Gestational Hypertension Group Research Articles

Association of preeclampsia, placental pathology, and maternal-fetal features with gestational hypertension before and after 34 weeks of pregnancy

Objective: Evaluating the preeclampsia, placental pathology, maternal and fetal features in women with gestational hypertension (GH) at varying gestational ages. Methods: A series of maternal, fetal, placental pathological, and neonatal variables were prospectively evaluated and compared between two 30-tuple groups of eligible pregnant women with early GH before 34 weeks' gestation and those with late GH after 34 weeks' gestation. Results: Proteinuria and preeclampsia were more prevalent in the early GH group compared with the late GH group (80% vs 20%, P:0.001). The maternal high blood pressure and proteinuria were significantly associated with the early GH and preeclampsia (p<0.05). The percentage of syncytial knots significantly increased as preeclampsia progressed (P<0.05). A significant positive correlation existed between the early GH and the percentage of newborns admitted to NICU, the length of hospitalization, and the levels of the doppler indexes of umbilical and uterine arteries (p<0.05); the newborn Apgar scores were also lower in the early GH group (p<0.05). The mortality rate of newborns born to early hypertensive mothers (13.30%) was insignificantly higher than those delivered by the late hypertensive mothers (3.30%, p:0.16). Conclusion: Maternal high blood pressure and proteinuria may be predicting risk factors for the early GH and/or preeclampsia. The placentas of women with early GH were partially different from those with GH after 34 weeks' gestation. Higher rates of maternal and fetal pregnancy-related complications in the early GH group may be indicative of the different effects of GH and preeclampsia on pregnancy outcomes depending on the gestational age.

Expression and influence of KATP in umbilical artery smooth muscle cells of patients with hypertensive disorders of pregnancy

The objective of this study is to investigate the expression and influence of adenosine triphosphate-sensitive potassium channel (KATP) in human umbilical arterial smooth muscle cells (HUASMCs) of patients with hypertensive disorders of pregnancy (HDP). Western blotting was used to detect the protein expression levels of KATP inwardly rectifying potassium channel (Kir)6.1 and sulphonylurea receptor (SUR)2B subunits in HUASMCs from patients with normal parturients (NP), gestational hypertension (GH), chronic hypertension (CH), preeclampsia (PE) and chronic hypertension with superimposed preeclampsia (CHSP), respectively. There was no significant difference in the protein expression of Kir6.1 subunit in NP group, GH group, CH group, PE group and CHSP group (P > 0.05). The protein expression of SUR2B subunit was gradually decreased in NP group, GH group, CH group, PE group and CHSP group, with statistically significant difference among the groups (P < 0.05). The altered expression level of KATP SUR2B subunit may be involved in the pathogenesis of HDP. The severity of HDP may be related to the degree of decrease of SUR2B subunit.

Urinary protein and coagulation-fibrinolysis indicators in preeclampsia: Expression and significance.

This study investigates the expression and significance of urinary protein and coagulation-fibrinolysis indicators in preeclampsia, categorized into mild preeclampsia (109 cases) and severe preeclampsia (97 cases) based on disease severity. Additionally, 110 patients with gestational hypertension (gestational hypertension group) were included for comparative analysis. General information, laboratory indicators, urinary protein, and coagulation-fibrinolysis indicator levels were collected for each group. Significant differences were observed in blood pressure among groups (P<.05), while uric acid, serum creatinine, aspartate transaminase, alanine transaminase, and triglycerides showed no significant differences (P>.05). Total cholesterol, triglycerides, and low-density Lipoprotein levels in severe preeclampsia were higher than those in mild preeclampsia and gestational hypertension groups, whereas high-density lipoprotein, albumin, and platelet levels were lower in severe preeclampsia. No significant differences were observed in prothrombin time or D-dimer levels among groups (P>.05). Urinary protein, urinary protein quantification, activated partial thromboplastin time, thrombin time, and fibrinogen were identified as influencing factors for adverse maternal and infant outcomes in severe preeclampsia patients. The study concludes that urinary protein and coagulation-fibrinolysis indicators are elevated in preeclampsia, particularly in severe preeclampsia cases, suggesting their potential use as diagnostic influencing factors for severe preeclampsia.

