Hypertension in Pregnancy最新文献

Background: Preeclampsia (PE) is a serious and progressive multisystem disease that often results in negative outcomes for neonates. This study aimed to create a nomogram to identify high-risk women with PE in their first trimester.

Methods: This study involved a nested case-control cohort including 47 PE patients and 122 controls from The Second Affiliated Hospital of Zhengzhou University from January 1, 2023, to May 31, 2024. We identified independent risk factors for PE via multivariate logistic regression and developed a nomogram model. Calibration curves were used to assess accuracy, and decision curve analysis (DCA) was used to evaluate clinical applicability.

Results: Multivariate logistic regression revealed that pre-pregnancy body mass index (BMI), mean arterial pressure (MAP), and uric acid (UA) levels were positively correlated with PE, whereas placental growth factor (PLGF) was negatively correlated. The area under the curve (AUC) for the combined diagnostic value was 0.97 (95% CI: 0.96-0.99), suggesting satisfactory discrimination. DCA demonstrated that the predictive model provided high net benefits and significant clinical utility.

Conclusions: The nomogram developed in this study, which includes pre-pregnancy BMI, PLGF, MAP, and UA for the prediction of PE risk, can assist clinicians in identifying high-risk individuals during the first trimester.

Background and objective: Trophoblast pyroptosis contributes to the pathogenesis of preeclampsia (PE). Succinylation is a posttranslational modification that is involved in the progression of various diseases. This study aimed to explore the role of the succinyltransferase KAT2A in PE by evaluating its impact on pyroptosis.

Methods: Rats were injected with N-nitro-L-arginine methyl ester to generate a PE model, and blood pressure was detected. HTR-8/SVneo cells were treated with hypoxia and reoxygenation, and pyroptosis was evaluated by flow cytometry and western blotting. The mechanism was assessed using immunoprecipitation, cycloheximide chase experiment, and western blotting.

Results: KAT2A was highly expressed in the placentas of PE rats. Knockdown of KAT2A inhibited pyroptosis of the HTR-8/SVneo cell model in vitro and ameliorated blood pressure and pyroptosis in the placenta in vivo. Additionally, KAT2A promoted the succinylation of NLRP3 at the lysine (K)21 site, and mutation of NLRP3 at this site reduced its stability. Moreover, overexpression of NLRP3 counteracted the inhibition of pyroptosis caused by KAT2A knockdown.

Conclusion: Silencing of KAT2A inhibits trophoblast pyroptosis by downregulating NLRP3 expression, thereby alleviating PE. Mechanistically, KAT2A stabilizes NLRP3 by facilitating its succinylation at K21 site. These findings suggest that KAT2A may be a promising target for the treatment of PE.

Objective: To investigate the dynamic changes of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF) and their ratio in maternal plasma, from preeclampsia diagnosis to postpartum, evaluating its clinical utility.

Methods: Single-center prospective longitudinal cohort study with repeated sample collection in women with established preeclampsia (PE). Seventy-five (n = 75) women with PE were included, from which 19, 21 and 35 developed early-onset (EPE), late-onset (LPE) and severe-LPE (SLPE) preeclampsia, respectively. Thirty-five (n = 35) women with normotensive pregnancy (NP) served as the reference group.

Results: In all subgroups of PE, PlGF decreased from diagnosis to peripartum. In contrast, sFlt-1 and the ratio rose in LPE and SLPE subgroups, whereas they remained continuously higher and stable in the EPE subgroup. In all subgroups, postpartum concentrations decreased compared to pregnancy levels. Post-term NP had higher sFlt-1 and ratio, and lower PlGF in comparison to term and late-term NP. Preeclamptic pregnancies complicated with fetal growth restriction (FGR) had continuously higher and stable sFlt-1 concentrations and ratio, and lower PlGF concentrations compared to PE without FGR. Different patterns of the three biomarker trajectories were observed in a case-by-case analysis.

Conclusion: Further research is warranted to refine pattern analysis and to integrate trajectories of these biomarkers into clinical practice towards personalized care in preeclampsia management.

Objective: Preeclampsia (PE) is a severe pregnancy complication with unclear molecular mechanisms. Emerging evidence suggests that circadian rhythm disruption contributes to PE pathogenesis. The study aims to identify circadian rhythm-related genes in PE and explore their diagnostic value and immune characteristics.

