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Sugulle M. Preeclampsia, the placenta, ethnicity, and social determinants of health. Acta Obstet Gynecol Scand 2024; 103:1686-1688. [PMID: 39135324 PMCID: PMC11324930 DOI: 10.1111/aogs.14939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Meryam Sugulle
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
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Singh Thakur A, Tayade S, Patel D, Gupta A, Batra N. Unraveling the Predictive Power: Placenta Growth Factor and Pregnancy-Associated Plasma Protein A in Pre-eclampsia. Cureus 2024; 16:e52752. [PMID: 38389635 PMCID: PMC10881904 DOI: 10.7759/cureus.52752] [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: 01/03/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
This review provides a comprehensive exploration of the roles of placenta growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) in the context of pre-eclampsia, a pregnancy-related hypertensive disorder with significant implications for maternal and fetal health. The background elucidates the clinical significance of pre-eclampsia, highlighting its prevalence and impact. The review delves into the biological importance of PlGF and PAPP-A, emphasizing their critical roles in normal placental development and their dysregulation in pre-eclampsia. Notably, altered levels of these biomarkers emerge as potential diagnostic indicators, offering insights into the pathophysiology of the disorder. The exploration of pathophysiological mechanisms, including angiogenic imbalance and placental dysfunction, provides a nuanced understanding of pre-eclampsia's molecular landscape. The therapeutic implications of targeting PlGF and PAPP-A open avenues for future research, aiming at effective intervention strategies. The conclusion summarizes key findings, outlines implications for future research, and underscores the crucial role of PlGF and PAPP-A in understanding and managing pre-eclampsia, with the ultimate goal of improving outcomes for both mothers and infants.
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Affiliation(s)
- Aditi Singh Thakur
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Wardha, IND
| | - Surekha Tayade
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Wardha, IND
| | - Drashti Patel
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Wardha, IND
| | - Aishwarya Gupta
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Wardha, IND
| | - Nitish Batra
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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Cui J, Li P, Chen X, Li L, Ouyang L, Meng Z, Fan J. Study on the Relationship and Predictive Value of First-Trimester Pregnancy-Associated Plasma Protein-A, Maternal Factors, and Biochemical Parameters in Gestational Diabetes Mellitus: A Large Case-Control Study in Southern China Mothers. Diabetes Metab Syndr Obes 2023; 16:947-957. [PMID: 37033400 PMCID: PMC10075321 DOI: 10.2147/dmso.s398530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE To investigate the relationship and predictive value of first-trimester pregnancy-associated plasma protein A (PAPP-A), maternal factors, and biochemical parameters with gestational diabetes mellitus (GDM) in southern China mothers. METHODS This study recruited 4872 pregnant women. PAPP-A, the free beta subunit of human chorionic gonadotropin (free β-HCG), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high- and low-density lipoproteins (HDL, LDL) were measured at 11-13+ weeks of gestation. GDM was diagnosed based on a 75 g oral glucose tolerance test at 24-28 weeks of gestation. We performed stepwise logistic regression analysis to determine the odds ratio (OR) and the 95% confidence interval (CI) of GDM. We used Receiver Operating Characteristic (ROC) curves with the area under the curve (AUC) to evaluate the predictive value of PAPP-A, maternal factors, and biochemical markers. The significance of the differences between the AUC values was assessed using the DeLong test. RESULTS GDM was diagnosed in 750 (15.39%) women. Independent factors for GDM were age, pre-gestational BMI, GWG before a diagnosis of GDM, previous history of GDM, family history of diabetes, FPG, TG, LDL, PAPP-A, and TC. The AUC of PAPP-A was 0.56 (95% CI 0.53-0.58). The AUC of a model based on combined maternal factors, biochemical markers, and PAPP-A was 0.70 (95% CI 0.68-0.72). Differences in AUC values between PAPP-A alone and the model based on combined maternal factors, biochemical markers, and PAPP-A were statistically significant (Z= 9.983, P<0.001). CONCLUSION A Low serum PAPP-A level in the first trimester is an independent risk factor for developing GDM later in pregnancy. However, it is not a good independent predictor although the predictive value of a low serum PAPP-A level increases when combined with maternal factors and biochemical markers.
