Independent Risk Factor For Preeclampsia Research Articles

Maternal serum Numb in the first trimester of pregnancy as a biomarker for early prediction of pre-eclampsia: A prospective cohort study.

Early identification of women at risk of developing pre-eclampsia is beneficial as it allows for timely intervention strategies. This study aimed to evaluate the potential of serum Numb in the first trimester as a biomarker for early prediction of pre-eclampsia. This prospective observational cohort study was carried out at a tertiary teaching hospital between January 2021 and December 2022. A total of 1024 women were recruited during their 8-13 weeks of pregnancy and were followed up until delivery. Serum Numb levels were measured during 8-13 weeks of gestation for all participants. At the same time, the participants' anthropometric, clinical, and laboratory data were collected. A logistic regression model was used to investigate the potential association between serum Numb levels and the risk of pre-eclampsia. Receiver operating characteristic curves (ROCs) and area under the curves (AUCs) were utilized to evaluate the predictive efficacy of serum Numb levels for pre-eclampsia in the first trimester. Serum Numb levels were found to be significantly higher in pregnant women who developed pre-eclampsia compared to those who did not develop pre-eclampsia. Increased serum Numb levels were identified as an independent risk factor for pre-eclampsia, with an odds ratio (OR) of 3.27 (95% CI: 2.05-4.53) for the risk of pre-eclampsia. Numb levels showed a significant positive correlation with the risk of pre-eclampsia. Furthermore, Numb levels demonstrated a strong predictive efficacy for pre-eclampsia in the first trimester of pregnancy, with an AUC value of 0.86, a cutoff value of 48.73 ng/mL, a sensitivity of 79.24%, and a specificity of 75.73%. Serum Numb in the first trimester of pregnancy can serve as a biomarker for the early prediction of pre-eclampsia. This provides a valuable approach in clinical practice to identify pregnant women in the first trimester of pregnancy, who are at a higher risk of developing pre-eclampsia.

Prepregnancy Body Mass Index and Risk of Preeclampsia: A Meta-Analysis

Preeclampsia is a serious complication of pregnancy and is associated with an increased risk of maternal and fetal morbidity and mortality. Body mass index (BMI) before pregnancy has been identified as a potential risk factor for preeclampsia. This study aims to conduct a meta-analysis to evaluate the relationship between BMI before pregnancy and the incidence of preeclampsia, as well as identify effective prevention strategies. A literature search was conducted on the PubMed, Scopus, and Web of Science databases to identify observational studies published between 2018 and 2024. Studies that met the inclusion criteria had their data extracted and analyzed using a random effects model. Heterogeneity between studies was evaluated using the I2 statistic. Subgroup analyzes were performed based on geographic region and study design. A total of 25 studies with 534,000 respondents were included in this meta-analysis. The results of the analysis showed that increasing BMI before pregnancy was significantly associated with an increased risk of preeclampsia 2.22 (95% CI: 1.72-3.35). Subgroup analyzes revealed that these associations were consistent across geographic regions and study designs. This meta-analysis provides strong evidence that BMI before pregnancy is an independent risk factor for preeclampsia. Interventions to optimize BMI before pregnancy, such as nutritional counseling and promotion of physical activity, may be an effective preventive strategy to reduce the risk of preeclampsia.

Risk factors for preeclampsia in patients with chronic kidney disease primarily focused on stage 1 CKD. Are referred and registered patients alike?

Limited research exists on identifying risk factors for preeclampsia (PE) in the chronic kidney disease (CKD) population, especially across different patient sources. This study aimed to address this gap by analyzing clinical data from CKD pregnant women admitted to Peking University Third Hospital from January 2012 to December 2022. Logistic regression analysis identified independent risk factors for PE in the CKD population and assessed variations among patients from different sources. Additionally, a predictive model for PE was established using data from the registered group. The study included 524 CKD patients. Hypertension, proteinuria, fibrinogen >4 g/L, serum albumin ≤30 g/L, and uric acid >260 μmol/L were independent risk factors for PE in the overall CKD population. Subgroup analysis revealed that hypertension, serum albumin ≤30 g/L, and uric acid >260 μmol/L were independent risk factors in the referred group, while hypertension, uric acid >260 μmol/L, and fibrinogen >4 g/L were independent risk factors in the registered group. The prediction model based on registered group risk factors showed good predictive efficiency, with the area under the curve of 0.774 in the training set and 0.714 in the validation set. In conclusion, this study revealed that hypertension and elevated uric acid are independent risk factors for PE in CKD patients regardless of patient source, while serum albumin and fibrinogen levels are associated with PE risk in specific patient subgroups. Our predictive model enables clinicians to quickly identify the risk of PE in CKD patients, and early intervention treatment to improve pregnancy outcomes.

