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Qiang T, Ding X, Ling J, Fei M. Is platelet to lymphocyte ratio predictive of preeclampsia? A systematic review and meta-analysis. J OBSTET GYNAECOL 2023; 43:2286319. [PMID: 38014649 DOI: 10.1080/01443615.2023.2286319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND To evaluate the value of the platelet-to-lymphocyte ratio (PLR) in predicting preeclampsia (PE) in pregnant women. METHODS PubMed, EMBASE and Web of Science databases were searched for observational studies (cohort, case-control or cross-sectional) that reported pre-treatment maternal PLR values in women with and without PE. The analysis was done using a random effects model. Pooled effect sizes were reported as weighted mean difference (WMD) with 95% confidence intervals (CIs). Newcastle-Ottawa Scale (NOS) was used to evaluate the risk of bias. RESULTS Twenty-five studies with 7755 patients were included in this meta-analysis. PLR was comparable in patients with PE and healthy pregnant women (WMD -2.97; 95% CI: -11.95 to 6.02; N = 16). Patients with mild (WMD -3.00; 95% CI: -17.40 to 11.41; N = 12) and severe PE (WMD -5.77; 95% CI: -25.48 to 13.94; N = 14) had statistically similar PLR, compared to healthy controls. CONCLUSIONS Our findings show similar PLR in PE and healthy pregnancies. PLR, therefore, may not be used to differentiate between PE and normal pregnancy or for assessing the severity of PE. The majority of included studies were case-control, potentially introducing bias, and we identified evidence of publication bias as well.
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Affiliation(s)
- Tianyong Qiang
- Clinical Laboratory, Huzhou Nanxun District Hospital of Traditional Chinese Medicine, Huzhou, China
| | - Xiuqin Ding
- Department of Gynaecology and Obstetrics, Huzhou Nanxun District People's Hospital, Huzhou, China
| | - Jiajia Ling
- Clinical Laboratory, Huzhou Nanxun District Hospital of Traditional Chinese Medicine, Huzhou, China
| | - Meirong Fei
- Department of Gynaecology and Obstetrics, Huzhou Nanxun District People's Hospital, Huzhou, China
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Selen DJ, Edelson PK, James K, Corelli K, Hivert MF, Meigs JB, Thadhani R, Ecker J, Powe CE. Physiological subtypes of gestational glucose intolerance and risk of adverse pregnancy outcomes. Am J Obstet Gynecol 2022; 226:241.e1-241.e14. [PMID: 34419453 PMCID: PMC8810751 DOI: 10.1016/j.ajog.2021.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Women with gestational glucose intolerance, defined as an abnormal initial gestational diabetes mellitus screening test, are at risk of adverse pregnancy outcomes even if they do not have gestational diabetes mellitus. Previously, we defined the physiological subtypes of gestational diabetes mellitus based on the primary underlying physiology leading to hyperglycemia and found that women with different subtypes had differential risks of adverse outcomes. Physiological subclassification has not yet been applied to women with gestational glucose intolerance. OBJECTIVE We defined the physiological subtypes of gestational glucose intolerance based on the presence of insulin resistance, insulin deficiency, or mixed pathophysiology and aimed to determine whether these subtypes are at differential risks of adverse outcomes. We hypothesized that women with the insulin-resistant subtype of gestational glucose intolerance would have the greatest risk of adverse pregnancy outcomes. STUDY DESIGN In a hospital-based cohort study, we studied women with gestational glucose intolerance (glucose loading test 1-hour glucose, ≥140 mg/dL; n=236) and normal glucose tolerance (glucose loading test 1-hour glucose, <140 mg/dL; n=1472). We applied homeostasis model assessment to fasting glucose and insulin levels at 16 to 20 weeks' gestation to assess insulin resistance and deficiency and used these measures to classify women with gestational glucose intolerance into subtypes. We compared odds of adverse outcomes (large for gestational age birthweight, neonatal intensive care unit admission, pregnancy-related hypertension, and cesarean delivery) in each subtype to odds in women with normal glucose tolerance using logistic regression with adjustment for age, race and ethnicity, marital status, and body mass index. RESULTS Of women with gestational glucose intolerance (12% with gestational diabetes mellitus), 115 (49%) had the insulin-resistant subtype, 70 (27%) had the insulin-deficient subtype, 40 (17%) had the mixed pathophysiology subtype, and 11 (5%) were uncategorized. We found increased odds of large for gestational age birthweight (primary outcome) in women with the insulin-resistant subtype compared with women with normal glucose tolerance (odds ratio, 2.35; 95% confidence interval, 1.43-3.88; P=.001; adjusted odds ratio, 1.74; 95% confidence interval, 1.02-3.48; P=.04). The odds of large for gestational age birthweight in women with the insulin-deficient subtype were increased only after adjustment for covariates (odds ratio, 1.69; 95% confidence interval, 0.84-3.38; P=.14; adjusted odds ratio, 2.05; 95% confidence interval, 1.01-4.19; P=.048). Among secondary outcomes, there was a trend toward increased odds of neonatal intensive care unit admission in the insulin-resistant subtype in an unadjusted model (odds ratio, 2.09; 95% confidence interval, 0.99-4.40; P=.05); this finding was driven by an increased risk of neonatal intensive care unit admission in women with the insulin-resistant subtype and a body mass index of <25 kg/m2. Infants of women with other subtypes did not have increased odds of neonatal intensive care unit admission. The odds of pregnancy-related hypertension in women with the insulin-resistant subtype were increased (odds ratio, 2.09; 95% confidence interval, 1.31-3.33; P=.002; adjusted odds ratio, 1.77; 95% confidence interval, 1.07-2.92; P=.03) compared with women with normal glucose tolerance; other subtypes did not have increased odds of pregnancy-related hypertension. There was no difference in cesarean delivery rates in nulliparous women across subtypes. CONCLUSION Insulin-resistant gestational glucose intolerance is a high-risk subtype for adverse pregnancy outcomes. Delineating physiological subtypes may provide opportunities for a more personalized approach to gestational glucose intolerance.
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Affiliation(s)
- Daryl J Selen
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - P Kaitlyn Edelson
- Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics and Gynecology, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kaitlyn James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - Kathryn Corelli
- Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Marie-France Hivert
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - James B Meigs
- Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA
| | - Ravi Thadhani
- Harvard Medical School, Boston, MA; Mass General Brigham, Boston, MA
| | - Jeffrey Ecker
- Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - Camille E Powe
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA.
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Wenger NK, Arnold A, Bairey Merz CN, Cooper-DeHoff RM, Ferdinand KC, Fleg JL, Gulati M, Isiadinso I, Itchhaporia D, Light-McGroary K, Lindley KJ, Mieres JH, Rosser ML, Saade GR, Walsh MN, Pepine CJ. Hypertension Across a Woman's Life Cycle. J Am Coll Cardiol 2019; 71:1797-1813. [PMID: 29673470 DOI: 10.1016/j.jacc.2018.02.033] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 01/17/2023]
Abstract
Hypertension accounts for 1 in 5 deaths among American women, posing a greater burden for women than men, and is among their most important risk factors for death and development of cardiovascular and other diseases. Hypertension affects women in all phases of life, with specific characteristics relating to risk factors and management for primary prevention of hypertension in teenage and young adult women; hypertension in pregnancy; hypertension during use of oral contraceptives and assisted reproductive technologies, lactation, menopause, or hormone replacement; hypertension in elderly women; and issues of race and ethnicity. All are detailed in this review, as is information relative to women in clinical trials of hypertension and medication issues. The overarching message is that effective treatment and control of hypertension improves cardiovascular outcomes. But many knowledge gaps persist, including the contribution of hypertensive disorders of pregnancy to cardiovascular disease risk, the role of hormone replacement, blood pressure targets for elderly women, and so on.
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Affiliation(s)
- Nanette K Wenger
- Division of Cardiology, Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Anita Arnold
- Lee Health System, Florida State University School of Medicine, Fort Myers, Florida
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, College of Pharmacy, Gainesville, Florida; Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Keith C Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jerome L Fleg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Martha Gulati
- Department of Medicine (Cardiology), University of Arizona-Phoenix, Phoenix, Arizona
| | - Ijeoma Isiadinso
- Division of Cardiology, Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Dipti Itchhaporia
- Jeffrey M. Carlton Heart & Vascular Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California
| | - KellyAnn Light-McGroary
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer H Mieres
- Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York
| | - Mary L Rosser
- Division of General Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York
| | - George R Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Mary Norine Walsh
- Heart Failure and Cardiac Transplantation Program, St. Vincent Heart Center, Indianapolis, Indiana
| | - Carl J Pepine
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida.