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Affiliation(s)
- Jinhui Cui
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Ping Li
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Xinjuan Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Ling Li
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Liping Ouyang
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Zhaoran Meng
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Jianhui Fan
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
- Correspondence: Jianhui Fan, No. 600, Tianhe Road, Tianhe, Guangzhou, People’s Republic of China, Tel +86 18922102608, Email
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Zhang X, Wang C. Predictive value of PAPP-A for ectopic pregnancy and analysis of related factors. Exp Ther Med 2021; 22:801. [PMID: 34093757 PMCID: PMC8170667 DOI: 10.3892/etm.2021.10233] [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] [Received: 03/10/2020] [Accepted: 12/14/2020] [Indexed: 11/06/2022] Open
Abstract
The present study was designed to analyze the expression of pregnancy-associated plasma protein-A (PAPP-A) in the serum of patients with ectopic pregnancy (EP) and related factors inducing this condition. Seventy-five patients with EP admitted to the Affiliated Hospital of Jining Medical University from January 2018 to February 2019 were selected as the research group, and another 59 healthy pregnant women of the corresponding age, gravidity and gestational week were enrolled in the control group. ELISA was employed to detect the serum expression levels of PAPP-A and inflammatory factors such as interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α). ROC was adopted to evaluate the diagnostic value of serum PAPP-A in patients with EP, and Pearson correlation coefficient was applied to analyze the correlation of PAPP-A with inflammatory factors IL-8 and TNF-α. Serum PAPP-A expression was significantly lower in EP patients than those in the control group. The area under the curve (AUC) of serum PAPP-A in diagnosing EP patients was 0.812, and the PAPP-A value in the control group was significantly higher than that of the research group at 7-8 weeks and ≥9 weeks. With regard to the expression of inflammatory factors, the research group presented markedly higher IL-8 and TNF-α levels than the control group. PAPP-A was negatively related to inflammatory factors IL-8 and TNF-α in the research group. In addition, it was revealed that patients with a history of genital surgery, salpingotomy, pelvic infection, EP or low PAPP-A expression were at high risk of EP. In conclusion, PAPP-A was revealed to be lowly expressed in the serum of EP patients, and to negatively be correlated with inflammatory factors IL-8 and TNF-α, which may serve as a useful marker for the diagnosis and prognosis of EP.
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Affiliation(s)
- Xiaoyun Zhang
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Chunxia Wang
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
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Buhimschi IA, Zhao G, El Helou Y, Frye LJ, Winikoff B, Raymond EG. Analytical Comparison of Pregnancy-Associated Plasma Protein-A (PAPP-A) Immunoassays for Biochemical Determination of Gestational Age. J Appl Lab Med 2021; 6:1517-1532. [PMID: 34329446 DOI: 10.1093/jalm/jfab057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Accurate pregnancy dating is critical for maternal and child health and for counseling on safe and effective abortion methods. While last menstrual period and first trimester ultrasound are often used together to determine gestational age (GA), they have limited accuracy and availability, respectively. Prior studies have shown that pregnancy-associated plasma protein-A (PAPP-A) increases exponentially during pregnancy and has the potential to serve as a biochemical marker of GA. We aimed to analyze the relationship between sonographically determined GA and serum PAPP-A concentration measured by different immunoassays and to derive cutoff levels informative for the 70 days GA commonly recommended limit for medical abortion in outpatient settings. METHODS We compared technical characteristics of 4 commercially available PAPP-A immunoassays and tested 120 maternal serum samples (GA range: 34-231 days) along with contrived pool samples and traceable quality controls. These characteristics included area under the receiver operator characteristic (AUROC) plot, sensitivity and specificity based on cutoffs defined by the Youden Index, and likelihood ratios. RESULTS All 4 immunoassays had sensitivities and specificities ≥80%, and AUROC values ranging from 0.948 to 0.968. Marked differences among absolute PAPP-A values were noted depending on immunoassay. PAPP-A cutoff values at 70 days GA for each individual immunoassay were established along with procedural recommendations that increase equivalence among immunoassays. CONCLUSIONS Maternal serum PAPP-A levels correlated strongly with GA despite differences in immunoassay formats and absolute data output. Serum PAPP-A has biomarker potential for future development of a point-of-care test aimed at increasing access to medical abortion.
