multicenter cohort of nulliparous pregnant women from different regions of Brazil. The first study showed a wide difference in consumption of industrialized foods among women from the south and southeast regions compared with northeastern women who chose to eat a healthier diet with fresh natural food. The second investigation intended to understand maternal eating habits, where five dietary patterns were identified: two considered healthy and three with excess protein, ultra-processed foods, fats, and sweets. Considering some barriers to classifying nutrition status during prenatal care, when data on pre-pregnancy weight is unknown, the third study developed a tool to identify three levels of risk for each gestational age range, assessed by measuring arm circumference. Applying those new tools, the associations between maternal nutrition and pregnancy outcomes were investigated: prematurity, pre-eclampsia, gestational diabetes mellitus, and small-for-gestational-age infants. From these analyses, a predictive model was developed indicating that obesity, non-white color, and dietary pattern with excess protein consumption were associated with a greater probability of adverse pregnancy outcomes. Moreover, the potential of the intergenerational influence of head circumference as a proxy for maternal nutrition was analyzed. Using a Path Analysis method, the model was evidenced by different socioeconomic variables. Finally, understanding the complexity of the nutritional assessment, the present conceptual framework was proposed for nutritional assessment, and tracking and monitoring of pregnant women.

Effect of the interaction between advanced maternal age and pre-pregnancy BMI on pre-eclampsia and GDM in Central China

INTRODUCTION

To investigate the independent and combined effects of advanced maternal age and pre-pregnancy body mass index (BMI) on the risk of pre-eclampsia and gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

Logistic regression models were used to estimate the OR and 95% CIs of pre-eclampsia and GDM with advanced maternal age and pre-pregnancy BMI, respectively, and the interaction between advanced maternal age and pre-pregnancy BMI. We also used causal mediation analysis to assess the mediating role of pre-pregnancy BMI on maternal age-pre-eclampsia/GDM associations.

RESULTS

In this study, 788 cases (2.31%) were diagnosed with pre-eclampsia and 5430 cases (15.92%) were diagnosed with GDM. We found that advanced maternal age was associated with a higher risk for pre-eclampsia and GDM, with adjusted ORs (aORs) of 1.74 (95% CI 1.49-2.05) and 1.76 (95% CI 1.65-1.89) after adjusting for potential confounders, respectively. In addition, maternal pre-pregnancy overweight/obesity was associated with the risk of pre-eclampsia and GDM, with the corresponding aORs of 3.64 (95% CI 3.12-4.24) and 1.71 (95% CI 1.60-1.85), respectively. We also observed the interaction between maternal age and pre-pregnancy BMI for the risk of pre-eclampsia/GDM (all p for interaction <0.001). In the mediating effect analysis, we found that maternal pre-pregnancy BMI mediated the associations between maternal age and the development of pre-eclampsia and GDM.

CONCLUSIONS

Advanced maternal age and pre-pregnancy BMI were respectively associated with the risk of pre-eclampsia/GDM, and there was an interaction between the two risk factors. In addition, we found that pre-pregnancy BMI served as a mediator of the association between advanced maternal age and the risk of pre-eclampsia/GDM, providing an essential target for the prevention of maternal overweight/obesity.

Metabolomic analysis-identified 2-hydroxybutyric acid might be a key metabolite of severe preeclampsia

This study set out to determine the key metabolite changes underlying the pathophysiology of severe preeclampsia (PE) using metabolic analysis. We collected sera from 10 patients with severe PE and from 10 healthy pregnant women of the same trimester and analyzed them using liquid chromatography mass spectrometry. A total of 3,138 differential metabolites were screened, resulting in the identification of 124 differential metabolites. Kyoto encyclopedia of genes and genomes pathway analysis revealed that they were mainly enriched in the following metabolic pathways: central carbon metabolism in cancer; protein digestion and absorption; aminoacyl-transfer RNA biosynthesis; mineral absorption; alanine, aspartate, and glutamate metabolism; and prostate cancer. After analysis of 124 differential metabolites, 2-hydroxybutyric acid was found to be the most critical differential metabolite, and its use allowed the differentiation of women with severe PE from healthy pregnant women. In summary, our analysis revealed that 2-hydroxybutyric acid is a potential key metabolite for distinguishing severe PE from healthy controls and is also a marker for the early diagnosis of severe PE, thus allowing early intervention.

