Hypertension in Pregnancy最新文献

Background: Advanced maternal age, obesity, and primiparity are established risk factors for preeclampsia (PE). While soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) are key biomarkers for predicting PE, their variation based on maternal background factors remains unclear. This study aimed to identify maternal factors associated with sFlt-1 and PlGF levels.

Methods: We analyzed blood concentrations of sFlt-1 and PlGF in 830 pregnant women during the second trimester. Multivariate analysis was performed to examine their associations with maternal background factors. Based on the results, pregnant women who did not develop PE or superimposed PE were categorized by parity (0, 1, and ≥2) and pre-pregnancy BMI (<18.5, 18.5-25, and ≥25), and comparisons were conducted within each category.

Results: Multivariate analysis revealed that sFlt-1 was affected by parity and pre-pregnancy BMI, while PlGF was influenced by pre-pregnancy BMI. Multiparous women exhibited lower sFlt-1 and sFlt-1/PlGF ratios than primiparous women. Additionally, women with a BMI ≥ 25 showed lower sFlt-1 and PlGF levels, but higher sFlt-1/PlGF ratios than those with a BMI < 25.

Conclusion: These findings suggest differences in placental development based on maternal background factors and raise the possibility that parity and BMI could influence the interpretation of cutoff values for PE prediction.

Preeclampsia (PE) is a common multi-organ disorder in pregnancy. Urine as a source for test samples is noninvasive and easy to obtain. This study followed the Priority Reporting Project for Systematic Evaluation and Meta-Analysis protocol. We searched PubMed and Web of Science databases for studies relating to urine biomarker analysis for PE from inception to the 28^th of February 2023. The Chi-squared test was utilized to evaluate the statistical heterogeneity of the results. The combined sensitivity, combined specificity, combined positive likelihood ratio, combined negative likelihood ratio, combined diagnostic odds ratio for urine analysis in the context of PE were calculated. Sixty-five studies were eventually included in the final analysis. In only hypertensive disorders of pregnancy (HDP) pregnant women, the the area under the summary receiver operating characteristic curve (AUC) of urine analysis to predict PE was 0.93 (0.91-0.95). The results show that spot random urine analysis or shortened-hour urinary analysis for the diagnosis of PE is a credible alternative method when 24-h urine collection is difficult to complete. The protein/creatinine ratio from spot random urine analysis may be an effective biomarker of the further progression of HDP into PE.

Preeclampsia is a complex, progressive multisystem hypertensive disorder during pregnancy that significantly contributes to increased maternal and perinatal morbidity and mortality. Two screening algorithms are in clinical use for detecting preeclampsia: first-trimester screening, which has been developed and validated for predicting early-onset preeclampsia but is less effective for late-onset disease; and the sFlt-1:PlGF biomarker ratio (soluble tyrosine kinase and placental growth factor) used in suspected cases of preeclampsia. This ratio has a high negative predictive value, allowing for the reliable exclusion of the disease. Both of these screening tests have not met expectations. This review attempts to summarize the current knowledge on the pathogenesis and prediction of preeclampsia and to draw attention to novel biomarkers with a focus on microRNAs and galectins. Although these molecules belong to two distinct biological classes, they functionally converge in regulating placental and immune pathways. Ample evidence supports their involvement in the molecular mechanisms underlying preeclampsia. Based on current knowledge, galectin-13, C19MC members, and miRNA-210 are associated with the trophoblast/placenta and conditions of placental ischemia or hypoxia. Their levels differ significantly in pregnant women at risk of preeclampsia as early as the late first and early second trimester, making them potential markers for predicting preeclampsia.

Objective: This was a pilot study to investigate the feasibility of developing a low-cost mobile technology-based intervention to encourage blood pressure (BP) monitoring and adoption of healthy lifestyle habits.

Methods: This was a prospective, controlled, randomized, non-blinding feasibility study that involved the use of electronic BP monitor and smartphone. Eligible participants in the intervention group were instructed to send the BP measurements to members of the LifeAPP team digitally from an application for smartphones linked to the BP device by Bluetooth and also via WhatsApp. The LifeAPP team sent feedback containing information as follows: a) safety of the BP levels; b) motivational messages aiming at maintaining self-monitoring; c) motivational messages aiming at the importance of developing healthy lifestyle habits. The primary outcome was feasibility: recruitment capacity, retention, and compliance with follow-up rates.