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Affiliation(s)
- Irina A Buhimschi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612
| | - Guomao Zhao
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612
| | - Yara El Helou
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612
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Djeha A, Girard S, Trottier H, Kakkar F, Soudeyns H, Boucher M, Lapointe N, Boucoiran I. No association between early antiretroviral therapy during pregnancy and plasma levels of angiogenic factors: a cohort study. BMC Pregnancy Childbirth 2019; 19:482. [PMID: 31815612 PMCID: PMC6902555 DOI: 10.1186/s12884-019-2600-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/14/2019] [Indexed: 01/18/2023] Open
Abstract
Background Early antiretroviral therapy (ART) during pregnancy has dramatically reduced the risk of perinatal HIV transmission. However, studies have shown an association between premature delivery and the use of ART during pregnancy (particularly protease inhibitor (PI)-based therapies), which could be explained by placental dysfunction. The objective of this study was to evaluate the association of ART (class, duration of exposure and time of initiation) with placental function by using angiogenic factors placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) as biomarkers. Methods Clinical and biological data from 159 pregnant women living with HIV were analyzed. Levels of each biomarker were measured in the first and second trimester of pregnancy. After logarithmic transformation, we compared these using generalized estimating equations according to (a) the type of ART; (b) the duration of exposure to ART; and (c) the time of initiation of ART. Results After adjusting for variables such as ethnicity, maternal age, gestational age, body mass index, parity, smoking status, and sex of the fetus, we found no significant association between the class of ART (PI-based or not) and serum concentrations of PlGF or sFlt-1. Furthermore, no significant association was found between biomarker levels and the duration of ART exposure or the timing of ART initiation (pre- or post-conception). Conclusions This study suggests that first and second trimester angiogenic factor levels are not significantly associated with ART, regardless of the duration or type (with or without PI). These observations seem reassuring when considering the use of ART during early pregnancy.
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Affiliation(s)
- Ameyo Djeha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Sylvie Girard
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du CHU Sainte-Justine, Montreal, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du CHU Sainte-Justine, Montreal, Canada
| | - Fatima Kakkar
- Centre d'infectiologie Mère-Enfant, CHU Sainte-Justine, Montreal, Canada.,Division of Infectious Diseases, CHU Sainte-Justine, Montreal, Canada.,Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Hugo Soudeyns
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montreal, Canada.,Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Marc Boucher
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre d'infectiologie Mère-Enfant, CHU Sainte-Justine, Montreal, Canada.,Department of Obstetrics and Gynecology, Centre hospitalier universitaire (CHU) Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Normand Lapointe
- Centre d'infectiologie Mère-Enfant, CHU Sainte-Justine, Montreal, Canada.,Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada. .,Department of Social and Preventive Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada. .,Centre de recherche du CHU Sainte-Justine, Montreal, Canada. .,Centre d'infectiologie Mère-Enfant, CHU Sainte-Justine, Montreal, Canada. .,Department of Obstetrics and Gynecology, Centre hospitalier universitaire (CHU) Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
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Ng QJ, Han JY, Saffari SE, Yeo GSH, Chern BSM, Tan KH. Longitudinal circulating placental growth factor (PlGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1) concentrations during pregnancy in Asian women: a prospective cohort study. BMJ Open 2019; 9:e028321. [PMID: 31129598 PMCID: PMC6537992 DOI: 10.1136/bmjopen-2018-028321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To analyse the placental growth factor (PlGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1) trends in the normal pregnant Asian population in Singapore. DESIGN A prospective study was conducted. SETTING The largest tertiary hospital in Singapore. METHODS Women with single viable pregnancies, less than 14 weeks of gestation, were recruited between September 2010 and November 2013 in KK Women's and Children's Hospital. They were followed up from recruitment till their postnatal discharge from the hospital. There were four antenatal visits: gestational age (GA) less than 14+0 weeks of gestation (V1), GA 18+0 to 22+0 weeks (V2), GA 28+0 to 32+0 weeks (V3) and GA 34+0 and above (V4). Serum biochemical markers (sFlt-1, PlGF) were measured at each visit. RESULTS There were 934 participants in the study, of which 674 had normal pregnancy outcomes. The sFlt-1 remained relatively constant till GA 28-32 weeks before it increased (p<0.001). The sFlt-1 levels increased earlier before 30 weeks' of gestation among the Malay participants and the other ethnicities. For PlGF, the levels increased from the first to the third trimester, peaking at 30-32 weeks before decreasing (p<0.001). Its serum levels significantly differed among the Indian participants and other ethnicities as compared with the Malay and Chinese participants at V3 and V4, (p=0.04 and p<0.001, respectively). CONCLUSION There are significant differences in the PlGF and sFlt-1 concentrations during pregnancy between different ethnicities, which should be taken into consideration when using these references values for further research.