Effects of hypertensive disorders of pregnancy on the complications in very low birth weight neonates

ABSTRACT Objective This study was designed to investigate the effects of hypertensive disorders of pregnancy (HDP) on the complications in very low birth weight (VLBW) neonates. Methods We retrospectively included VLBW neonates (<37 weeks) who were delivered by HDP pregnant women with a body weight of < 1,500 g (HDP group) hospitalized in our hospital between January 2016 and July 2021. Gestational age matched VLBW neonates delivered by pregnant women with a normal blood pressure, with a proportion of 1:1 to the HDP group in number, served as normal control. Results Then we compared the peripartum data and major complications between HDP group and control. The body weight, prelabor rupture of membrane (PROM), maternal age, cesarean section rate, fetal distress, small for gestational age (SGA), mechanical ventilation, RDS, necrotizing enterocolitis (NEC) (≥2 stage), Apgar score at 1 min, and mortality in HDP group showed statistical differences compared with those of the control (all p < 0.05). To compare the major complications among HDP subgroups, we classified the VLBW neonates of the HDP group into three subgroups including gestational hypertension group (n = 72), pre-eclampsia (PE) group (n = 222), and eclampsia group (n = 14), which showed significant differences in the fetal distress, Apgar score at 1 min, SGA, ventilation, RDS and NEC (≥2 stage) among these subgroups (all p < 0.05). Multivariate regression analysis showed that eclampsia and PE were the independent risk factors for SGA and NEC, respectively. Conclusion HDP was associated with increased incidence of neonatal asphyxia, fatal distress, SGA, mechanical ventilation, RDS, NEC and mortality. Besides, eclampsia and PE were independent risk factors for SGA and NEC.

Evaluation of maternal serum fibroblast growth factor-23 levels in fetal growth restriction and gestational hypertensive disease.

The objective of this study was to determine serum fibroblast growth factor-23 levels in preeclampsia, eclampsia, gestational hypertension, and the presence of fetal growth restriction subgroups. A total of 55 pregnant women with planned cesarean section were included in this cross-sectional study. They were divided into two groups, namely, control (25) and gestational hypertensive disease (30). The gestational hypertensive disease group was evaluated by dividing it into three subgroups (preeclampsia, eclampsia, and gestational hypertension) according to the clinical and laboratory findings of the disease and two subgroups (presence of fetal growth restriction and absence of fetal growth restriction) according to the birth weight percentile. Demographic parameters, obstetric history, physical examination findings, and laboratory values were evaluated. Demographic parameters and obstetric history were similar between the two groups, while gestational week of delivery was lower in the gestational hypertensive disease group (p=0.002). Laboratory parameters and serum fibroblast growth factor-23 (pg/mL) values were similar between the two groups. In the subgroup analysis for gestational hypertension, preeclampsia, and eclampsia, there was no statistically significant difference in serum fibroblast growth factor-23 levels between gestational hypertension, preeclampsia, eclampsia, and control groups. In the subgroup analysis based on the presence of fetal growth restriction, serum fibroblast growth factor-23 levels were similar to the control group in the gestational hypertensive disease absence of fetal growth restriction, while serum fibroblast growth factor-23 levels and serum calcium levels were statistically significantly lower in the gestational hypertensive disease with the presence of fetal growth restriction (p=0.044 and p<0.001, respectively). Serum fibroblast growth factor-23 levels are similar between pregnancies complicated with gestational hypertensive disease and normotensive pregnancies. However, serum fibroblast growth factor-23 levels were found to be lower in pregnancies complicated with gestational hypertensive disease with the presence of fetal growth restriction.