Methods: Four gene expression datasets (GSE75010, GSE60438, GSE186257, GSE14722) were downloaded from the GEO database. Modules correlated with PE were identified via weighted gene co-expression network analysis (WGCNA). Differential expression was assessed with the limma package in R, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes were carried out using clusterProfiler. Diagnostic accuracy was evaluated using Receiver operating characteristic curves in training and validation sets. Immune infiltration was analyzed using CIBERSORT and Single Sample Gene Set Enrichment Analysis algorithms. PE patients were clustered into subtypes with ConsensusClusterPlus. ceRNA and Transcription Factor regulatory networks were constructed using miRTarBase, ENCODE, and NetworkAnalyst.

Results: CRH and LEP were identified as circadian rhythm-related hub genes with strong diagnostic value. Molecular subtyping based on their expression revealed two PE subtypes with distinct immune infiltration patterns and biological functions. Regulatory network construction highlighted potential upstream mechanisms.

Conclusion: This bioinformatics analysis provides preliminary evidence for CRH and LEP as potential circadian rhythm-related diagnostic biomarkers in PE. However, as the findings are derived from limited GEO datasets, they should be interpreted with caution, and large‑scale, multi‑center prospective studies measuring their expression in serum or placental tissues across diverse populations are required to confirm their clinical utility.

Advanced maternal age (AMA) is associated with preeclampsia (PE). Although serum sFlt-1 levels at term are lower in PE cases among AMA women compared to those in PE cases among non-AMA women, evidence from mid-pregnancy remain limited. Since the clinical phenotype of PE has not yet emerged at 18-20 weeks of gestation, assessing angiogenic markers during this period may lead to a better understanding of the pathophysiology of PE. We retrospectively analyzed singleton pregnancies delivered at The University of Tokyo Hospital between January 2022 and March 2024. Serum sFlt-1 and PlGF levels were measured at 18-20 weeks of gestation, and their associations with PE were assessed based on maternal age (<35 years: non-AMA; 35-44 years: AMA). In non-AMA pregnancies, serum sFlt-1 levels tended to be lower in PE cases compared to normotensive (NT) cases. Conversely, in AMA pregnancies, PE cases showed significantly higher serum sFlt-1 levels and sFlt-1/PlGF ratios than NT cases. Serum PlGF levels did not differ significantly between any of the groups. These findings highlight differences in PE-associated markers between AMA and non-AMA pregnancies at mid-pregnancy. Clarifying these differences is essential for optimizing early risk stratification and management strategies in AMA populations.

Background: Preeclampsia (PE) is a severe pregnancy-related disorder characterized by hypertension and end-organ manifestation, and remains a leading cause of perinatal maternal and fetal mortality and morbidity in developing countries. The pathogenesis of PE involves reduced uteroplacental blood flow and impaired trophoblast invasion; however, the role of exosomes in these processes is not fully understood.

Methods: This study employed Transwell assay, wound healing assay, and CCK-8 assays to evaluate the effects of umbilical cord exosomes derived from women with PE (PE-exosomes) on trophoblast function. Additionally, miRNA sequencing, in vitro transfection, western blotting, RT-PCR amd FISH assays were used to investigate the involvement of the microRNA-548 (miR-548)/Ras homolog family member A (RhoA) axis. Statistical analysis was performed using t-tests, with a significance threshold of P  <  0.01.

Results: Expression levels of miR-548 were significantly elevated in PE-exosomes. Both treatment with PE-exosomes and the overexpression of miR-548 inhibited trophoblast invasion and proliferation. These effects were reversed by RhoA overexpression. Together, these findings suggest that PE-exosomes suppress trophoblast invasion via the miR-548/RhoA axis. In pregnant women with PE, high miR-548 expression levels were observed, and were positively correlated with blood pressure and proteinuria.

Conclusions: Elevated miR-548 levels may contribute to the development of PE, suggesting that miR-548 could serve as a novel diagnostic or therapeutic target for this condition.

Background: French Guiana is France's largest overseas territory, accounting for 1/6th of mainland France. French Guiana has the highest fertility rate in France and Latin America. However, infant mortality, especially neonatal mortality, remains 2.6 times higher than in mainland France. Preeclampsia was found to be the most important pregnancy-related condition contributing to preterm birth in the primary analysis of risk factors for preterm birth in French Guiana.

Methods: Therefore, by analyzing the Registre des Issues de Grossesse de Guyane (RIGI), we sought to better describe this condition and understand its risk factors in our area. A retrospective and comparative study was conducted using 2014-2020 data from the RIGI, which describes 53,522 viable births (≥22 weeks of amenorrhea) in all four perinatal facilities in French Guiana. The RIGI is performed by midwives after patients' delivery. It records data up to two hours postpartum.

