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Vinogradov R, Holden E, Patel M, Grigg R, Errington L, Araújo-Soares V, Rankin J. Barriers and facilitators of adherence to low-dose aspirin during pregnancy: A co-produced systematic review and COM-B framework synthesis of qualitative evidence. PLoS One 2024; 19:e0302720. [PMID: 38701053 PMCID: PMC11068207 DOI: 10.1371/journal.pone.0302720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Women at increased risk of developing pre-eclampsia are advised to take a daily low-dose of aspirin from 12 weeks of pregnancy to reduce their risks. Despite the well-established prophylactic effect of aspirin, adherence to this therapy is low. This systematic review aimed to summarise evidence on the barriers and facilitators of adherence to low-dose aspirin to inform intervention development to support decision making and persistence with aspirin use for pre-eclampsia prevention. MATERIALS AND METHODS A systematic review and meta-synthesis of qualitative research was co-produced by representatives from charities, and public, clinical and academic members. Eight electronic databases (MEDLINE, PsycINFO, CINAHL, Web of Science, Scopus, EMBASE, Prospero, OpenGrey), archives of charities and professional organisations were searched (between October and November 2023 and re-run in August 2023) using predefined search terms. Studies containing qualitative components related to barriers and facilitators of adherence to low-dose aspirin during pregnancy were included. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. A combination of the COM-B framework with phases of adherence process as defined by international taxonomy was used as the coding framework. Co-production activities were facilitated by use of 'Zoom' and 'Linoit'. RESULTS From a total of 3377 papers identified through our searches, five published studies and one dissertation met our inclusion criteria. Studies were published from 2019 to 2022 covering research conducted in the USA, Canada, UK, Netherlands and Australia. Barriers and facilitators to adherence were mapped to six categories of the COM-B for three phases of adherence: initiation, implementation, and discontinuation. The discontinuation phase of adherence was only mentioned by one author. Four key themes were identified relating to pregnancy: 'Insufficient knowledge', 'Necessity concerns balance', 'Access to medicine', 'Social influences', and 'Lack of Habit'. CONCLUSIONS The COM-B framework allowed for detailed mapping of key factors shaping different phases of adherence in behavioural change terms and now provides a solid foundation for the development of a behavioural intervention. Although potential intervention elements could be suggested based on the results of this synthesis, additional co-production work is needed to define elements and plan for the delivery of the future intervention. TRIAL REGISTRATION PROSPERO CRD42022359718. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022359718.
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Affiliation(s)
- Raya Vinogradov
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- National Institute of Health and Care Research Applied Research Collaboration North East and North Cumbria, Newcastle, United Kingdom
- Research Directorate, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle, United Kingdom
| | - Eleanor Holden
- Public Contributor and Expert by Experience, London, United Kingdom
| | - Mehali Patel
- Public Contributor and Expert by Experience, London, United Kingdom
- Stillbirth and Neonatal Death Society (Sands), Charitable Organisation, London, United Kingdom
| | - Rowan Grigg
- Public Contributor and Expert by Experience, London, United Kingdom
- Action on Pre-eclampsia (APEC), Charitable Organisation, Evesham, United Kingdom
| | - Linda Errington
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Vera Araújo-Soares
- Medical Faculty Mannheim, Division of Prevention, Center for Preventive Medicine and Digital Health (CPD), Heidelberg University, Heidelberg, Germany
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- National Institute of Health and Care Research Applied Research Collaboration North East and North Cumbria, Newcastle, United Kingdom
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Sium AF, Gudu W, Tolu LB, Birara M, Bekele D. Missed opportunity for aspirin prophylaxis for preeclampsia prevention: a cross-sectional study from Sub-Saharan Africa. AJOG GLOBAL REPORTS 2024; 4:100295. [PMID: 38205131 PMCID: PMC10777106 DOI: 10.1016/j.xagr.2023.