The Relationship between Serum Neuropeptide FFR2, Serum Smoothelin and Pregnancy Outcomes in Pregnant Women with Gestational Hypertension

Gestational hypetension is a major public health concern due to its links with cardiovascular disease, stroke and neonatal morbidity and mortality. Timely diagnosis and effective management of gestational hypertension are essential for both maternal and neonatal health. Neuropeptide FF Receptor 2 (NPFFR2) is a protein secreted by the brain and placenta, involved in pain regulation, water balance, and the modulation of cardiovascular effects. This study aims to conduct a comparative analysis of NPFFR2, smoothelin (SMTH), echocardiographic results and pregnancy outcomes in pregnant women with and without gestational hypertension. This study included 78 pregnant participants, which were grouped into women with gestational hypertension (n = 39) and those without gestational hypetension (n = 39). The gestational hypertension population was classified into two groups, i.e., dipper and non-dipper groups, based on the 24-hour ambulatory blood pressure monitoring results. Smoothelin and NPFFR2 analyses were performed using the blood samples and placental tissue samples collected from all participants, along with echocardiography and 24-hour ambulatory blood pressure monitoring. The study group comprised 78 pregnant women with a mean age of 28.8 years and mean gestational age of 27.7 weeks. The gestational hypertension group had a significantly higher NPFFR2 levels, lower SMTH levels and gestational age at birth and higher all 24-hour ambulatory blood pressure monitoring findings. The left atrial-to-aortic ratio and Tricuspid annular plane systolic excursion (TAPSE) were significantly higher in GİH group than in the control group. NPFFR2 and gestational age at birth were found to be independently associated with neonatal intensive care unit admission. Serum NPFFR2 levels were increased in women with gestational hypertension, SMTH levels were decreased, and pregnancy prognosis was found to be associated with NPFFR2 levels.

Thyroid-stimulating hormone and total bile acids can predict adverse pregnancy outcome among patients with gestational hypertension.

To investigate the correlation between serum thyroid-stimulating hormone (TSH) and total bile acid (TBA) levels in gestational hypertension and their combined predictive value for pregnancy outcome. A total of 194 patients with gestational hypertension (GH), treated from June 2020 to May 2022, were included in this study. The patients were divided into two subgroups based on pregnancy outcome: an adverse pregnancy outcome group (77 cases) and a normal pregnancy outcome group (117 cases). Additionally, 50 healthy pregnant women undergoing routine prenatal checkups during the same period served as the control group. In this study, serum TBA and TSH levels were measured and compared between the control and GH groups as well as between adverse pregnancy outcome and normal pregnancy outcome groups. The independent risk factors for adverse pregnancy outcome were screened using logistic regression, and their predictive value for pregnancy outcome in patients with GH was analyzed using receiver operating characteristic (ROC) curves. Serum TSH and TBA levels were significantly higher in the GH group compared to the normal group (both P < 0.001). Logistic regression analysis revealed that age, body mass index (BMI), TSH, and TBA were independent risk factors for adverse pregnancy outcome. ROC curve analysis showed that combined TSH and TBA for predicting adverse pregnancy outcome had an Area Under the Curve (AUC) of 0.896, surpassing the AUCs of each individual index (0.843 for TSH and 0.765 for TBA), which indicates a stronger predictive value (P < 0.001). The combined measurement of serum TBA and TSH can serve as a valuable predictive tool for pregnancy outcome in patients with gestational hypertension.

Cardiovascular Biomarkers and Blood Pressure at 6 Weeks and 6-12 Months Postpartum in Women With or Without Hypertensive Disorders During Pregnancy: A Prospective Study