Effects of Pre-Pregnancy Overweight/Obesity on the Pattern of Association of Hypertension Susceptibility Genes with Preeclampsia

The aim of this study was to explore the effects of pre-pregnancy overweight/obesity on the pattern of association of hypertension susceptibility genes with preeclampsia (PE). Ten single-nucleotide polymorphisms (SNPs) of the 10 genome-wide association studies (GWAS)-significant hypertension/blood pressure (BP) candidate genes were genotyped in 950 pregnant women divided into two cohorts according to their pre-pregnancy body mass index (preBMI): preBMI ≥ 25 (162 with PE and 159 control) and preBMI < 25 (290 with PE and 339 control). The PLINK software package was utilized to study the association (analyzed four genetic models using logistic regression). The functionality of PE-correlated loci was analyzed by performing an in silico database analysis. Two SNP hypertension/BP genes, rs805303 BAG6 (OR: 0.36−0.66) and rs167479 RGL3 (OR: 1.86), in subjects with preBMI ≥ 25 were associated with PE. No association between the studied SNPs and PE in the preBMI < 25 group was determined. Further analysis showed that two PE-associated SNPs are functional (have weighty eQTL, sQTL, regulatory, and missense values) and could be potentially implicated in PE development. In conclusion, this study was the first to discover the modifying influence of overweight/obesity on the pattern of association of GWAS-significant hypertension/BP susceptibility genes with PE: these genes are linked with PE in preBMI ≥ 25 pregnant women and are not PE-involved in the preBMI < 25 group.

The effect of preeclampsia on adverse maternal outcomes in Sidama region, Ethiopia: a prospective open cohort study

Ethiopia has made improvements in the reduction of maternal mortality; the high burden of preeclampsia remains a concern in the Sidama region. This study aimed to measure the effect of preeclampsia on adverse maternal outcomes and identify risk factors among women with preeclampsia in Sidama region. A prospective open cohort study was conducted from August 8, 2019, to October 1, 2020. We enrolled a total of 1015 the pregnant women who had preeclampsia and normotensive women at ≥ 20 weeks of gestation and followed them until 42 days after delivery. A log-binomial logistic regression model was used to estimate the incidence of adverse maternal outcomes and its risk factors. There were 276 adverse maternal outcomes observed in the preeclampsia group compared to 154 adverse maternal outcomes in the normotensive group (P < 0.001). Women with severe features of preeclampsia had a 43% (aRR = 1.43, 95% CI 1.3-1.58) higher risk for adverse maternal outcomes compared to women without severe features of preeclampsia. Women without severe features of preeclampsia had a 39% (aRR = 1.39, 95% CI 1.2-1.76) higher risk for adverse maternal outcomes compared to women in the normotensive group. More adverse maternal outcomes occurred among women with preeclampsia after controlling for confounders.

A prospective study of arsenic and manganese exposures and maternal blood pressure during gestation

BACKGROUND

Pregnancy is a sensitive time for maternal cardiovascular functioning and exposures to arsenic or manganese may adversely affect blood pressure (BP).

OBJECTIVES

This study examined the associations between arsenic and manganese exposures and maternal BP measured during pregnancy. Effect modification by pre-pregnancy body mass index (BMI) was evaluated.

METHODS

Pregnant women (N = 1522) were recruited for a prospective cohort study in Bangladesh (2008-2011). Exposure to arsenic and manganese was measured in drinking water at <16 weeks gestation and toenails at one-month postpartum. Systolic and diastolic BP were measured monthly. Linear mixed models estimated mean BP and differences in mean BP over gestation for arsenic or manganese exposures and adjusted for covariates.

RESULTS

Arsenic levels had an increasing dose-response association with maternal BP after 25 weeks gestation. Effect modification was observed for BMI. Participants with lower BMI (<23 kg/m²) exposed to 50 μg/L arsenic had 2.83 mmHg (95% CI:1.74-3.92) greater mean systolic and 1.96 mmHg (95% CI: 1.02-2.91 mmHg) diastolic BP compared to those exposed to ≤ 1 μg/L arsenic at 40 weeks gestation. Participants with higher BMI (≥23 kg/m²) showed a greater mean systolic BP of 5.72 mmHg (95% CI: 3.18-8.27 mmHg) and diastolic BP change of 6.09 mmHg (95% CI: 4.02-8.16 mmHg) at 40 weeks gestation when exposed to 50 μg/L compared to ≤ 1 μg/L arsenic. Participants with lower BMI exposed to drinking water manganese in the 2nd quartile (181-573 μg/L) had 1.04 mmHg higher mean diastolic BP (95% CI: 0.01-2.07 mmHg) at 40 weeks gestation compared to those in the 1st quartile (0.5-180 μg/L).

CONCLUSION

Arsenic exposures during pregnancy were consistently associated with increased average maternal systolic and diastolic BP. The effect of manganese on BP was less consistent.

Determinants and neonatal outcomes of preeclampsia among women living with and without HIV at a tertiary hospital in Zambia: a review of medical records

Introduction

pre-eclampsia, a pregnancy-specific condition that occurs after 20 weeks of gestation, is a significant public health problem. In the extant literature, there are still conflicting reports on whether Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) affect preeclampsia rates. We, therefore, explored the determinants and neonatal outcomes of preeclampsia among pregnant women living with and without HIV.

Methods

we reviewed delivery registers and neonatal files from the 1^st January 2018, to 30^th of September 2019 for women who delivered at Women and Newborn Hospital. The logistic regression model estimated the odds of preeclampsia and described the neonatal outcomes.