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Rimaitis K, Grauslyte L, Zavackiene A, Baliuliene V, Nadisauskiene R, Macas A. Diagnosis of HELLP Syndrome: A 10-Year Survey in a Perinatology Centre. Int J Environ Res Public Health 2019; 16:E109. [PMID: 30609811 DOI: 10.3390/ijerph16010109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 11/16/2022]
Abstract
HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome is a severe and rapidly progressing condition that requires distinct diagnostic considerations. The aim of this study was to evaluate the impact of the Mississippi triple-class system on the HELLP syndrome diagnosis, treatment, and outcomes in a perinatology centre during a 10-year period, and consider its effectiveness and necessity in everyday practice. A retrospective observational cohort study was carried out using the medical records of a tertiary perinatology centre with the diagnosis of HELLP syndrome from the period of time between 2005 and 2014. The patients who fit the HELLP syndrome diagnosis were grouped by the Mississippi triple-class system. The means of diagnosis and treatment outcomes within those groups were analysed statistically. There was insufficient statistical evidence of the blood pressure levels corresponding to the severity of patients’ condition (p > 0.05 in all of the groups). The clinical presentation varied within all of the classes, and the only objective means of diagnosis and evaluation of progression of the condition were laboratory tests. Even though HELLP syndrome is considered a hypertensive multi-organ disorder of pregnancy, the level of hypertension does not correlate to the severity of the condition; hence, the diagnosis should be based on biochemical laboratory evidence. Vigilance in suspicion and the recognition of HELLP syndrome and appropriate treatment are essential in order to ensure better maternal and neonatal outcomes.
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Canlorbe G, Matheron S, Mandelbrot L, Oudet B, Luton D, Azria E. Vasculoplacental complications in pregnant women with HIV infection: a case-control study. Am J Obstet Gynecol 2015; 213:241.e1-9. [PMID: 25797234 DOI: 10.1016/j.ajog.2015.03.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/21/2015] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Data from the international literature suggest that there may be an association between maternal human immunodeficiency virus (HIV) infection and vasculoplacental complications during pregnancy. Studies on this subject have reached discordant conclusions. The aim of this study was to assess the incidence of vasculoplacental complications during pregnancy in women with and without HIV infection. STUDY DESIGN This single-center case-control study compared the incidence of pregnancy-related hypertension, preeclampsia, eclampsia, and vascular intrauterine growth restriction in 280 women with HIV and 560 women not infected with HIV, matched for age, parity, and geographic origin. RESULTS The incidence rates of pregnancy-related hypertension, preeclampsia, eclampsia, and vascular growth restriction did not differ between the women with and without HIV infection. The overall incidence of vasculoplacental complications did not differ between the 2 groups (7.5% vs 9.8%, respectively; P = .27). The risk of these was not associated with exposure to antiretroviral treatments, viral load, or CD4 T-cell counts at the beginning of pregnancy. CONCLUSION This study shows no difference in the incidence of vasculoplacental complications between women with and without HIV infection.
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Affiliation(s)
- Geoffroy Canlorbe
- Department of Gynecology and Obstetrics, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France; Hospital and University Departments of Risk in Pregnancy, Paris, France
| | - Sophie Matheron
- Department of Infectious and Tropical Infections, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France; Infection, Antimicrobials, Modeling, and Evolution Unité Mixte de Recherche 1137, French Institute of Health and Medical Research, Paris, France
| | - Laurent Mandelbrot
- Hospital and University Departments of Risk in Pregnancy, Paris, France; Department of Gynecology and Obstetrics, Assistance Publique-Hôpitaux de Paris Hôpital Louis Mourier, Colombes, France
| | - Barbara Oudet
- Department of Gynecology and Obstetrics, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France; Hospital and University Departments of Risk in Pregnancy, Paris, France
| | - Dominique Luton
- Department of Gynecology and Obstetrics, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France; Hospital and University Departments of Risk in Pregnancy, Paris, France
| | - Elie Azria
- Department of Gynecology and Obstetrics, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France; Hospital and University Departments of Risk in Pregnancy, Paris, France; Obstetric, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Center, Institute of Health and Medical Research Unité 1153, Sorbonne Paris Cité Center, Paris, France.
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Abstract
Hypertension is the most common modifiable risk factor for cardiovascular disease, the leading cause of death in both men and women. The prevalence and severity of hypertension rise markedly with age, and blood pressure control becomes more difficult with aging in both genders, particularly in women. In addition, there are forms of hypertension that occur exclusively in women, e.g., hypertension related to menopause, oral contraceptive use, or pregnancy (e.g., chronic hypertension, gestational hypertension, pre-eclampsia or eclampsia). Randomized controlled trials show that antihypertensive therapy provides similar reductions in major cardiovascular events in men and women. Therefore, gender should not influence decisions on selection of blood pressure lowering therapies, except for consideration of gender-specific side effects or contraindications for use in women who are or may become pregnant. This article reviews the prevalence, awareness, treatment, and control of hypertension in women, as well as recent guidelines for management of hypertension in women.
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