Objective: To measure and compare cardiovascular biomarkers and blood pressure in women with hypertensive disorders of pregnancy (HDP) to those with normotensive pregnancies evaluated at 6 weeks and 6-12 months after delivery.Material and Methods: A prospective cohort study of postpartum women following HDP and normotensive pregnancies at 6 weeks and 6-12 months postpartum was conducted. Postpartum blood pressure and cardiovascular biomarkers including body mass index (BMI), levels of serum high-sensitivity C-reactive protein (hs-CRP), creatinine, glucose, glycated hemoglobin, low-density lipoprotein cholesterol, and levels of urine microalbumin/creatinine ratio (UACR), sodium, and potassium were quantified.Results: A total of 118 women involving 40 with previous preeclampsia (PE), 27 with gestational hypertension (GHT), 10 with chronic hypertension (CHT) during recent pregnancy, and 41 normotensive pregnancies were enrolled at 6 weeks postpartum, of whom 73 (61.9%) completed the study at 6-12 months postpartum. Women in the PE and GHT groups had significantly elevated blood pressure, serum hs-CRP and hypertension at 6 weeks and 6-12 months postpartum. Both the PE and CHT groups had an increase in UACR at 6-12 months postpartum. Multivariate linear regression showed that a history of PE and GHT was independently and persistently associated with increased postpartum blood pressure.Conclusion: Women with HDP had increased blood pressure, risk of hypertension, and increased levels of biomarkers associated with cardiovascular risk at both 6 weeks and 6-12 months postpartum, including serum hs-CRP and UACR. Women with HDP should be counselled about cardiovascular risks as early as 6 weeks postpartum.

Altered Placental Insulin Signaling in the Absence of Systemic Insulin Resistance in Hypertensive Disorders of Pregnancy among South Indian Tamil Population

A cross sectional study was conducted to explore the possible derangements in placental insulin signaling and also to investigate the presence or absence of maternal systemic insulin resistance in different types of hypertensive disorders of pregnancy (HDP). Study Design: Healthy pregnant women (n=32) and pregnant women with gestational hypertension (GH) (n=18), late onset Pre-eclampsia (LP) (n=18) and early onset Pre-eclampsia (EP) (n=19) were recruited for the study. Maternal venous blood and placental samples were collected from the study subjects at 35±7 weeks of gestation. Insulin resistance parameters such as fasting glucose, fasting insulin, homeostatic model assessment of insulin resistance, beta cell function and insulin sensitivity and glycated hemoglobin were estimated in the maternal venous blood samples. Placental protein expressions of insulin signaling molecules were analyzed by western blotting method. Results: Maternal venous blood insulin resistance parameters were not significantly different between the study groups. However, placental content of phospho insulin receptor beta was significantly decreased in GH, LP and EP groups in comparison to controls. We also found a significant decrease in placental protein expression of phosphatidyl inositol 3-kinase p85 alpha in LP group when compared to other groups.

Diagnostic value of random urine protein/creatinine ratio for preeclampsia

ObjectiveThe 24-h urine protein remains the gold standard to diagnose proteinuria in suspected preeclamptic patients. However, this test is time consuming and sometimes inaccurate. In this study, we aimed to analyse the correlation between the random urine protein/creatinine ratio (UPCR) and 24-h urine protein and to explore the clinical value of UPCR in the diagnosis of preeclampsia. MethodWe retrospectively evaluated 109 pregnant women from our hospital who had hypertensive diseases. They were grouped according to time of urine collection and disease severity to compare differences in random urine protein, urine creatinine, and UPCR. The correlation between the UPCR and 24-h urine protein was determined by Pearson's linear correlation. ResultsWe found no statistically significant differences in random urine protein, urine creatinine, or UPCR among the four time of sampling groups. Further, random urine protein, UPCR, and 24-h urine protein between the gestational hypertension and preeclampsia groups differed significantly (P < 0.001). Correlation analysis showed significant positive correlation between random urine protein, and 24-h urine protein, and UPCR and 24-h urine protein, with r values of 0.789 and 0.810, respectively. According to the receiver operating characteristic (ROC) curve, the optimal threshold, sensitivity, specificity, and area under the curve of UPCR for the diagnosis of preeclampsia were 0.456 g/mmol, 67.8 %, 78.3 %, and 0.747, respectively (95 % confidence interval [CI], 0.65–0.844). ConclusionThis study indicated that UPCR is significantly correlated with 24-h urine protein and is expected to replace the 24-h urine protein test as a diagnostic indicator of preeclampsia.