Results

the prevalence of preeclampsia was 7.7% (95% confidence intervals: 6.8 to 8.7). On ART, pregnant women with HIV infection were less likely to develop preeclampsia than those without HIV infection (aOR=0.50; 95% CI: 0.32 to 0.80). However, neonates born to women with preeclampsia were more likely to be admitted to kangaroo mother care than neonates born to normotensive women, regardless of the HIV-exposure status.

Conclusion

overall, the prevalence of preeclampsia was 7.7%, but it was less common among HIV-infected pregnant women receiving ART. Neonates born from women with preeclampsia are at increased risk of adverse outcomes, including admission to kangaroo mother care. These findings underscore the need for healthcare workers to direct their efforts on early diagnosis and detection of preeclampsia in pregnant women to prevent poor outcomes.

Circulating levels of transforming growth factor beta-1, 2 and 3 in HIV associated preeclamptic pregnancies

The active role of transforming growth factor-beta in implantation, embryonic development and decidualization has driven our interest to evaluate circulating TGF-β(1-3) in the synergy of HIV associated pregnancy. Serum TGF-β(1-3) was quantified in normotensive (n = 38) and preeclamptic (n = 38) pregnant women, who were stratified by HIV status, HIV negative (n = 19) and HIV positive (n = 19), using a Bioplex immunoassay.Based on HIV status, we report no significant difference in TGF-β-1 (p = .95) and TGF-β2 (p = .80) however, TGF-β3 was significantly downregulated in HIV positive (p = .03) vs the HIV negative groups. A significant positive correlation (p < .05) was noted between TGF-β3 and gestational age (p = .03) (r = 0.51), birth weight (p = .04) (r = 0.53) and CD4 count (p = .02) (r = 0.53). Bivariate correlation between isoforms based on HIV status showed several significant positive associations. In the synergy of HIV infected PE, we demonstrate an association between TGF-β(1-3) with PE emanating from the hypoxic microenvironment that affects receptor-SMAD activity. Decreased TGF-β3 levels in HIV infected PE, may originate from ARV usage and/or the mutational/physiological dysregulation of SMAD expression. Impact StatementWhat is already known on this subject? TGF-β overexpression can convert its protective functions into pathogenic variants. It has a significant role in the oxidatively stressed and inflammatory condition of tissue fibrosis and hence may also be dysregulated in the microenvironment of PE. In HIV infection, TGF-β promotes viral replication and spreading through the induction of cellular proteins which induce TGF-β production. Also, mononuclear phagocytes infected with HIV also produce increased TGF-β mRNA and proteins.What do the results of the study add? Our results show no association of TGF-β isoforms (1-3) based on pregnancy type (PE vs normotensive pregnant) at term. The lack of association may be linked to TGF-βs dual promoter/suppresser nature or to gestational age.What are the implications of these findings for clinical practice and/or further research? Large-scale comprehensive clinical trials are warranted to elucidate the association and mechanistic role of TGF-β receptor-SMAD signalling, the effect of its inhibitors on cell invasion and angiogenesis as well as to deliver valuable data for the detection of novel therapeutic agents in pregnancies complicated by HIV infection.

Comparison Levels of Copper, Zinc, and Cu/Zn Ratio of in Pre-eclampsia and Normal Pregnancy

Introduction Preeclampsia is a syndrome that occurs in pregnancy, characterized by hypertension, proteinuria and edema. Zinc and copper are micronutrients that play a role in the performance of several important enzymes in the human body, such as CuZnSOD and ACE2 enzymes that play a role in the pathogenesis of severe preeclampsia. Zinc also plays a role in the kallikrein-kinin system in the formation of bradykinin which then acts as a vasodilator. This study plans to compare the level of copper (Cu), Zink (Zn), and Cu/Zn ratio in preeclamtic and normal pregnancy women. Method The study recruited 30 pregnant women with severe preeclampsia who were treated at Dr. Hasan Sadikin Bandung and 30 normal pregnant women at one of the Independent Practice Midwives in the Cibabat area, which was conducted in the period September 2021 - November 2021. This research was an analytical observational study with a cross sectional study design. Cu and Zn levels were examined using  inductively coupleds plasma mass spectrometry (ICP-MS). Chi Square, student’s t test, Mann Whitney and multivariat analysis were used for statistical analysis. Results The results of this study showed that the average Cu levels were higher in severe preeclampsia (mean: 2.149 vs. 2.116 mol/L, p=0.728). The median Zn level in the subjects with severe preeclampsia was higher than in normal pregnancies (58 vs 49 g/dL, p<0.001). The median Cu/Zn ratio in severe preeclampsia subjects was lower than in normal pregnancies (0.034 vs 0.063 g/dL, p=0.021). Conclusion  Zn levels was significantly increased in the preeclampsia group, Cu  levels was not  significantly increased in the preeclampsia group  and the ratio of Cu/Zn levels was significantly  decreased in  preeclampsia group compared to normal pregnancies.  