Heart disease in pregnancy and risk of pre-eclampsia: a Swedish register-based study

Background and aimsPre-eclampsia complicates 3–5% of pregnancies worldwide and is associated with adverse outcomes for the mother and the offspring. Pre-eclampsia and heart failure have common risk factors, including hypertension,...

High Sensitivity C-Reactive Protein as an Independent Risk Factor for Preeclampsia with Severe Features

Background: One of the most dangerous complications of pregnancy and a major contributor to maternal and perinatal morbidity and death is preeclampsia. The goal of the current study was to measure the level of inflammation in severe preeclampsia by measuring serum high-sensitive C-reactive protein (hs-CRP) and establishing a relationship between hs-CRP and blood pressure. Objective: The aim of this study is to evaluate the impact high sensitivity C-reactive protein as an independent risk factor for preeclampsia with severe features. Methods: The cross-sectional study was carried out in the Department of Obstetrics & Gynecology of Dhaka Medical College Hospital, Dhaka, from July 2022 to June 2023. A total of 200 patients were enrolled and analyzed in this study. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, majority 95 (47.5%) of the patients were in 21 – 30 years age group and 60 (30.00%) patients were in >30 years age group, Mean±SD of age was 27.12 ± 4.12 years. Most of the patients 150 (75.00%) were housewife and 50 (25.00%) patients were service holder. About 55 (27.5) patients were completed their graduation, 50 (25.00%) were completed higher secondary and 20 (10) were illiterate, most of the patients 145 (72.5%) came from rural area and 55(27.5) patients came from urban area. Nullipara was found in 75 (37.5%) patients and multigravida was found in most of the patients 110 (55.00%). Antenatal care was found irregular in 105 (52.5%) patients. Preterm pregnancy was found in majority 145 (72.5%) of the patients. Systolic and diastolic blood pressure were found higher and hsCRP was also found higher in PE with severe features. APGAR score was found less in 65 (32.5%) neonate at birth and APGAR score was found good in 55 (27.5%) neonate at 5 minutes. Average birth weight was found in 75 (37.5%) neonates, LBW was found in 85 (42.5) neonates and very LBW was found in 40 (20.00%) neonates of PE with severe features patients. Intrauterine growth retardation and prematurity were found in 75 (37.5%) and 20 (10.00%) neonates, admission to NICU was needed for 45 (22.5%) neonates, birth asphyxia was found in 15 (7.5%) neonates and stillbirth was occured in 35 (17.5%) cases. Conclusion: An exaggerated systemic inflammatory response, which may produce reactive oxygen species and worsen endothelial dysfunction, is present in preeclampsia. Clinical signs of hypertension and proteinuria in preeclampsia result from this. Preeclampsia-related maternal mortality and systemic complications may be reduced with early identification. hsCRP may therefore be a valuable gauge of preeclampsia severity.

Predictive Factors for the Common Adverse Maternal and Fetal Outcomes in Pregnancies Complicated by Systemic Lupus Erythematosus.

This study aimed to evaluate the outcomes of pregnancy in patients with systemic lupus erythematosus (SLE). It focused on identifying clinical and laboratory markers that could predict the common adverse pregnancy outcomes (APOs) after 20 weeks of gestation, namely preeclampsia (PE) and preterm birth (PTB) in them. Pregnant SLE women who delivered at the study center from 2010 to 2023 were retrospectively analyzed. Categorical variables were evaluated using the chi-square test or Fisher's exact test, while continuous variables underwent Mann-Whitney U testing. Stepwise regression was used to assess the predictors of pregnancy outcomes. The study enrolled 445 pregnancies in 408 women diagnosed with SLE. Of these, 202 pregnancies (45.4%) resulted in at least one APO. Disease flare-ups, hypertension, and proteinuria during the first trimester were primary predictors of at least one APO and PTB. The most frequently recorded maternal adverse outcome was PE (14.6%), while PTB accounted for 32.6% of fetal adverse outcomes. Multivariate regression analysis identified hypertension, history of PE, associated antiphospholipid syndrome (APS), proteinuria, and low serum C4 in the first trimester as independent risk factors for PE. Regular follow-ups at our center correlated with lower risks of APOs, PE, and PTB. APS also emerged as a risk factor for PTB, whereas the use of hydroxychloroquine (HCQ) during pregnancy seemed to protect against PTB. For pregnancies complicated by SLE, we recommend early pregnancy screening for proteinuria-even in the absence of lupus nephritis-as well as continued use of HCQ and routine prenatal care throughout pregnancy.