Correlation between ABO blood group and gestational hypertensive disorder among pregnant women in Abuja, Nigeria

Gestational hypertensive disorder (GHD) is among the major health problems in pregnant women. In this study, we assessed the relationship between gestational hypertensive disorder and ABO blood groups among women who attended the antenatal clinic at the University of Abuja Teaching Hospital, Abuja, Nigeria. Correlational study design was used on a total of 138 patients with sociodemographic characteristics and clinical data such as blood group, gestational hypertensive disorder status, maternal age at pregnancy, and parity were extracted. Descriptive statistics was carried out on the collected data and chi-square test for the test of association or Fisher’s exact where necessary. The maternal age of the women ranged from fifteen to fifty-one years old with a mean age of 30.7 ± 9.8. Clinical information revealed that 17 (12.3%) primigravida and 121 (87.7%) non-primigravida patients. The patients’ distribution by blood group revealed that 33 (23.9%), 32 (23.2%), 47 (34.1%) and 26 (18.8%) belonged to blood group A, B, AB, and O respectively. Our results showed a relationship between blood pressure and the ABO blood group but not significant with χ2 = 12.31 and p = 0.421 with blood pressure of 150/100–154/104 mmHg ranked highest in frequency among all the blood groups. Also, we observed a non- significant relationship between maternal age and the occurrence of GHD at χ2 =19.81 and p = 0.229 which implies that GHD is not associated with age but that blood pressure increases with gestational age. Interestingly, a significant relationship exists between gestational hypertension and parity at χ2 = 26.71 and p = 0.045. Blood group AB was more susceptible to gestational hypertensive disorder whereas blood groups O, A and B were less susceptible to it. We recommend increased awareness of GHD among pregnant women, all health workers, and the general public about its danger to pregnant mothers and fetuses.

Identification of gene signature markers in gestational hypertension and early-onset pre-eclampsia

IntroductionHypertensive disorders in pregnancy (HDP) are the leading cause of perinatal mortality worldwide. Inflammatory responses induced by insufficient placental perfusion have become a focal point in understanding the pathogenesis and aetiology of HDP and developing reliable and consistent biomarkers. Therefore, this study aims to identify gene signatures linked to the pathophysiology of HDP (gestational hypertension and early and late-onset pre-eclampsia). MethodsRNA was extracted from the maternal serum from the blood samples collected from different groups of HDP patients. A multiplex inflammation panel (255 inflammatory and housekeeping genes) and further gene expression analysis using NanoString Digital Direct Detection were done. The prominent expressions of these genes were further validated through qPCR techniques. ResultsNanoString analysis identified nine unique, significantly expressed genes (MAPK1, MAPK3, MAFF, HLA-DRA, IL12B, RHOA, MASP2, MEF2A and NR3C1) between specific group comparisons of different HPD classes and the normotensive groups. The qPCR showed that the HLA-DRA gene was significantly upregulated in the early-onset pre-eclamptic and gestational hypertensive group compared to its respective normotensive group. In contrast, MAFF and MEF2A were significantly downregulated in both HDPs compared to their controls. The MAPK1 gene was significantly higher in the early-onset group compared to the gestational hypertensive and normotensive groups. DiscussionThe upregulation of these distinctive genes in hypertensive groups compared to normotensives confirmed their diagnostic potential. Therefore, HLA-DRA, MAFF and MEF2A could be candidate markers of HDP, while the MAPK1 gene could be a differentiating marker between early-onset pre-eclampsia and gestational hypertension.

Longitudinal change of gut microbiota in hypertensive disorders in pregnancy: a nested case–control and Mendelian randomization study