Results: Between 1 June 2020 and 24 January 2021, 48 participants were randomized to the intervention group, and 48 participants were randomized to the control group. The recruitment capacity of the participating centers proved to be adequate. Among the participants recruited for intervention group, 21 (43.7%) attended predefined visits at 3 months and only 12 (25%) attended predefined visits at 6 months. Similar loss to follow-up was observed in the control group.

Conclusion: Despite successful recruitment of a cohort of women following preterm preeclampsia, there was no sufficient retention of participants. Therefore, new strategies for long-term follow-up of women who developed preeclampsia are needed before a further study in this group of patients can be contemplated.

Objective: Autism spectrum disorder (ASD) has multifactorial origins, some related to the prenatal period. Preeclampsia, a serious pregnancy complication, is also multifactorial. This study aimed to explore the potential association between preeclampsia and ASD in a diverse population.

Study design: A retrospective cohort study including all deliveries of Clalit Health Services-insured women at Soroka University Medical Center from 2005 to 2017. The study compared ASD incidence in offspring of mothers with varying severities of preeclampsia. Kaplan-Meier survival curves assessed cumulative ASD incidence, and Cox proportional hazards models adjusted for confounding factors.

Results: Of 115,081 parturients, 2,856 (2.5%) had preeclampsia, 956 (0.8%) with severe features. Preeclampsia, especially severe, was linked to adverse outcomes (e.g. fetal growth restriction, earlier delivery, cesarean delivery; p < 0.001). Among 767 (0.7%) offspring diagnosed with ASD, prevalence was higher in the preeclampsia group compared to those without preeclampsia (1.1% mild, 0.9% severe, no preeclampsia 0.7%; p = 0.02). However, Kaplan-Meier analysis showed no significant difference in cumulative ASD morbidity (log-rank p = 0.928). Cox regression models, conducted both with and without adjustment for gestational age, showed no significant association between preeclampsia and ASD after adjustment for relevant confounders.

Conclusion: To gain a deeper understanding of the obstetrical aspects related to the development of autism spectrum disorder, our findings indicate that preeclampsia does not play a contributory role.

Background: Abnormal hedgehog (Hh) signaling is linked to preeclampsia (PE). This study aimed to identify Hh-related diagnostic biomarkers for PE and assess the role of immune infiltration.

Methods: The PE dataset was obtained from GEO to screen DEGs. WGCNA was utilized to identify Hh pathway-related genes. Following the intersection of the two genes, key genes were screened by using LASSO, SVM-RFE, and RF. A model was constructed, with ROC applied for evaluating its performance. The ssGSEA was employed to analyze immune infiltration. Network Analyst was utilized to predict miRNA/TF targets.

Results: Six Hh-related diagnostic genes were identified (SLC20A1, GPT2, PDK4, COASY, KRT81, CD163L1). The diagnostic model showed high accuracy (AUC > 0.8) in training and validation sets. PE patients exhibited immune dysfunction, including reduced dendritic cell, macrophage, and mast cell activity. Diagnostic genes strongly correlated with immune cells. Additionally, 25 miRNAs and 34 TFs potentially regulating these genes were predicted.

Conclusions: Six potential PE diagnostic biomarkers were identified, and their immune interactions were explored. This study enhances understanding of PE pathogenesis and suggests therapeutic targets.

Objective: This study evaluated the maternal deaths due to hypertensive disorders in Brazil from 2012 until 2023.

Methods: We performed a cross-sectional study including public data from Brazilian Ministry of Health, including age group, self-reported skin color, and geographical region. The Maternal Mortality Ratio (MMR) was calculated for each year and for the entire period; we estimated the prevalence ratio (PR), confidence interval (CI) and trend (R2) of MMR according to the variables included.