Cardiovascular impact on risk of preeclampsia, -an epidemiologic cohort study

Abstract Introduction Preeclampsia complicates 3-5% of pregnancies worldwide and accounts for approximately 45 000 maternal deaths yearly. Preeclampsia is defined as new onset hypertension with organ dysfunction after 20 weeks’ gestation. Preeclampsia and cardiovascular disease have common risk factors such as chronic hypertension, obesity, and diabetes. In addition, preeclampsia is an independent risk factor for later cardiovascular disease. Preeclampsia might result from maladaptation of the cardiovascular system to pregnancy, but it is not known if other cardiac diagnoses are also risk factors for developing preeclampsia. Purpose The aim of this study was to evaluate the impact of heart failure and other cardiovascular disease on the risk of developing preeclampsia. Methods This was a registry-based case-control study using data form Swedish national registers including the medical birth register, national patient register and the LISA register. For every case with preeclampsia (90 354 pregnancies) five controls were chosen (Figure 1). Controls were matched to cases on mother’s year of birth. A sub-analysis investigated the risk for preterm preeclampsia (delivery <37 gestational weeks) by risk-factor. Potential cardiac risk factors were congenital heart disease, pulmonary hypertension, aortic/peripheral artery disease, valvular heart disease, myocardial infarction, other coronary artery disease, arrythmia, hypertension, myocarditis/pericarditis. Also known cardiometabolic risk factors were analyzed. All diagnoses were defined by ICD-9 and ICD-10 codes. We used multiple logistic regression analysis adjusted for confounders (BMI, age, smoking, assisted reproductive technology, parity, multifetal pregnancy, and comorbidities before pregnancy). Results Women with preeclampsia were more often obese, less often nulliparous and had more often multifetal pregnancies compared with women with normotensive pregnancies. Heart failure, valvular heart disease, hypertension, and diabetes (type 1+2) were independent risk factors for preeclampsia (Figure 2). Women with heart failure (n=273) had an adjusted odds ratio (aOR) of 2.09 (95% confidence interval (CI) 1.58-2.75) for developing any preeclampsia and an aOR of 2.90 (95% CI 1.82-4.61) for developing preterm preeclampsia. For women with valvular heart disease (n=424), the aOR was 1.50 (95% CI 1.17-1.92) for any preeclampsia and 2.55 (1.62-4.01) for preterm preeclampsia. The remaining seven cardiac diseases were not independent risk factors for preeclampsia. Conclusion Women with heart failure and valvular heart disease are at increased risk of developing preeclampsia. This association was particularly strong in women with preterm preeclampsia. Our results support the theory of preeclampsia as a stress test for cardiovascular disease. Although a rare patient group, these women have to be monitored closely during pregnancy, both for cardiac complications and for development of preeclampsia.Figure 1.Flow chart.Figure 2.Results.

Abstract 16096: Systolic Blood Pressure, Preeclampsia, and Leiomyoma Genes - A Multivariable Mendelian Randomization and Mediation Analysis