How to Improve Awareness, Treatment, and Control of Hypertension in Africa, and How to Reduce Its Consequences: A Call to Action From the World Hypertension League

Hypertension is the leading preventable risk factor for cardiovascular diseases and disability globally. In low- and middle-income countries hypertension has a major social impact, increasing the disease burden and costs for national health systems. The present call to action aims to stimulate all African countries to adopt several solutions to achieve better hypertension management. The following 3 goals should be achieved in Africa by 2030: (1) 80% of adults with high blood pressure in Africa are diagnosed; (2) 80% of diagnosed hypertensives, that is, 64% of all hypertensives, are treated; and (3) 80% of treated hypertensive patients are controlled. To achieve these aims, we call on individuals and organizations from government, private sector, health care, and civil society in Africa and indeed on all Africans to undertake a few specific high priority actions. The aim is to improve the detection, diagnosis, management, and control of hypertension, now considered to be the leading preventable killer in Africa.

The Relationship between Obesity and Pre-Eclampsia: Incidental Risks and Identification of Potential Biomarkers for Pre-Eclampsia

Obesity has been steadily increasing over the past decade in the US and worldwide. Since 1975, the prevalence of obesity has increased by 2% per decade, unabated despite new and more stringent guidelines set by WHO, CDC, and other public health organizations. Likewise, maternal obesity has also increased worldwide over the past several years. In the United States, pre-pregnancy rates have increased proportionally across all racial groups. Obesity during pregnancy has been directly linked to obstetric complications including gestational diabetes, HTN, hematomas, pre-eclampsia, and congenital defects. In the particular case of pre-eclampsia, the incidence rate across the globe is 2.16%, but the condition accounts for 30% of maternal deaths, and a robust body of evidence underscored the relationship between obesity and pre-eclampsia. More recently, attention has focused on the identification of reliable biomarkers predictive of an elevated risk for pre-eclampsia. The aim of this literature review is to elucidate the relationship between obesity and these predictive biomarkers for future prediction and prevention of pre-eclampsia condition in women at risk.

Magnitude of Preeclampsia and Associated Factors Among Women Attending Delivery Service in Debre Tabor Specialized Hospital

BACKGROUND

Preeclampsia is among the leading causes of maternal and perinatal morbidity and mortality, and it continues as a global health concern. Therefore, this study was aimed to assess the magnitude of pre-eclampsia and its determinant factors among women attending delivery services in Debre Tabor Comprehensive Specialized Hospital Northwest Ethiopia.

METHODS

Institutional-based cross-sectional study was conducted among 261 women from January 1- 30, 2021. A systematic sampling technique was applied. Data were collected using a structured and pre-tested questionnaire. The collected data were entered using Epi-data version 4.2 and analyzed by statistical package for social science (SPSS) version 23. A significant association was declared at a p-value of < 0.05 with a 95% Confidence interval.

RESULTS

Overall 15,7% of women had preeclampsia. Age at menarche (10-15 years) (AOR=4.79; 95% CI: 2.07-15.27), unwanted pregnancy (AOR:1.29; 95% CI: 1.59-8.44), history of chronic hypertension (AOR:2.93; 95% CI: 1.00-6.20), BMI ≥ 30 Kg/m² (AOR:1.79; 95% CI: 1.06-3.65), and alcohol consumption (AOR:2.12; 95% CI: 4.00-14.14) were significantly associated with preeclampsia.

CONCLUSION

This study showed that the magnitude of preeclampsia was significantly high compared with previous national reports. Early menarche age, the status of current pregnancies, history of chronic hypertension, BMI, and alcohol consumption were significantly associated with preeclampsia. Therefore, the government and respective stakeholders should be strengthening antenatal care services to early identify and manage women with preeclampsia. Besides, health education and promotion should be strengthened regarding the maintenance of appropriate body weight and alcohol intake before pregnancy.

Risk of preeclampsia by gestational weight gain in women with varied prepregnancy BMI: A retrospective cohort study

INTRODUCTION

Despite the important clinical significance, limited data on the joint contribution of prepregnancy body mass index (BMI) and gestational weight gain (GWG) to preeclampsia, the second leading cause of maternal mortality worldwide. This study aimed to estimate the risk of preeclampsia by GWG among women with varied prepregnancy BMI.

METHODS

We conducted a retrospective cohort study using data of 117 738 singleton pregnant women aged 18-49 years from 150 maternity hospitals in China between 2015 and 2018. GWG was calculated as the measured weight at the time of preeclampsia assessment minus prepregnancy weight; GWG velocity was calculated as the GWG divided by the gestational age at weighing. The non-linear associations of GWG with preeclampsia were examined by restricted cubic spline regression analysis according to prepregnancy BMI. The association of the GWG categories with preeclampsia was further examined by performing robust Poisson regression stratified by the prepregnancy BMI categories.