Mounting evidence has shown that gut microbiota (GM) is related to hypertensive disorders in pregnancy (HDP), however, most studies only focused on one time point in pregnancy. In this study, we conducted a nested case–control study utilizing a follow-up cohort, resulting in the collection of 47 HDP patients and 30 healthy controls. The GM profiles were explored using 16S rRNA sequencing at three time points during pregnancy. The diversity analysis of GM showed no significant difference between HDP patients and controls, however, we found 21 differential GM during pregnancy. Trend analysis showed that there are statistical differences in the relative abundance of Thermomonas, Xanthomonas, and Phenylobacteriumat during pregnancy in the gestational hypertension group, and of Xanthomonas, Polycyclovorans, and Phenylobacterium in the control group. The correlation study found that six genera of GM are related to blood pressure. Furthermore, the MR analysis identified the causal relationship between Methanobrevibacter and pre-eclampsia (PE). This study first explored the longitudinal change of GM in HDP patients during pregnancy, found the differential GM, and detected the causal association. Our findings may promote the prevention and treatment of HDP from the perspective of GM and provide valuable insights into the pathogenesis of HDP.

Increased urinary albumin leakage is related to injuries of glomerular glycocalyx and podocytes, and associated with tubular dysfunction in preeclampsia.

The pathogenesis of preeclampsia (PE) is known to be endothelial cell damage; however, the existence of dysfunction in glomerular endothelial glycocalyx, podocytes and tubules remains unclear. The glomerular endothelial glycocalyx, basement membrane, podocytes, and tubules are permeability barriers against albumin excretion. This study aimed to assess the relationship between urinary albumin leakage and injuries of the glomerular endothelial glycocalyx, podocytes, and tubules in patients with PE. A total of 81 women with uncomplicated pregnancies (control, n=22), PE (PE, n=36), or gestational hypertension (GH) (GH, n=23) were enrolled. We assessed urinary albumin and serum hyaluronan for glycocalyx injuries, podocalyxin for podocytes injuries, and urinary N-acetyl-β-d-glucosaminidase (NAG) and liver-type fatty acid-binding protein (l-FABP) for renal tubular dysfunctions. The serum hyaluronan and the urinary podocalyxin levels were higher in the PE and GH groups. The urinary NAG and l-FABP levels were higher in the PE group. Urinary NAG and l-FABP levels positively correlated with urinary albumin excretion. Our findings suggest that increased urinary albumin leakage is related to injuries of the glycocalyx and podocytes, and associated with tubular dysfunction in pregnant women with PE. The clinical trial described in this paper was registered at the UMIN Clinical Trials Registry under registration number UMIN000047875. URL of registration: https://centre6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000054437.

Fetal Cardiac Function at Midgestation and Subsequent Development of Preeclampsia

To assess differences in cardiac morphology and function at midgestation in fetuses from pregnancies that subsequently developed preeclampsia (PE) or gestational hypertension (GH). This was a prospective study in 5,801 women with singleton pregnancies attending for a routine ultrasound examination at midgestation, including 179 (3.1%) who subsequently developed PE and 149 (2.6%) who developed GH. Conventional and more advanced echocardiographic modalities, such as speckle-tracking, were used to assess fetal cardiac function in the right and left ventricle. The morphology of the fetal heart was assessed by calculating the right and left sphericity index. In fetuses from the PE group (vs the no PE or GH group) there was a significantly higher left ventricular global longitudinal strain and lower left ventricular ejection fraction that could not be accounted for by fetal size. All other indices of fetal cardiac morphology and function were comparable between groups. There was no significant correlation between fetal cardiac indices and uterine artery pulsatility index multiple of the median or placental growth factor multiple of the median. At midgestation, fetuses of mothers at risk of developing PE, but not those at risk of GH, have mild reduction in left ventricular myocardial function. Although absolute differences were minimal and most likely not clinically relevant, these may suggest an early programming effect on left ventricular contractility in fetuses of mothers who develop PE.

