Abstract
Pregnancy-induced hypertension (PIH), especially when complicated with pre-eclampsia (PE), could be a life-threatening complication of pregnancy. Pre-eclampsia is one of the leading causes of perinatal morbidity and mortality in women. Pre-eclampsia is mainly characterized by hypertension and kidney damage with proteinuria. Abnormal placentation and altered structure of the placental barrier are believed to participate in the pathogenesis of pregnancy-induced hypertension, leading to PE. In the current study, we aimed to analyze the immunohistochemical expression pattern of E-cadherin and p120, two markers of epithelial–mesenchymal transition, in placental samples derived from a group of 55 patients with pregnancy-induced hypertension, including pre-eclampsia and 37 healthy pregnant controls. The results were correlated with the presence of an obtained early uterine artery flow notching during diastole on Doppler ultrasound. We observed a higher frequency of discontinuous E-cadherin staining in the basement membrane of syncytiotrophoblast in patients with PIH/PE compared to controls (p < 0.001, Fisher’s exact test). Moreover, the loss of continuity of E-cadherin expression correlated with the presence of a bilateral early diastolic notch on Doppler ultrasound (p < 0.001, Fisher’s exact test) and the presence of proteinuria (p = 0.013, Fisher’s exact test). These findings suggest that E-cadherin contributes to the integrity of the placental barrier, and its loss could be an immunohistochemical marker of PE.
Highlights
Pre-eclampsia (PE) is a complication in 2–5% of pregnancies and is one of the leading causes of perinatal morbidity and mortality in women, especially when it has an early onset
We demonstrated that the loss of E-cadherin continuity in the syncytiotrophoblastic basal membrane correlates with the presence of an early diastolic notch in the uterine arteries, maternal proteinuria, and lower Apgar scores in newborns
It may indicate that altered E-cadherin expression could be a marker of placental barrier disruption
Summary
Pre-eclampsia (PE) is a complication in 2–5% of pregnancies and is one of the leading causes of perinatal morbidity and mortality in women, especially when it has an early onset. It is more common in developing countries due to older maternal age and obesity [1,2]. There is still no agreement on the definition of pre-eclampsia amongst many guidelines [2]. Some guidelines recommend a combined screening strategy including maternal blood pressure, maternal factors, uterine artery doppler, and placenta growth factor levels [2]. Treatment recommendations vary on whether non-severe hypertension should even be treated, there is an overall agreement on the drugs of choice (methyldopa, labetalol, and nifedipine), and the timing of delivery in uncomplicated gestational hypertension cases, which should be on or after 37 weeks of gestation [2]
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