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Recent studies showed that aspirin for preeclampsia prevention is underused despite its effectiveness in preventing preeclampsia among patients with moderate and high risk factors. Little is known about this issue in the Sub-Saharan setting, including Ethiopia. OBJECTIVE This study aimed to determine the missed opportunity for aspirin prophylaxis among candidates for this preeclampsia preventive intervention at a national tertiary referral hospital in Ethiopia. STUDY DESIGN This was a cross-sectional study on pregnant women who had preeclampsia and who were managed at the St. Paul's Hospital Millennium Medical College (Ethiopia) over a 6-month period (April 1-September 30, 2023). Data were collected prospectively using a structured questionnaire. The primary outcome was the proportion of women who had an indication for aspirin prophylaxis for preeclampsia prevention but were not given the opportunity (missed opportunity for aspirin) among all pregnant preeclampsia patients presenting to our hospital. Secondary outcomes were adverse maternal and perinatal outcomes. Data were analyzed using SPSS version 23. Descriptive statistics were employed to analyze the data. Proportions and percentages were used to present the results. RESULTS A total of 427 pregnant women with preeclampsia were screened for inclusion and 32 of them were excluded based on the study criteria. Among the 395 pregnant women with preeclampsia who were included in the final analysis, 195 (50.6%) had an indication for aspirin prophylaxis for the prevention of preeclampsia. The mean systolic and diastolic blood pressure measurements at presentation were 153.8±12.8 and 100.6±8.5 mm Hg, respectively. Most patients had proteinuria (51.7% of the participants had a urine test-strip protein level of +2, whereas 18.5% [74/395] had a urine test-strip protein level of +1 and 10.9% had 24-hour urine protein levels in the preeclampsia range). Among the women who had an indication for aspirin prophylaxis, only 1.1% received aspirin (the missed opportunity for aspirin prophylaxis for preeclampsia prevention was 98.9%). The perinatal morality rate was 11.9%, whereas the neonatal intensive care unit admission rate was 20.5%. The rate of a low Apgar score at 5 minutes was 8.9%. Eight mothers (2.1%) developed hemolysis, elevated liver enzymes, and low platelet count syndrome, whereas another 3 (0.8%) mothers developed a pulmonary edema. CONCLUSION In this study, the missed opportunity for administration of aspirin prophylaxis for the prevention of preeclampsia was high although more than half of the study subjects were candidates for this preventive intervention. Preeclampsia was also associated with higher rates of adverse perinatal outcomes and serious maternal morbidity.
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Affiliation(s)
- Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wondimu Gudu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Malede Birara
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Cormick G, Moraa H, Zahroh RI, Allotey J, Rocha T, Peña-Rosas JP, Qureshi ZP, Hofmeyr GJ, Mistry H, Smits L, Vogel JP, Palacios A, Gwako GN, Abalos E, Larbi KK, Carroli G, Riley R, Snell KI, Thorson A, Young T, Betran AP, Thangaratinam S, Bohren MA. Factors affecting the implementation of calcium supplementation strategies during pregnancy to prevent pre-eclampsia: a mixed-methods systematic review. BMJ Open 2023; 13:e070677. [PMID: 38135336 DOI: 10.1136/bmjopen-2022-070677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Daily calcium supplements are recommended for pregnant women from 20 weeks' gestation to prevent pre-eclampsia in populations with low dietary calcium intake. We aimed to improve understanding of barriers and facilitators for calcium supplement intake during pregnancy to prevent pre-eclampsia. DESIGN Mixed-method systematic review, with confidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research approach. DATA SOURCES MEDLINE and EMBASE (via Ovid), CINAHL and Global Health (via EBSCO) and grey literature databases were searched up to 17 September 2022. ELIGIBILITY CRITERIA We included primary qualitative, quantitative and mixed-methods studies reporting implementation or use of calcium supplements during pregnancy, excluding calcium fortification and non-primary studies. No restrictions were imposed on settings, language or publication date. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. We analysed the qualitative data using thematic synthesis, and quantitative findings were thematically mapped to qualitative findings. We then mapped the results to behavioural change frameworks to identify barriers and facilitators. RESULTS Eighteen reports from nine studies were included in this review. Women reported barriers to consuming calcium supplements included limited knowledge about calcium supplements and pre-eclampsia, fears and experiences of side effects, varying preferences for tablets, dosing, working schedules, being away from home and taking other supplements. Receiving information regarding pre-eclampsia and safety of calcium supplement use from reliable sources, alternative dosing options, supplement reminders, early antenatal care, free supplements and support from families and communities were reported as facilitators. Healthcare providers felt that consistent messaging about benefits and risks of calcium, training, and ensuring adequate staffing and calcium supply is available would be able to help them in promoting calcium. CONCLUSION Relevant stakeholders should consider the identified barriers and facilitators when formulating interventions and policies on calcium supplement use. These review findings can inform implementation to ensure effective and equitable provision and scale-up of calcium interventions. PROSPERO REGISTRATION NUMBER CRD42021239143.