Effects of genetic polymorphisms of CYP2J2, CYP2C9, CYP2C19, CYP4F2, CYP4F3 and CYP4A11 enzymes in preeclampsia and gestational hypertension

IntroductionThe aim of this study was to investigate the effects of cytochrome P450 (CYP) 2J2, CYP2C9, CYP2C19 and CYP4F2, CYP4F3 and CYP4A11 genetic polymorphisms in preeclampsia and gestational hypertension (GHT) patients in a sample of Turkish population. Materials-methodsPatients (n = 168; 110 GHT and 58 preeclampsia) and healthy pregnant women (n = 155, controls) participated in the study. For genotyping, polymerase chain reaction (PCR) and restriction analysis (RFLP) were used. Substance levels were measured using LC-MS. ResultsPlasma DHET levels in GHT and preeclampsia patients were significantly lower than those in the control group (62.7%, 66.3% vs.100.0%, respectively, p < 0.0001). An increase in CYP2J2*7 allele frequency was observed in the preeclampsia group, as compared to GHT group (12.1% vs. 4.5%; odds ratio, O.R. = 2.88, p < 0.01). The frequencies of CYP2C19*2 and*17 alleles were higher in GHT group as compared to the control group (17.7% vs. 11.6%, O.R. = 1.99, p < 0.01; and 28.6% vs.18.4%, O.R. = 2.03, p < 0.01, respectively). An increased frequency of CYP4F3 rs3794987 G allele was found in GHT group as compared to the control group (48.0% vs. 38.0%; O.R. = 1.53, p < 0.01). DiscussionDHET plasma levels were significantly reduced in hypertensive pregnant groups as compared to the control group. The allele frequency distributions for CYP2J2*7, CYP2C19 *2, *17 and CYP4F3 rs3794987 were significantly different in hypertensive pregnant patients as compared to the healthy control subjects. Our results may suggest that investigated genetic polymorphisms may be useful in diagnosis and clinical management of GHT and preeclampsia patients.

Higher PAPP-A Values in Pregnant Women Complicated with Preeclampsia Than with Gestational Hypertension

The purpose of this study is to compare the levels of maternal serum pregnancy–associated plasma protein-A at the first trimester in pregnancies complicated by impaired placental diseases, such as preeclampsia (PE), intrauterine fetal growth restriction (IUGR), and gestational hypertension (GH), with those in pregnancies without the development of any of these outcomes to expand the knowledge of how this protein behaves in the different impaired placental diseases. This current work is an observational study based on a prospective cohort. Pregnancy-associated plasma protein-A was measured in 422 patients who had completed maternal-perinatal outcomes. Comparisons of pregnancy characteristics and the biomarker between outcome groups (PE, IUGR, gestational hypertension, and not impaired placental outcomes) were analyzed. PAPP-A MoM in the IUGR (0.8 IQR: 0.6–0.9) and GH groups (0.5 IQR: 0.3–1.4) compared to the PE group (1.06 IQR: 0.66–1.52) was significantly lower (p < 0.005). Pregnant women who developed early-onset PE (1.11 IQR 1.08–1.18) presented significant differences with the IUGR group (0.83 IQR: 0.59–0.98; p = 0.002) and those who developed preterm-PE (1.19 IQR: 0.66–1.58; p = 0.045). The results demonstrate that the levels of PAPP-A at first trimester in the sample of women who developed PE, and specially term-PE, were higher than those in women who developed GH or IUGR. The GH group had the lowest PAPP-A values in this sample of pregnant women. Research in a population with a high prevalence of preeclampsia is still lacking and deserves more extended studies to define if these patients could have different rates of PAPP-A.

Thyroid hormone profile in preeclampsia patients: a case control study

Objective: Preeclamptic women are reported to have a higher incidence of thyroid dysfunction that correlates with the severity of preeclampsia. The aim of this study was to assess thyroid hormone profiles in in pregnant women with preeclampsia and gestational hypertension and the risk for thyroid dysfunction. Methods: In this study, age-matched pregnant females in the second trimester of pregnancy, diagnosed with preeclampsia (PE), gestational hypertension (GH), as cases, and apparently healthy normotensive (NT) pregnant woman as controls were recruited. Blood samples were drawn for the assessment of thyroid hormone (TSH, FT3 and FT4) levels and thyroid dysfunction. Results: Out of the total of 133 pregnant women recruited for this study, sub-clinical hypothyroidism was the only thyroid dysfunction common to all study groups, with a prevalence of 3.3% in both PE and NT groups, and 4.3% in the GH group. 1% of women in the PE group had sub-clinical hyperthyroidism, compared to 3.3% in the NT group. Although TSH and FT3 were elevated in normotensives, mean differences between the three groups were not statistically significant. However, mean FT4 levels in the GH group (12.99 ± 1.24) and PE group (12.33 ± 2.26), when compared to the control group (11.55 ± 1.94), were significantly higher (p < 0.05). Conclusion: Undiagnosed subclinical hypothyroidism was found in all the categories of pregnant women studied, which if uncontrolled, could increase the risk of pregnancy-related complications, especially in pregnant women with preeclampsia and gestational hypertension.