RESULTS

Among participants, 2426 (2.06%) were diagnosed with preeclampsia. Compared to women with normal BMI, those who were overweight and obese had 1.92- fold (95%CI, 1.73-2.14) and 5.06- fold (95%CI, 4.43-5.78) increased risks for preeclampsia, respectively. The association of GWG velocity with preeclampsia was presented as a J-shaped curve with the varied inflexion point (where the rate of preeclampsia was 2%), which was 0.54, 0.38, and 0.25 kg/week in women with normal BMI, overweight, and obesity, respectively; a steep risk rise was observed along with GWG velocity beyond the inflexion points. The overall adjusted relative risk for preeclampsia was calculated among women with the different GWG categories of GWG.

CONCLUSIONS

The findings highlight that high prepregnancy BMI and exceed GWG contributed to increased risk of preeclampsia with a superimposed effect and underscore the need to optimize the recommendations for GWG for women with different prepregnancy BMI.

The Importance of Doppler Analysis of Uterine Circulation in Pregnancy for a Better Understanding of Preeclampsia

BACKGROUND

The etiology of preeclampsia has still not been completely explained. Early identification of women with the risk of developing preeclampsia is a key goal of antenatal care.

OBJECTIVE

To investigate risk factors for preeclampsia from the history, laboratory and ultrasound findings (Doppler).

METHODS

Pregnant women with normal Doppler sonography in the second trimester of pregnancy were classified as a control group, while pregnant women with impaired Doppler in the second trimester were considered as the investigated group with presumably increased risk for preeclampsia. A total number of 80 patients was included in the study (40 patients in each group).

RESULTS

The difference of urea, uric acid and lactate dehydrogenase (LDH) in the serum of the control and investigated group was statistically significant, while the differences were not statistically significant for creatinine, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The presence of a notch sign during assessment of blood flow in uterine arteries in subjects in the investigated group with the diagnosis of preeclampsia had the specificity of 47.62%, and sensitivity of 88.89%. The positive predictive value of a notch sign during assessment of blood flow in uterine arteries as a marker for diagnosis of preeclampsia in the second trimester of pregnancy was 90.91%, and its negative. Systolic and diastolic blood pressure are dependent variables which are predicting preeclampsia, whilst a notch sign in uterine arteries was designated as an independent variable predicting preeclampsia.

CONCLUSION

From the laboratory tests the following parameters were considered as the risk factors for preeclampsia: increasing levels of urea, uric acid, and LDH. Notch sign was considered to be a very strong predictor of preeclampsia, especially if present bilaterally. Doppler sonography in the second trimester of pregnancy is a good predictor for early diagnosis of preeclampsia.

Association between preeclampsia and prostasin polymorphism in Pakistani females

Objectives:

To investigate the relationship between a prostasin gene variations and the development of preeclampsia in a Pakistani female population.

Methods:

This was a case-control study carried out at University of Karachi, Karachi, Pakistan between May 2018 and 2019. A single nucleotide polymorphism (SNP) at rs12597511 locus was examined with polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analyses in 76 preeclamptic and 74 normotensive expecting mothers.

Results:

We observed significantly increased risk of preeclampsia associated with the CC genotype of rs12597511 polymorphism as compared to TT (p<0.001, OR=8.08, 95% CI:1.28-31.19) and TT/TC (p<0.001, OR=14.66 and 95% CI: 3.31-65.07) genotypes carriers. Calculation of the allelic distribution revealed a higher frequency of the T allele (82%) among controls; however, the C allele was more prevalent in the preeclamptic group (36%) significantly.

Conclusion:

The significantly higher C allele frequency in the prostasin gene at the rs12597511 locus in the preeclamptic group indicates that the distribution of the C allele of the prostasin gene is a potential risk factor contributing to the development of preeclampsia.

Systematic review of observational studies of the impact of cardiovascular risk factors on preeclampsia in sub-saharan Africa

Background

Maternal mortality is a public health issue, particularly in low- and middle-income countries (LMIC). Sub-Saharan Africa (SSA) is the region most affected worldwide by maternal mortality, and preeclampsia is one of the main causes. We performed a systematic review of observational studies to identify the impact of cardiovascular risk factors on preeclampsia in SSA with a more representative sample.

Methods

Databases: PubMed and Google Scholar were searched to identify published studies. Studies were included if they reported results on the link between at least one cardiovascular risk factor and preeclampsia. Relevant studies quality was assessed with the Newcastle-Ottawa Scale (NOS). Odds ratios and relative risk (RR) were reported with their confidence intervals.