Results: During the study 12.9% of children were born preterm at less than 37 WA (weeks of amenorrhea). 4.5% of the study population had preeclampsia, of which almost half, 49.5%, were expected to deliver prematurely. The Afro-Caribbean population has a higher risk of preeclampsia than the white population, more than double that of the caucasians. Despite adjustment for place of birth, there are spatial heterogeneities in preeclampsia, with an increased risk for residents of towns in western French Guiana.

Conclusion: In conclusion, preeclampsia is a major cause of preterm birth and morbidity in French Guiana. The great heterogeneity between populations and geographical areas requires specific blood tests such as angiogenic balance or still heavy metal assays.

Preeclampsia is a complex condition characterized by elevated blood pressure and organ damage involving kidneys or liver, resulting in significant morbidity and mortality for both the mother and the fetus. Increasing evidence suggests that oxidative stress, often caused by mitochondrial dysfunction within fetal trophoblast cells may play a major role in the development and progression of preeclampsia. Oxidative stress occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the capacity of antioxidant defenses, which can lead to placental cellular damage and endothelial cell dysfunction. Targeting oxidative stress appears to be a promising therapeutic approach that has the potential to improve both short- and long-term maternal and fetal outcomes, thus reducing the global burden of preeclampsia. The purpose of this review is to provide a comprehensive account of the mechanisms of oxidative stress in preeclampsia. Furthermore, it also examines potential interventions for reducing oxidative stress in preeclampsia, including natural antioxidant supplements, lifestyle modifications, mitochondrial targeting antioxidants, and pharmacological agents.A better understanding of the mechanism of action of proposed therapeutic strategies targeting oxidative stress is essential for the identification of companion biomarkers and personalized medicine approaches for the development of effective treatments of preeclampsia.

Background: Proteinuria is a widely used biomarker for risk stratification in hypertensive pregnancies, with potential predictive value for adverse maternal and perinatal outcomes. This study evaluated the predictive value of 24-hour urine protein levels for adverse maternal and perinatal outcomes in hypertensive pregnancies.

Methods: A retrospective cohort of 213 pregnant women with hypertension was categorized into four groups based on proteinuria severity: <300 mg (n = 147), 300-500 mg (n = 22), 500-2000 mg (n = 25), and > 2000 mg (n = 19).

Methods: Higher proteinuria levels were significantly associated with increased rates of oligohydramnios (p = 0.001) and fetal growth restriction (FGR; p = 0.005), particularly in the > 2000 mg group (44.0% and 68.4%, respectively). Gestational age at delivery decreased with worsening proteinuria (p < 0.001), with the lowest mean age (32.84 ± 3.82 weeks) in the > 2000 mg group. Postpartum hospital stays were prolonged in chronic hypertension (p = 0.002) and severe proteinuria groups (p = 0.007). ROC analysis identified a 24-hour urine protein cutoff of 135 mg (AUC: 0.635, p = 0.001) for predicting fetal distress. The > 2000 mg group had universal magnesium sulfate use, earlier deliveries, and higher FGR rates. Chronic hypertension correlated with longer postpartum stays (p = 0.002) and higher postpartum renal disease (p = 0.040).

Conclusion: These findings underscore proteinuria as a prognostic marker for adverse outcomes, supporting its role in risk stratification for hypertensive pregnancies. Future research should validate thresholds and explore targeted interventions.

Objective: To evaluate the effect of lifestyle intervention using a self-management model based on the medical Internet of Things (mIoT) for women with gestational diabetes mellitus (GDM).

Methods: 240 eligible participants were initially enrolled, with 225 completing the trial (116 in the intervention group, 109 in the control group) due to 15 dropouts (4 in the intervention, 11 in the control) caused by delivery at non-study hospitals. The control group regularly received the lifestyle interventions. The intervention group received the same interventions based on mIoT. Data on glucose metabolism and lipid metabolism were collected at 4 weeks and 8 weeks after the intervention and pre-delivery at the admission. Maternal and infant outcomes were compared between the two groups.

Results: After the intervention, the fast blood glucose (FBG) and weight gain in the intervention group were significantly decreased than those in the control group. The glucose-metabolism indexes and lipid metabolism indexes were significantly lower in the intervention group than the control group. The rates of preeclampsia, preterm birth, neonatal hypoglycemia, and fetal macrosomia were also significantly lower in the intervention group than those in the control group.

Conclusion: The lifestyle intervention based on the medical Internet of things could improve the compliance and effectiveness of self-management in women with gestational diabetes mellitus, and it had a good clinical effect on their metabolic status in terms of blood glucose and lipids in late pregnancy and pregnancy outcomes.