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Affiliation(s)
- Qiu Ju Ng
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Jonathan Youxiang Han
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Duke-NUS Medical Centre, Singapore, Singapore
| | - George Seow-Heong Yeo
- Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Bernard Su Min Chern
- KK Women's and Children's Hospital, Division of Obstetrics and Gyneacology, Singapore, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Division of Obstetrics and Gyneacology, Singapore, Singapore
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First trimester prenatal screening biomarkers and gestational diabetes mellitus: A systematic review and meta-analysis. PLoS One 2018; 13:e0201319. [PMID: 30048548 PMCID: PMC6062092 DOI: 10.1371/journal.pone.0201319] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/12/2018] [Indexed: 12/12/2022] Open
Abstract
Biomarkers commonly assessed in prenatal screening have been associated with a number of adverse perinatal and birth outcomes. However, it is not clear whether first trimester measurements of prenatal screening biomarkers are associated with subsequent risk of gestational diabetes mellitus (GDM). We aimed to systematically review and statistically summarize studies assessing the relationship between first trimester prenatal screening biomarker levels and GDM development. We comprehensively searched PubMed/MEDLINE, EMBASE, CINAHL, and Scopus (from inception through January 2018) and manually searched the reference lists of all relevant articles. We included original, published, observational studies examining the association of first trimester pregnancy associated plasma protein-A (PAPP-A) and/or free β-human chorionic gonadotropin (free β-hCG) levels with GDM diagnosis. Mean differences were calculated comparing PAPP-A and free β-hCG multiples of median (MoM) levels between women who developed GDM and those who did not and were subsequently pooled using two-sided random-effects models. Our meta-analysis of 13 studies on PAPP-A and nine studies on free β-hCG indicated that first trimester MoM levels for both biomarkers were lower in women who later developed GDM compared to women who remained normoglycemic throughout pregnancy (MD -0.17; 95% CI -0.24, -0.10; MD -0.04; 95% CI -0.07–0.01). There was no evidence for between-study heterogeneity among studies on free β-hCG (I2 = 0%). A high level of between-study heterogeneity was detected among the studies reporting on PAPP-A (I2 = 90%), but was reduced after stratifying by geographic location, biomarker assay method, and timing of GDM diagnosis. Our meta-analysis indicates that women who are diagnosed with GDM have lower first trimester levels of both PAPP-A and free β-hCG than women who remain normoglycemic throughout pregnancy. Further assessment of the predictive capacity of these biomarkers within large, diverse populations is needed.