Introduction: Preeclampsia (PE) (sudden-onset hypertension (>20 weeks gestation) with proteinuria, maternal organ/uteroplacental dysfunction or angiogenic imbalance) affects ~4 million women annually, causing death of >70,000 women and 500,000 babies, and sequelae like heart failure. Hypothesis: We hypothesize that among the known genetic associations of PE is an independent risk factor (IRF). Methods: Data Publicly available European ancestry genome-wide association study (GWAS) summary statistics (SS) derived single nucleotide polymorphism (SNP) based genetic instruments ( P- value≤5x10 -08 , r 2 <0.001) for known associations of PE [body mass index (BMI, kg/m 2 ) (339,224 subjects), high density lipoprotein (HDL, mg/dl) (188,577), blood pressure BP (mm Hg) - systolic (S) and diastolic (D) (458,577)] with SS for PE or eclampsia (7212 cases, 194266 controls) (outcome). Analyses 1) univariate two-sample Mendelian randomization (MR) [inverse variance weighted method (IVWM) for results; MR-Egger, and weighted-median methods for sensitivity analyses]; 2) multivariable (MV) MR to identify IRF after MV adjustment, 3) quantify change in effect size of IRF after adjustment (results reported as odds of PE per 10 unit change in SBP/DBP/HDL, and per standard deviation (SD) change in BMI); and 4) FUMA based analysis of IRF SNPs to annotate uterine genes using GTEx v8. Results: In 1) IVWM analysis, SBP (OR= 2.23 [95% CI= 1.82, 2.72]), DBP (3.32 [2.46,4.48], HDL (0.22 [0.09,0.55]), and BMI (1.58 [1.34,1.86]) associated with the odds of a diagnosis of PE; 2) MVMR analysis, only SBP (1.82 [1.11, 3.00] remained significant, after adjustment for BMI, DBP, and HDL; 3) proportion-explained analysis, ~18% reduction in the OR of SBP, after adjustment for BMI, DBP, and HDL; and 4) in FUMA based analyses, out of 7 gene associations, the top 2 uterine genes for SBP SNPs were ZNF859 , and CDC25A . Conclusions: Genetic predisposition to elevated SBP associated with increased odds of PE, independent of BMI, DBP, and HDL. Adjustment attenuated risk, suggesting shared genetic mechanisms. SBP is an independent risk factor for PE. SBP SNPs map to uterine ZNF859 and CDC25A, known leiomyoma associated genes, suggesting a pleiotropic role in PE development.

Low pregnancy-specific beta-1-glycoprotein is associated with nondipper hypertension and increased risk of preeclampsia in pregnant women with newly diagnosed chronic hypertension

Chronic hypertension is one of the major risk factors for preeclampsia. Pregnancy-specific beta-1-glycoprotein (PSG-1) is a protein that plays a critical role in fetomaternal immune modulation and has been shown to be closely associated with pregnancy adverse events such as preeclampsia. It is also known that PSG-1 and its source placenta are associated with many molecular pathways associated with blood pressure regulation. In addition, the nondipping pattern (NDP) of chronic hypertension has been shown to be an independent risk factor for preeclampsia. Dipper individuals experience a notable nighttime drop in blood pressure, typically around 10% or more compared to daytime levels, while nondipper individuals show a smaller nighttime blood pressure decrease, indicating potential circadian blood pressure regulation disruption. In this context, we aimed to reveal the relationship between PSG-1, NDP and preeclampsia in this study. A total of 304 pregnant women who were newly diagnosed in the first trimester and started on antihypertensive medication were included in this study. All subjects performed 24-h ambulatory blood pressure monitoring twice throughout pregnancy, the first in the 1. trimester to confirm the diagnosis of hypertension and the second between 20+0 and 21+1 gestational weeks to determine the dipper–nondipper status of hypertension. Subjects were grouped as dipper and nondipper according to blood pressure, and groups were compared in terms of PSG-1 levels. In this study, low PSG-1 levels and NDP were independently associated with preeclampsia. Findings from this study suggest that PSG-1 may play an important role in the causal relationship between NDP and preeclampsia.

Essential Trace Elements Status in Portuguese Pregnant Women and Their Association with Maternal and Neonatal Outcomes: A Prospective Study from the IoMum Cohort.

Cobalt (Co), copper (Cu), manganese (Mn), molybdenum (Mo), and zinc (Zn) are essential trace elements (ETEs) and important cofactors for intermediary metabolism or redox balance. These ETEs are crucial during pregnancy, their role on specific pregnancy outcomes is largely unknown. This prospective study (#NCT04010708) aimed to assess urinary levels of these ETEs in pregnancy and to evaluate their association with pregnancy outcomes. First trimester pregnant women of Porto and Lisbon provided a random spot urine sample, and sociodemographic and lifestyle data. Clinical data were obtained from clinical records. Urinary ETEs were quantified by inductively coupled plasma mass spectrometry (ICP-MS). A total of 635 mother:child pairs were included. Having urinary Zn levels above the 50th percentile (P50) was an independent risk factor for pre-eclampsia (PE) (aOR [95% CI]: 5.350 [1.044-27.423], p = 0.044). Urinary Zn levels above the P50 decreased the risk of small for gestational age (SGA) birth head circumference (aOR [95% CI]: 0.315 [0.113-0.883], p = 0.028), but it increased the risk SGA length (aOR [95% CI]: 2.531 [1.057-6.062], p = 0.037). This study may provide valuable information for public health policies related to prenatal nutrition, while informing future efforts to de-fine urinary reference intervals for ETEs in pregnant women.