Results

Twelve articles (8 case-controls, 3 cohorts, 1 cross-sectional) were included in this review, with a total of 24,369 pregnant women. Cardiovascular risk factors such as chronic hypertension, overweight, obesity, diabetes and alcohol were significantly associated with a high risk of preeclampsia. Very few data were available concerning some risk factors. None of the articles reported tobacco consumption as a preeclampsia risk factor. There is a lack of data from French-speaking SSA countries.

Conclusion

Cardiovascular risk factors increase the risk of preeclampsia. Our results suggest the need for prospective cohort studies to ascertain this association in order to reduce maternal mortality due to preeclampsia.

Role of Palm Oil Vitamin E in Preventing Pre-eclampsia: A Secondary Analysis of a Randomized Clinical Trial Following ISSHP Reclassification

Background: Preeclampsia is a significant cause of maternal and perinatal mortality worldwide. Oxidative stress plays a key role in its pathophysiology, hence antioxidants such as tocotrienol may be preventive against preeclampsia. In 2018, the ISSHP revised the definition of preeclampsia. In accordance with the new definition, we report a secondary data analysis from a clinical trial comparing palm oil vitamin E in the form of tocotrienol-rich fraction (TRF) against placebo, in preventing preeclampsia.

Method: A randomized double-blind controlled trial was conducted in 2002–2005 to assess the benefits of TRF in preeclampsia prevention. A total of 299 primigravidae were recruited. The intervention group was supplemented with TRF 100 mg daily in super-olein capsules, whereas the placebo group was prescribed super-olein capsules without TRF, beginning from 12 to 16 gestational weeks until delivery. The primary outcome measure was incidence of preeclampsia.

Results: The total incidence of pregnancy induced hypertension (PIH) was 5%, whereas the incidence of preeclampsia was 2.3%. The odds of developing PIH (adjusted OR 0.254; 95% CI: 0.07–0.93; p–value 0.038) and preeclampsia (adjusted OR 0.030; 95% CI: 0.001–0.65; p-value 0.025) were significantly lower in the TRF arm compared to the placebo arm.

Conclusion: Antenatal supplementation with palm oil vitamin E in the form of TRF is associated with significant reductions in the incidence of preeclampsia and PIH in a single urban tertiary hospital. Palm oil vitamin E deserves further scrutiny as a potential public health preventive measure against preeclampsia and PIH.

Early-pregnancy transcriptome signatures of preeclampsia: from peripheral blood to placenta

Several studies have linked maternal asthma, excess BMI, and low vitamin D status with increased risk of Preeclampsia (PE) development. Given prior evidence in the literature and our observations from the subjects in the Vitamin D Antenatal Asthma Reduction Trial (VDAART), we hypothesized that PE, maternal asthma, vitamin D insufficiency, and excess body mass index (BMI) might share both peripheral blood and placental gene signatures that link these conditions together. We used samples collected in the VDAART to investigate relationships between these four conditions and gene expression patterns in peripheral blood obtained at early pregnancy. We identified a core set of differentially expressed genes in all comparisons between women with and without these four conditions and confirmed them in two separate sets of samples. We confirmed the differential expression of the shared gene signatures in the placenta from an independent study of preeclampsia cases and controls and constructed the preeclampsia module using protein-protein interaction networks. CXC chemokine genes showed the highest degrees of connectivity and betweenness centrality in the peripheral blood and placental modules. The shared gene signatures demonstrate the biological pathways involved in preeclampsia at the pre-clinical stage and may be used for the prediction of preeclampsia.

Comparative risks and predictors of preeclamptic pregnancy in the Eastern, Western and developing world

Preeclampsia (PE) is a complication of pregnancy characterized by hypertension (HTN-Preg), and often proteinuria. If not managed promptly, PE could lead to eclampsia and seizures. PE could also lead to intrauterine growth restriction (IUGR) and prematurity at birth. Although PE is a major cause of maternal and fetal morbidity and mortality, the underlying mechanisms are unclear. Also, there is a wide variability in the incidence of PE, ranging between 2 and 8% of pregnancies in the Eastern, Western and Developing world, suggesting regional differences in the risk factors and predictors of the pregnancy-related disorder. Several demographic, genetic, dietary and environmental factors, as well as maternal circulating biomarkers have been associated with PE. Demographic factors such as maternal race and ethnicity could play a role in PE. Specific genetic polymorphisms have been identified in PE. Maternal age, parity, education and socioeconomic status could be involved in PE. Dietary fat, protein, calcium and vitamins, body weight, and environmental factors including climate changes and air pollutants could also play a role in PE. Several circulating cytoactive factors including anti-angiogenic factors and cytokines have also been associated with PE. Traditional midwifery care is a common practice in local maternity care units, while advanced perinatal care and new diagnostic tools such as uterine artery Doppler velocimetry have been useful in predicting early PE in major medical centers. These PE risk factors, early predictors and diagnostic tools vary vastly in different regions of the Eastern, Western and Developing world. Further understanding of the differences in the demographic, genetic, dietary and environmental factors among pregnant women in different world regions should help in designing a region-specific cluster of risk factors and predictors of PE, and in turn provide better guidance for region-specific tools for early detection and management of PE.