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Affiliation(s)
- Gabriela Cormick
- Centro de Investigaciones en Epidemiología y Salud Pública (Consejo Nacional de Investigaciones Científicas y Técnicas- CONICET), Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
- Universidad Nacional de La Matanza, San Justo, Provincia de Buenos Aires, Argentina
| | | | - Rana Islamiah Zahroh
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
| | - Thaís Rocha
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | | | - G Justus Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand Faculty of Health Sciences, East London, Eastern Cape, South Africa
- University of Botswana, Gaborone, Botswana
| | - Hema Mistry
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Luc Smits
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Joshua Peter Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Alfredo Palacios
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Centre for Health Economics, University of York, York, UK
| | | | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | | | - Guillermo Carroli
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Santa Fe, Argentina
| | - Richard Riley
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Anna Thorson
- Human Reproduction Program/World Health Organization (Geneva), Geneva, Switzerland
| | - Taryn Young
- Centre for Evidence-based Health Care, Division Epidemiology and Biostatistics, Dept. of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Ana Pilar Betran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Nikčević AV, Sacchi C, Marino C, O’Gorman N, Poon LC, Nicolaides KH. Psychological Impact and Women's Evaluation of the First-Trimester Pre-Eclampsia Screening and Prevention: ASPRE Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5418. [PMID: 37048032 PMCID: PMC10094560 DOI: 10.3390/ijerph20075418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study aims to extend the understanding of the psychological impact of the first-trimester pre-eclampsia (PE) screening on women identified as high risk for preterm PE. We examined the differences between low- vs. high-risk women throughout pregnancy in: symptoms of distress (anxiety, depression, physical and mental health, and worry), health behaviour changes, the experience of pregnancy, and attitudes towards PE screening. METHODS This study was nested within the ASPRE trial. Pregnant women were screened for preterm-PE risk status in the first trimester; the assessments were carried out before the screening, in the second and in the third trimester (n = 155 low-risk women and N = 82 high-risk women in the second trimester). RESULTS The high-risk-for-PE women exhibited more depressive symptoms compared to the low-risk women in the second but not in the third trimester. No differences were observed between the two groups in other distress symptoms or in the women's evaluation of their experience of pregnancy. The high-risk group reported greater health behaviour changes compared to the low-risk group, but this was moderated by depression levels. CONCLUSIONS Overall, pregnant women reported positive attitudes towards first-trimester PE screening, despite transient depressive symptoms. This study offers supportive evidence concerning the appropriateness of PE screening in ethical terms.
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Affiliation(s)
- Ana V. Nikčević
- Department of Psychology, Kingston University, London KT1 2EE, UK
| | - Chiara Sacchi
- Department of Developmental and Social Psychology, University of Padova, 35121 Padova, Italy
| | - Claudia Marino
- Department of Developmental and Social Psychology, University of Padova, 35121 Padova, Italy
| | - Neil O’Gorman
- Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
| | - Liona C. Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Kypros H. Nicolaides
- Harris Birthright Research Centre of Fetal Medicine, King’s College Hospital, London SE5 8BB, UK
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Mkhize P, Phoswa W, Khaliq O, Dorsamy V, Moodley J. Aspirin in the prevention of preeclampsia: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2021; 100:e27916. [PMID: 35049195 PMCID: PMC9191338 DOI: 10.1097/md.0000000000027916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Aspirin is widely used to prevent pregnancy related vascular disorders such as preeclampsia (PE), intrauterine growth restriction and maternal disorders. However, the indications for the use of aspirin during pregnancy is currently controversial because the dosage of aspirin used and the sample sizes in various studies differ considerably. Furthermore, women of African ancestry are more likely to have higher rates of PE and more severe cases than those of their Caucasian counterparts. Yet, there are very few studies in this population group. Therefore, the aim of this review will be to determine the effect of low-dose aspirin (LDA) for prevention of PE in women of African ancestry. METHODS AND ANALYSIS This is a protocol for a systematic review and meta-analysis of published studies on the effect of LDA for prevention of PE. Relevant information will be accessed from the following databases; PubMed, Cochrane Central Register of Controlled Trials, Google Scholar, Google, EBSCO Host, and the Web of Science. The studies will be mapped in 2 stages: stage 1 will map studies descriptively by focus and method; stage 2 will involve additional inclusion criteria, quality assessment and data extraction undertaken by 2 reviewers in parallel. Evidence will be synthesized using relevant systematic research tools. Meta-analysis and subgroup analysis will be conducted using RevMan whilst Stata 13 will be used for meta-regressions. We will follow recommendations described in the preferred reporting items for systematic reviews and meta-analyses statement and the Cochrane Handbook for Intervention Reviews. DISCUSSION The use of LDA as a prophylactic treatment has been considered for the prevention of PE. However, studies evaluating the use of LDA in women of African ancestry are few. Therefore, with the increase in the prevalence of PE in the African population, it is critical to further investigate the use of LDA in pregnant women of African ancestry. ETHICS AND DISSEMINATION The review and meta-analysis will not require ethical approval and the findings will be published in peer-reviewed journals and presented at local and international conferences. The findings of this review will inform all stakeholders on current and future guidelines on the use of aspirin in pregnancy, especially in populations of African ancestry. SYSTEMATIC REVIEW REGISTRATION International prospective Register of Systematic Reviews (PROSERO) number: (CRD42020213213).