Association between estradiol levels in early pregnancy and risk of preeclampsia after frozen embryo transfer.

The failure of remodeling the spiral arteries is associated with the pathogenesis of preeclampsia. Estradiol (E2) plays a crucial role in placentation and may be involved in the development of preeclampsia. However, there is a lack of data in this area. This study aims to assess the association between serum estradiol levels in early pregnancy and the risk of preeclampsia. We conducted a retrospective cohort study on patients who conceived after frozen embryo transfer (FET) using data from a database at a university-affiliated in vitro fertilization center. The study period spanned from January 1, 2010, to December 31, 2020. Multivariable logistic regression analyses were performed to determine the adjusted effect of E2 levels on the risk of preeclampsia. We compared the odds ratios of preeclampsia across quartiles of E2 levels and assessed their significance. Serum E2 levels at the fifth gestational week were significantly different between women with and without preeclampsia after FET programmed cycles (607.5 ± 245.4 vs. 545.6 ± 294.4 pg/ml, p=0.009). A multivariable logistic regression model demonstrated that E2 levels in early pregnancy were independent risk factors for preeclampsia. We observed an increased odds ratio of preeclampsia with increasing quartiles of estradiol levels after adjusting for potential confounders in FET programmed cycles. When comparing quartiles 3 and 4 (E2 > 493 pg/ml at the fifth gestational week) to quartiles 1 and 2, the odds ratios of preeclampsia were significantly higher. We found that serum E2 levels in early pregnancy may impact the risk of preeclampsia, particularly following FET programmed cycles. The association between E2 levels in early pregnancy and preeclampsia deserves further investigation.

Evaluation of the angiogenic factors sFlt-1, PlGF, and the sFlt-1/PlGF ratio in preeclampsia and associated features.

Soluble Fms-like tyrosine kinase-1 (sFLT-1) and placental growth factor (PlGF) were previously reported to play a key role in the pathogenesis of preeclampsia (PE). We tested the link between altered PlGF and sFLT-1 levels, and their ratio (sFlt-1/PlGF) with PE and PE-associated featured in Tunisian PE cases and age- and BMI-matched normotensive women. Peripheral blood specimens from 88 women with PE, and 60 control women were tested for PlGF and sFLT by commercially available ELISA. Significant increases in sFlt-1 levels and in the sFlt-1/PlGF ratio, more than changes in PlGF levels were noted in PE subjects when compared to control women. Elevation in sFlt-1 and sFlt-1/PlGF ratio was observed at different percentile values in PE cases. The receiver operating characteristic (ROC) area under the curve (AUC) for sFlt-1, PlGF, and sFlt-1/PlGF ratio were 0.869±0.031, 0.463±0.048, and 0.759±0.039, respectively. A systematic shift in sFlt-1, but not in PlGF, distributions for higher values occurred in PE subjects. A progressive increase in the adjusted OR paralleled increased sFlt-1 and the sFlt-1/PlGF ratio percentile values; no similar trend was noted for the PlGF percentiles. Increased sFlt-1 levels and sFlt-1/PlGF ratio were significantly correlated with dysmenorrhea, hypertension, baby weight, and C-section. In contrast, no correlation was found between PlGF and the PE-associated features tested. Increased sFlt-1 levels and corresponding sFlt-1/PlGF ratio, but not circulating PlGF levels, constitute an independent risk factor for PE.