High-fat diet from parental generation exaggerates body and adipose tissue weights in pregnant offspring

Parental high-fat diet (HFD) programs for obesity and hypertension in female offspring in rats, but it is unknown how the pregnancies of these offspring are impacted. Therefore, the hypothesis was tested that parental HFD exaggerates obesity and hypertension during pregnancy of the offspring. Wistar Hannover rat dams (the parental, P generation) were maintained on normal-fat diet (NFD) or HFD from weaning and were kept on respective diets through pregnancy and lactation. Their offspring (the first filial, F1 generation) were weaned onto the same diet as the P generation, or they were changed to the other diet to determine if combined HFD in the P and F1 generations exaggerates body weight and blood pressure levels during pregnancy in these offspring. This diet paradigm resulted in the following groups of pregnant F1 offspring: P-NFD/F1-NFD, P-HFD/F1-NFD, P-NFD/F1-HFD, and P-HFD/F1-HFD. Maternal body and adipose tissue weights were greatest in the P-HFD/F1-HFD group compared to the other 3 groups by the end of pregnancy. Plasma leptin and conscious mean arterial blood pressure were not significantly different between any group, although there was a main effect for increased blood pressure in the F1-HFD groups. Circulating levels of the antihypertensive pregnancy factor, placental growth factor (PlGF), were assessed. Although average PlGF levels were similar among all groups, correlative studies revealed that lower levels of PlGF were associated with higher blood pressure only in the P-HFD/F1-HFD group. In summary, HFD feeding from the P generation exaggerated HFD-induced body and adipose tissue weights in the pregnant offspring.

Systematic and meta-analysis of factors associated with preeclampsia and eclampsia in sub-Saharan Africa

Background

Preeclampsia and eclampsia are common complications of pregnancy globally, including sub-Saharan African (SSA) countries. Although it has a high burden on maternal and neonatal mortality and morbidity, evidence on the risk of the problem is limited. Therefore, the aim of this review was to examine the factors associated with preeclampsia and eclampsia among mothers in SSA countries.

Methods

We searched article from SSA countries using electronic database MEDLINE, EMBASE, PubMed, CINAHL published in English from January 2000 to May 2020. Two reviewers independently screened, extracted and assessed the quality of the articles. Both random and fixed effect model were used for analysis. Heterogeneity of the studies and publication bias were checked. STATA 16 used for analysis.

Results

Fifty-one studies met the inclusion criteria and included in this review. The following factors were identified through meta-analysis: being primiparous (OR: 2.52; 95% CI:1.19, 3.86), previous history of maternal preeclampsia/eclampsia (OR:5.6; 95% CI:1.82, 9.28), family history of preeclampsia/eclampsia (OR:1.68; 95% CI:1.26, 2.11), high maternal body mass index (OR: 1.69; 95% CI:1.17, 2.21), chronic hypertension (OR: 2.52; 95% CI:1.29, 3.74), anaemia during pregnancy (OR: 3.22; 95% CI:2.70, 3.75) and lack of antenatal care visits (OR: 2.71; 95% CI:1.45, 3.96). There was inconclusive evidence for a relationship with a number of other factors, such as nutrition and related factors, antenatal care visits, birth spacing, and other factors due to few studies found in our review.

Conclusions

The risk of preeclampsia and eclampsia is worse among women who have a history of preeclampsia/eclampsia (either themselves or family members), primiparous, obesity and overweight, living with chronic disease, having anaemia during pregnancy and absence from ANC visits. Therefore, investment must be made in women’s health needs to reduce the problem and health service providers need to give due attention to high-risk women.

Prophylactic aspirin for preventing pre-eclampsia and its complications: An overview of meta-analyses

Benefits of aspirin administration on pre-eclampsia and IUGR depend on the gestational age and dose of aspirin administration. Meta-analyses show that, to prevent preterm labor, aspirin could be administrated even after 16 weeks of gestational age.

Maternal obesity and intrapartum obstetric complications among pregnant women: Retrospective cohort analysis from medical birth registry in Northern Tanzania

BACKGROUND

In the last decade, Tanzania has observed a dramatic increase in overweight and obesity among women of childbearing age, a demographic shift that has been associated with intrapartum obstetric complications in high-income countries. Similar increases in maternal morbidity including postpartum haemorrhage, hypertensive disorders of pregnancy, and rates of caesarean delivery have not yet documented in Tanzania. This analysis describes intrapartum obstetric complications associated with maternal obesity among pregnant women delivering at teaching hospital in Northern Tanzania.

METHODS

A retrospective cohort analysis was conducted using the hospital's antenatal care (ANC) and birth registries from 2000 to 2015. The World Health Organization (WHO) body mass index (BMI) categories were applied to classify BMI status of pregnant women within 16 weeks of gestational age at their first ANC visit. Relative risk (RR) of obstetric complications with corresponding 95% confidence intervals (CIs) were estimated using multivariable log-binomial regression, adjusting for clustering effect for the correlation between multiple deliveries of the same woman.