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Antwi E, Klipstein-Grobusch K, Browne JL, Schielen PC, Koram KA, Agyepong IA, Grobbee DE. Improved prediction of gestational hypertension by inclusion of placental growth factor and pregnancy associated plasma protein-a in a sample of Ghanaian women. Reprod Health 2018; 15:56. [PMID: 29587776 PMCID: PMC5870183 DOI: 10.1186/s12978-018-0492-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/09/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We assessed whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of a previously developed model for gestational hypertension in a cohort of Ghanaian pregnant women. METHODS This study was nested in a prospective cohort of 1010 pregnant women attending antenatal clinics in two public hospitals in Accra, Ghana. Pregnant women who were normotensive, at a gestational age at recruitment of between 8 and 13 weeks and provided a blood sample for biomarker analysis were eligible for inclusion. From serum, biomarkers PAPP-A and PlGF concentrations were measured by the AutoDELFIA immunoassay method and multiple of the median (MoM) values corrected for gestational age (PAPP-A and PlGF) and maternal weight (PAPP-A) were calculated. To obtain prediction models, these biomarkers were included with clinical predictors maternal weight, height, diastolic blood pressure, a previous history of gestational hypertension, history of hypertension in parents and parity in a logistic regression to obtain prediction models. The Area Under the Receiver Operating Characteristic Curve (AUC) was used to assess the predictive ability of the models. RESULTS Three hundred and seventy three women participated in this study. The area under the curve (AUC) of the model with only maternal clinical characteristics was 0.75 (0.64-0.86) and 0.89(0.73-1.00) for multiparous and primigravid women respectively. The AUCs after inclusion of both PAPP-A and PlGF were 0.82 (0.74-0.89) and 0.95 (0.87-1.00) for multiparous and primigravid women respectively. CONCLUSION Adding the biomarkers PAPP-A and PlGF to maternal characteristics to a prediction model for gestational hypertension in a cohort of Ghanaian pregnant women improved predictive ability. Further research using larger sample sizes in similar settings to validate these findings is recommended.
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Affiliation(s)
- Edward Antwi
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. .,Ghana Health Service, P.M.B, Ministries, Accra, Greater Accra, Ghana.
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter C Schielen
- Center for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Irene A Agyepong
- Ghana Health Service, P.M.B, Ministries, Accra, Greater Accra, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Dutta A, Brito K, Khramstova G, Mueller A, Chinthala S, Alexander D, Adu D, Ibigbami T, Olamijulo J, Odetunde A, Adigun K, Pruitt L, Olopade O, Ojengbede O, Rana S, Olopade CO. Household air pollution and angiogenic factors in pregnant Nigerian women: A randomized controlled ethanol cookstove intervention. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 599-600:2175-2181. [PMID: 28575932 DOI: 10.1016/j.scitotenv.2017.05.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Maternal exposure to ambient air pollution affects placental growth markers. OBJECTIVES Investigate impact of household air pollution (HAP) on placental growth markers. METHODS Two groups of pregnant women were identified: firewood/kerosene stove-users (A, n=33) and bioethanol stove-users (B, n=44) that participated in a randomized control trial in Ibadan, Nigeria. A third group of non-smoking and presumed liquefied petroleum gas-using Chicago women (C, n=19) were included in this exploratory pilot to assess for possible differences between similar racial groups. Levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) were measured in maternal and cord plasma using ELISA. RESULTS Maternal and cord blood sFlt-1 and PlGF did not differ significantly between women of groups A and B. Nevertheless, both groups differed significantly from the Chicago group in that group A women had lower maternal sFlt-1 (1372.50 vs. 3194.19) but higher PlGF (1607.87 vs. 442.80), and higher cord blood sFlt-1 (2925.02 vs. 107.53) and PlGF (223.68 vs. 6.92), all p≤0.001. Group B showed similar trends (all p≤0.002). Maternal PlGF levels were positively correlated to minutes of HAP exposure when PM2.5 concentration was above 100μg/m3 in Nigerian women. CONCLUSIONS Maternal levels of PlGF and cord blood levels of sFlt-1 and PlGF in Nigerian women with varying HAP exposures were significantly higher than Chicago-based women who had no presumed HAP exposure. It suggests that in-utero exposure to HAP influenced levels of angiogenic factors involved in normal placentation and growth and could represent compensation for pollutants exposure to preserve fetal viability.