High ratio of neutrophils to lymphocytes and high triglyceride levels in serum as risk factors for pre-eclampsia

Background: Preeclampsia is still a concerning health problem in pregnancy which can get worse if it is supported by low patient compliance. Appropriate screening method modalities can help in predicting the possibility of worsening. Neutrophil to Lymphocyte Ratio (NLR) and serum triglycerides could be used as blood parameters in preeclampsia conditions. This study determined the high Neutrophil to Lymphocyte Ratio (NLR) and high triglyceride levels as risk factors for preeclampsia in pregnant women. Methods: A case-control study was conducted from January to June 2022 at the Obstetrics and Gynecology Polyclinic, Prof. dr. I.G.N.G Ngoerah Hospital. This study involved pregnant women over 18 years of age with a gestational age of more than 20 weeks by consecutive purposive sampling. Neutrophil to Lymphocyte Ratio (NLR) and serum triglycerides were obtained by tracing complete blood laboratory results in the medical record. Chi-square analysis was conducted and continued by logistic regression analysis with the p-value <0.05 categorized as a significant result. Results: High NLR levels were at risk of experiencing preeclampsia 32.2 times higher than those with low NLR (95%CI 6.8 – 151; p=0.000). Patients with high triglyceride levels had a risk of experiencing preeclampsia 23.1 times higher than those with low triglycerides (95%CI 5.45 – 97.26; p=0.000). NLR, serum triglycerides, and maternal age were independent risk factors for preeclampsia after controlling for parity variables (p<0.05). Conclusion: Neutrophil to Lymphocyte Ratio (NLR) and high triglyceride levels are risk factors for preeclampsia.

Biological Role of Folic Acid in Pregnancy and Possible Therapeutic Application for the Prevention of Preeclampsia.

The rationale and importance of folic acid supplementation during pregnancy for fetal congenital defect prevention are accepted worldwide. Moreover, a sufficient plasma concentration of folates can reduce the incidence of spontaneous abortions, and support the normal expansion of placental blood vessels, ensuring physiological placental blood flow, thus promoting appropriate fetal growth and development. Furthermore, there is emerging evidence that long-term supplementation with folic acid can effectively prevent preeclampsia. Preeclampsia is unique to the human species in complications during pregnancy, which contributes to maternal and perinatal mortality worldwide. In the pathogenesis of preeclampsia abnormal placental invasion, the excess of antiangiogenic factors and maternal-placental syndrome play a key role. Increased blood levels of homocysteine during pregnancy are associated with the risk of preeclampsia. Moreover, hyperhomocysteinemia has been proposed to be an independent risk factor for preeclampsia. Folate supplementation helps to decrease elevated levels of homocysteine; thus, the role of folic acid supplementation in pregnancy is even more important. Multiple reports suggest that folate administration decreases the level of serum homocysteine and, therefore, reduce the risk and severity of preeclampsia. However, the association between folic acid supplementation and the decreased risk of preeclampsia has been investigated with controversial conclusions. Currently, the optimal dose of folic acid that is effective for preeclampsia prevention remains uncertain. In this review, we aim to summarize the accumulated knowledge on the role of folic acid in the pathogenesis of preeclampsia, and the possible impact of folate supplementation on the decreased risk of preeclampsia.

Fructose might be a clue to the origin of preeclampsia insights from nature and evolution.

Preeclampsia is a hypertensive disorder of pregnancy and is due to abnormal placentation. The pathogenesis remains unclear. Fructose is biologically distinct from glucose and has a critical role in fetal growth in early pregnancy. Many species, including humans, produce fructose in their placenta during the first trimester to assist fetal growth and survival during a time when hypoxia is significant. Fructose is preferred over glucose in hypoxic tissues, and in the developing fetus, fructose has a critical role in stimulating the production of nucleic acids, lipids and glycosaminoglycans. Fructose production normally decreases significantly following the establishment of maternal-fetal circulation following placentation. However, if there is impaired placentation, local hypoxia will continue to drive fructose production. Excessive fructose metabolism drives endothelial dysfunction, oxidative stress, elevated blood pressure, insulin resistance, fatty liver, and a rise in uric acid and vasopressin levels, all of which are features of the preeclamptic state. In addition to fructose production, dietary fructose, for example, from soft drinks, would be additive and has been reported to be a strong independent risk factor for preeclampsia. Uric acid-associated endothelial dysfunction disturbs the invasion of the spiral artery, leading to placental ischemia and further placental hypoxia. Here, we summarize the previous literature regarding the physiological and pathological roles of fructose in pregnancy and propose studies to further investigate the pathogenesis of preeclampsia. Fructose might be a Clue to the Origin of Preeclampsia Insights from Nature and Evolution Preeclampsia is a hypertensive disorder of pregnancy. The pathogenesis remains unclear. Fructose has a critical role in fetal growth in early pregnancy, and might be a key role to developing preeclampsia. Here, we summarize the previous literatures regarding the physiological andpathological roles of fructose in pregnancy to propose studies to further investigate the pathogenesis of preeclampsia.