Results: We analyzed 3,721 deaths attributed to complications of hypertension (MMR = 11.01/100,000 live births; R2 = 0.03). Those deaths were most prevalent among women aged 30 and older (PR 1.73, CI 1.61-1.85), especially those over 40 (PR 3.77, CI 3.34-4.25). Black (PR 2.75, CI 2.46-3.06), mixed-race (Pardo) (PR 1.27, CI 1.18-1.37), and Indigenous (PR 2.28, CI 1.76-2.97) women had significantly higher MMRs compared to White women. Central-West (PR 1.30, CI 1.13-1.46), North (PR 1.92, CI 1.74-2.13), and Northeast (PR 1.82, CI 1.68-1.97) regions had the highest maternal mortality rates due to hypertension. MMR due to hypertensive disorders of pregnancy in Brazil remained stable.

Conclusion: Women at higher risk of dying were older, Black, Indigenous, Pardo, and lived in the Central-West, North, and Northeast regions of the country.

Background: Gestational diabetes mellitus (GDM) patients are one of the important high-risk groups for the development of pre-eclampsia (PE). The pathogenesis of PE in GDM patients is not fully understood. This study aims to identify hub genes and pathways associated with the co-occurrence of GDM and PE.

Methods: The matrix files of GDM and PE datasets were downloaded from GEO to identify differentially expressed genes (DEGs). The common DEGs were predicted for functional analysis through GO and KEGG analysis. A protein-protein interaction (PPI) network was constructed to determine the common hub genes for GDM and PE. Diagnostic hub genes were obtained through regression modeling and ROC analysis, and validated in publicly available datasets. The differences in immune infiltration between GDM and PE were analyzed. The expression and role of common hub genes in the co-occurrence of GDM and PE were explored through analysis of single-cell sequencing data.

Results: A total of 104 DEGs were identified between GDM and PE. These common DEGs were found to be involved in mucosal immune response and the JAK-STAT signaling pathway. A total of 27 common hub genes were identified for both GDM and PE. BCL6, DNAH9, and SCG2 were identified as potential diagnostic biomarkers for PE. BCL6 showed high expression in neutrophils and villous cytotrophoblasts (VCTs) in both PE and GDM.

Conclusion: This study identified BCL6, DNAH9, and SCG2 as common hub genes in GDM and PE. BCL6 is expected to be a new target for the diagnosis and treatment of GDM concurrent with PE.

Aim: The objective of this study was to explore emerging pharmacological approaches for the prevention and treatment of PE, with a focus on novel molecular targets.

Methods: A review of current literature on oxidative stress, inflammation, and endothelial dysfunction in PE, along with investigational therapies undergoing preclinical and clinical evaluation.

Results: PE is strongly associated with oxidative stress and inflammation, leading to impaired placentation and maternal endothelial dysfunction. However, the key regulatory factors driving these processes remain unidentified. Many investigational therapies, though not yet endorsed by obstetric and gynecological societies, are being evaluated for potential clinical application.

Conclusion: Currently, the only definitive intervention is preterm delivery, often via cesarean section, highlighting the limitations of existing preventive and therapeutic strategies. Ongoing research into novel pharmacological targets holds promise for improved management of PE in the future.

Background: Pre-eclampsia (PE) affects 2-8% of pregnant women and is a major cause of maternal and perinatal complications. Early risk identification is critical to reducing maternal and neonatal mortality and morbidity.

Objective: This systematic review evaluates the role of ophthalmic Doppler arteries parameters, combined with maternal risk factors, physical examination results, and laboratory results for PE screening.

Methods: Relevant articles were identified from PubMed, Wiley Online Library, and ScienceDirect using predefined inclusion and exclusion criteria. Articles were screened in two stages - primary extraction by title and abstract, followed by full-text evaluation. The final analysis included observational studies and randomized trials assessing PE prediction using ophthalmic Doppler artery indices.

Results: Of the 103 records screened, 24 articles were retrieved, and 7 met the eligibility criteria. All studies examined ophthalmic artery Doppler parameters - especially the peak systolic velocity (PSV) ratio - for PE screening across different gestational ages. The PSV ratio showed moderate-to-high predictive value when combined with established clinical biomarkers.

Conclusion: The ophthalmic Doppler artery is regarded as a viable alternative or combination for early detection of PE that is simple to implement and effective, particularly in healthcare facilities in developing countries. However, further large-scale, externally validated studies are needed to establish its clinical utility across different gestational stages.