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Affiliation(s)
- P.Z. Mkhize
- Department of Obstetrics and Gynecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - W.N. Phoswa
- Department of Life and Consumer Sciences, University of South Africa (UNISA), Science Campus, Florida, Roodepoort, South Africa
| | - O.P. Khaliq
- Department of Obstetrics and Gynecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - V. Dorsamy
- School of Laboratory Medicine and Medical Sciences College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - J. Moodley
- Department of Obstetrics and Gynecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Women's attitudes, beliefs and values about tests, and management for hypertensive disorders of pregnancy. BMC Pregnancy Childbirth 2021; 21:665. [PMID: 34592942 PMCID: PMC8485426 DOI: 10.1186/s12884-021-04144-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/11/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Advances in research suggest the possibility of improving routine clinical care for preeclampsia using screening (predictive) and diagnostic tests. The views of women should be incorporated into the way in which such tests are used. Therefore, we explored the views of women with experience of preeclampsia and other hypertensive disorders in pregnancy (HDPs) about predictive and diagnostic tests, treatment risks, and expectant management. METHOD Eight hundred and seven women with experience of preeclampsia or other HDPs completed an online questionnaire. These women were participants in the Preeclampsia Registry (USA). The questionnaire contained 22 items to elicit women's views about predictive tests (n = 8); diagnostic tests (n = 5); treatment risks (n = 7), and expectant management (n = 2). An optional text box allowed participants to add qualitative open-ended comments. Levels of agreement with the statements were reported descriptively for the sample as a whole, and a preliminary investigation of the role of lived experience in shaping women's views was conducted by comparing subgroups within the sample based on time of HDP delivery (preterm/term). The qualitative data provided in the optional text box was analysed using inductive thematic analysis to examine participants' responses. RESULTS Women generally favored predictive and diagnostic testing, although not because they would opt for termination of pregnancy. Participants generally disagreed that taking daily low-dose aspirin (LDA) would make them nervous, with disagreement significantly higher in the preterm delivery subgroup. A high proportion of participants, especially in the preterm delivery subgroup, would take LDA throughout pregnancy. The majority of participants would be more worried about the possibility of preeclampsia than about the risks of treatments to their health (60%), and that proportion was significantly higher in the preterm delivery subgroup. There were no differences between subgroups in the views expressed about expectant management, although opinion was divided in both groups. Overall, most participants opted to put the baby's interests first. CONCLUSION Women with experience of hypertensive disorders were enthusiastic about improved predictive and diagnostic tests. However, varied views about treatment options and expectant management suggest the need for a shared decision-making tool to enable healthcare professionals to support pregnant women's decision-making to maximize the utility of these tests and interventions.
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Georgiadou D, Boussata S, Ranzijn WHM, Root LEA, Hillenius S, Bij de Weg JM, Abheiden CNH, de Boer MA, de Vries JIP, Vrijkotte TGM, Lambalk CB, Kuijper EAM, Afink GB, van Dijk M. Peptide hormone ELABELA enhances extravillous trophoblast differentiation, but placenta is not the major source of circulating ELABELA in pregnancy. Sci Rep 2019; 9:19077. [PMID: 31836787 PMCID: PMC6911039 DOI: 10.1038/s41598-019-55650-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022] Open
Abstract
Preeclampsia is a frequent gestational hypertensive disorder with equivocal pathophysiology. Knockout of peptide hormone ELABELA (ELA) has been shown to cause preeclampsia-like symptoms in mice. However, the role of ELA in human placentation and whether ELA is involved in the development of preeclampsia in humans is not yet known. In this study, we show that exogenous administration of ELA peptide is able to increase invasiveness of extravillous trophoblasts in vitro, is able to change outgrowth morphology and reduce trophoblast proliferation ex vivo, and that these effects are, at least in part, independent of signaling through the Apelin Receptor (APLNR). Moreover, we show that circulating levels of ELA are highly variable between women, correlate with BMI, but are significantly reduced in first trimester plasma of women with a healthy BMI later developing preeclampsia. We conclude that the large variability and BMI dependence of ELA levels in circulation make this peptide an unlikely candidate to function as a first trimester preeclampsia screening biomarker, while in the future administering ELA or a derivative might be considered as a potential preeclampsia treatment option as ELA is able to drive extravillous trophoblast differentiation.
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Affiliation(s)
- Danai Georgiadou
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Souad Boussata
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Willemijn H M Ranzijn
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Leah E A Root
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Sanne Hillenius
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Jeske M Bij de Weg
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Carolien N H Abheiden
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Johanna I P de Vries
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Cornelis B Lambalk
- Reproductive Medicine, Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Esther A M Kuijper
- Reproductive Medicine, Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Gijs B Afink
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Marie van Dijk
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands.
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