RESULTS

Among 11 873 women who delivered babies in the hospital during the study period, 3139 (26.5%) fit the definition of overweight and 1464 (12.3%) women with obesity. Compared with women with normal weight, women with obesity were at over 2.6 times at risks of experiencing pre-eclampsia/eclampsia (RR: 2.66; 95% CI, 2.08-3.40), pregnancy-induced hypertension (RR 2.13; 95% CI, 1.26-3.62), and postpartum haemorrhage (RR 1.22; 95% CI, 1.00-1.49). Additionally, women with obesity had also higher risk of either elective (RR 2.40; 95% CI, 1.88-3.06) or emergency (RR: 1.53; 95% CI, 1.34-1.75) caesarean delivery.

CONCLUSION

Maternal obesity is an emerging health problem in Tanzania. This study clearly demonstrates an association between increased risk of intrapartum complications and obesity. A review of guidelines around ANC screening and intrapartum care practices considering BMI, as well as appropriate messages for women with obesity, should be considered to improve maternal and newborn outcomes.

Evaluation of vitamin D status, parathyroid hormone, and calcium among Iranian pregnant women with preeclampsia: A case-control study

BACKGROUND

Preeclampsia is considered as a serious life-threatening condition that could affect both maternal and fetal outcome. Many studies have examined the association of nutritional factors with the incidence of preeclampsia. However, little is known about the possible role of vitamin D in the development of preeclampsia among the Iranian population.

OBJECTIVE

The aim of the present study was to evaluate the association between vitamin D status and preeclampsia.

MATERIALS AND METHODS

A total of 120 pregnant women who were referred to Kamali and Alborz General Hospital located in the Karaj City were enrolled in this study and categorized into preeclamptic and control groups (n = 60/each). The clinical details of patients such as demographic characteristics and laboratory findings were obtained from the patients. The serum levels of vitamin D, calcium, phosphorus, and parathormone were also measured. Multivariate logistic regression analysis was used to assess for independent predictors of preeclampsia.

RESULTS

The mean age among pregnant women with preeclampsia and control group were 31.48 ± 5.25 and 29.01 ± 5.28, respectively. The mean body mass index among the preeclamptic group was 27.92 ± 4.98, which was significantly higher compared to the control group (p < 0.001). The serum vitamin D levels were significantly lower in women with preeclampsia compared to the control subjects (p = 0.007). Moreover, no correlation between vitamin D deficiency and predisposing factors of preeclampsia was observed after adjusting for confounding factors.

CONCLUSION

Our study revealed that serum vitamin D level is significantly lower in among the pregnant women diagnosed with preeclampsia compared to the healthy subjects. However, no correlation was observed between the vitamin D status and the risk of preeclampsia development.

Screening of differentially expressed proteins from syncytiotrophoblast for severe early-onset preeclampsia in women with gestational diabetes mellitus using tandem mass tag quantitative proteomics

BACKGROUND

Previous studies have revealed that women with gestational diabetes mellitus (GDM) have an increased risk of developing preeclampsia (PE). The possible reason is the abnormal lipid metabolism caused by GDM that leads to dysfunction of vascular endothelial cells and atherosclerosis, resulting in the onset of PE. However, studies focusing on the pathogenesis of PE in syncytiotrophoblast of GDM patients are lacking. This study aimed to compare differentially expressed proteins from syncytiotrophoblast between women with GDM and women with GDM with subsequently developed PE.

METHODS

Syncytiotrophoblast samples were obtained from pregnant women immediately after delivery. To explore the protein expression changes of syncytiotrophoblast that might explain the pathogenesis of PE in women with GDM, quantitative proteomics was performed using tandem mass tag (TMT) isobaric tags and liquid chromatography-tandem mass spectrometry. Bioinformatics analysis was performed to enrich the biological processes that these differentially expressed proteins were involved in.

RESULTS

A total of 28,234 unique peptides and 4140 proteins were identified in all samples. Among them, 23 differentially expressed proteins were identified between patients with GDM and patients with GDM with subsequently developed PE. Therein, 11 proteins were upregulated and 12 proteins were downregulated. Two relative proteins (FLT1 and PABPC4) were independently verified using immunoblotting analysis. Bioinformatic results indicated that the onset of PE in patients with GDM is a multifactorial disorder, involving factors such as apoptosis, transcriptional misregulation, oxidative stress, lipid metabolism, cell infiltration and migration, and angiogenesis.

CONCLUSION

These results indicated that the inadequacy of endometrium infiltration, angiogenic disorder, and oxidative stress in syncytiotrophoblast are more likely to occur in patients with GDM and may be the potential mechanisms leading to such patients secondarily developing severe early-onset PE.