Utility of sFtl-1 and Placental Growth Factor Ratio for Adequate Preeclampsia Management.

Introduction: The pathophysiology of preeclampsia is represented by placental ischemia and the release of angiogenic factors. Recent research suggests that using the value of the sFtl-1/PIGF ratio is more accurate for monitoring angiogenic activity. The aim of this study consists in assessing the clinical utility of the sFtl-1/PIGF ratio in determining the diagnosis and severity of preeclampsia. Material and Methods: In our study a descriptive and prospective plan was used for analyzing the specific value of the sFtl-1/PIGF ratio in women with preeclampsia and in women with gestational hypertension, depending on the gestational age and severity. Results: The study included 59 women with preeclampsia and 25 women with gestational hypertension. The mean value of the sFtl-1/PIGF ratio of pregnant women with preeclampsia was 209.2 pg/mL, while in the gestational hypertension group, the mean value of the sFtl-1/PIGF ratio was 46.08 pg/mL. The difference between the value of the sFtl-1/PIGF ratio of the group with preeclampsia and the gestational hypertension group was > 67 (pg/mL), with a sensitivity of 86.44% and a specificity of 92.00%. Significant differences were found between the median values of the sFtl-1/PIGF ratio in pregnant women with severe preeclampsia in the early-onset subgroup compared to those in the late-onset subgroup (307 pg/mL, and 98 pg/mL, respectively, p = 0.009 < α = 0.05). Conclusions: The sFtl-1/PIGF ratio may be an alternative method for diagnosing preeclampsia and it can provide data about this condition's severity.

Diagnostic and Prognostic Value of Deregulated Long Non-Coding RNA Plasmacytoma Variant Translocation 1 in Patients with Gestational Hypertension.

This study aimed to investigate the serum plasmacytoma variant translocation 1 (PVT1) level in pregnant women with gestational hypertension and pre-eclampsia and its diagnostic value for diseases and its influence on pregnancy outcome. Serum PVT1 levels in 72 pregnant women with gestational hypertension, 72 pregnant women with pre-eclampsia and 71 healthy pregnant women were evaluated by RT-qPCR, and the diagnostic significance of PVT1 for gestational hypertension was verified by receiver operator characteristic (ROC) curve. The correlation between PVT1 and clinical indicators were evaluated by Pearson correlation coefficient method. Logistic regression analysis evaluated the influencing factors in the development process of gestational hypertension to pre-eclampsia. The effect of PVT1 level on pregnancy outcome was evaluated by prognostic analysis. Results showed that PVT1 level was down-regulated in gestational hypertension group compared with healthy control group, whereas PVT1 level was down-regulated more significantly in pre-eclampsia group than in gestational hypertension group. ROC curve showed that PVT1 had high diagnostic accuracy for gestational hypertension. Pearson correlation coefficient and multiple linear regression analysis showed that PVT1 was correlated with systolic blood pressure, diastolic blood pressure, interleukin (IL)-6 and tumor necrosis factor-α. Logistic regression analysis revealed that IL-6 and PVT1 were the influencing factors of gestational hypertension to pre-eclampsia transition. Moreover, prognostic analysis manifested that the incidence of fetal growth restriction in low PVT1 expression group was significantly higher than that in high PVT1 expression group. The expression level of PVT1 has a high diagnostic accuracy for gestational hypertension, and the low PVT1 expression group is more prone to fetal growth restriction.