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Affiliation(s)
- Anindita Dutta
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics and Department of Medicine, University of Chicago, IL 60637, USA
| | - Katherine Brito
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics and Department of Medicine, University of Chicago, IL 60637, USA
| | - Galina Khramstova
- Center for Clinical Cancer Genetics and Department of Medicine, University of Chicago, IL 60637, USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sireesha Chinthala
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Donee Alexander
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Damilola Adu
- Healthy Life for All Foundation, Ibadan, Nigeria
| | | | | | - Abayomi Odetunde
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Kehinde Adigun
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Liese Pruitt
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Olufunmilayo Olopade
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics and Department of Medicine, University of Chicago, IL 60637, USA
| | - Oladosu Ojengbede
- Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria; Centre for Population and Reproductive Health, College of Medicine/University College Hospital, University of Ibadan, Nigeria
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Christopher O Olopade
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics and Department of Medicine, University of Chicago, IL 60637, USA.
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Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus. Cardiovasc Diabetol 2017; 16:45. [PMID: 28381225 PMCID: PMC5382447 DOI: 10.1186/s12933-017-0526-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/27/2017] [Indexed: 01/05/2023] Open
Abstract
Background The risk prediction of pregnancy-associated plasma protein-A (PAPP-A) for future cardiovascular (CV) events post acute coronary syndrome (ACS) in patients with type-2 diabetes mellitus (T2DM) was investigated in comparison to other risk factors. Methods PAPP-A was measured at hospital admission in 320 consecutive ACS patients (136 with T2DM and 184 without). All patients were followed for 2 years for occurrence of CV death, non-fatal MI or stroke. Effect of PAPP-A on the CV event risk was estimated using Cox regression models. Receiver operating characteristics (ROC) curves were generated to demonstrate the sensitivity and specificity of PAPP-A in predicting CV events. Results ACS patients with T2DM had higher PAPP-A (19.29 ± 16.36 vs. 13.29 ± 13.90 ng/ml, p < 0.001) and higher rate of CV events 2 years post ACS (27.2 vs. 13.6%, p = 0.002) than those without. Higher levels of PAPP-A were significantly associated with increased risk of CV events during 2-year follow-up [HR = 2.97 for 1 SD increase in log10(PAPP-A), 95% CI 2.11–4.18, p < 0.001] in T2DM and (HR = 3.16, 95% CI 2.27–4.39, p < 0.001) in non-T2DM. Among patients with T2DM, PAPP-A showed a larger area under the curve (AUC 0.79) that was significantly more predictive than hsCRP (AUC 0.64), eGFR (AUC 0.66) and LVEF < 50% (AUC 0.52); predictive ability did not improve significantly by including those factors into the model. Conclusions Patients with T2DM had higher levels of PAPP-A and increased risk of CV events. Elevated PAPP-A compared to other risk factors was a stronger predictor for future CV events 2 years post ACS in patients with T2DM. Trial registration ISRCTN10805074. Registered on 20 January 2017, retrospectively registered.
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Sharma S. The XXI International Society of Hypertension in Pregnancy meeting, São Paulo, Brazil - A global health perspective. Obstet Med 2017; 10:30-32. [PMID: 28491129 PMCID: PMC5405947 DOI: 10.1177/1753495x16689359] [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: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 11/17/2022] Open
Abstract
The 21st International Society of Hypertension in Pregnancy (ISSHP) meeting was held in São Paulo, Brazil from 23 to 26 October 2016. The discourse at this Congress brought global maternal health into the foray among basic science and clinical research. In concordance with the United Nations sustainable development goals which warrant an integrated view to health with investments in adolescence and childhood, the research at Congress focussed on a 'life course' approach to maternal health - examining intergenerational effects of maternal obesity and hypertension on the behavioral and physical developments of infants. Bringing in research from the Global South highlighted inequities in treatment and management of women with hypertensive disorders of pregnancy, in addition to the challenges in adoption of recommendations generated in Global North. The evidence shared can serve as platform for further discourse on global maternal health and in generating accountability to close the 'evidence to policy' gap.
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Affiliation(s)
- Sumedha Sharma
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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