Traffic Noise and Ambient Air Pollution Are Risk Factorsfor Preeclampsia.

Purpose: We aimed to evaluate the effect of traffic-related noise (TRN), environmental noise (EN) and traffic-related air pollution (TRAP) on preeclampsia. Methods: We followed 285 pregnant women from Maternal and Child Health Clinics who reported exposure to TRN on a scale from 0 (absence of EN) to 10 (high level of EN). EN was measured using a portable dosimeter, and NOx was calculated using the AERMOD pollutant dispersion model. Results: Using a multiple logistic regression model, adjusted for maternal age, BMI, number of births, fetal sex and maternal chronic illness, TRN (score ≥ 6 vs. score < 6) and TRAP (NOx ≥ 300 µ/m3 vs. NOx < 300 µ/m3) were noted as independent risk factors for preeclampsia, with OR = 3.07 (95% CI 0.97; 9.70, p = 0.056) and OR = 3.43 (95% CI 1.20; 9.87, p = 0.022), respectively. Joint exposure to TRN and TRAP was associated with a significant and independent risk for preeclampsia (OR of 4.11 (95% CI 1.31; 12.94, p = 0.016). Conclusions: In our population, traffic-related noise and ambient TRAP were risk factors for preeclampsia.

The association between chronic liver diseases and preeclampsia

BackgroundPreeclampsia is a multisystem disorder characterized by an abnormal vascular response to placentation associated with increased systemic vascular resistance. As liver involvement is one of the main clinical features of preeclampsia, we sought to determine if there is an association between chronic liver diseases and preeclampsia.MethodsA retrospective matched case–control analysis was conducted in a tertiary medical center. Three hundred eleven (311) pregnant women with preexisting chronic liver disease (study group), including viral and autoimmune hepatitis, non-alcoholic fatty liver, Wilson disease, and cirrhosis, were match for age, parity, and number of fetuses to 933 healthy pregnant women (control group). The primary outcome measure was the incidence of preeclampsia in each group. Secondary outcome measures were obstetrical and neonatal complications. Confounders found to be significant on univariate analysis were evaluated using logistic regression models, and odds ratios (OR) and confidence intervals (CI) were calculated.ResultsPreeclampsia was diagnosed in 28 women (9.0%) in the study group and 33 women (3.54%) in the control group (p < 0.001).On multivariate analysis adjusted for maternal age, parity, previous preeclampsia, chronic hypertension, gestational diabetes mellitus, pregestational diabetes mellitus, antiphospholipid syndrome, and mode of conception, chronic liver disease was found to be an independent risk factor for preeclampsia (aOR 2.631, 95% CI 1.518–4.561). Although there was no difference in the gestational week at delivery between the groups (38.6 ± 2.13 vs. 38.8 ± 2.17 for study and control group, respectively, p = 0.410), the study group had a lower mean neonatal birthweight (3088 ± 551 vs. 3182 ± 566 g, p = 0.011). There were no between-group differences in the other parameters evaluated.ConclusionIn our study, preexisting chronic liver disease was associated with a 2.6-fold increased risk of preeclampsia.

Fetal Cerebral Hemodynamic Changes in Preeclampsia Patients by Ultrasonic Imaging under Intelligent Algorithm.

This study was aimed at evaluating the adoption value of ultrasound imaging features on fetal cerebral hemodynamics in preeclampsia patients based on the partial difference algorithm and the hybrid segmentation network (HSegNet) algorithm. Forty pregnant women with preeclampsia diagnosed by ultrasound examination were selected as the research objects, and another forty normal pregnant women were selected as the control. Then, by using the partial differential algorithm, the imaging of fetal cerebral hemodynamics in preeclampsia patients was enhanced and optimized, and the general clinical data and experimental results were collected. The results showed that the automatic labeling of fetal cerebral artery in fetal middle cerebral artery (MCA) hemodynamic images was realized by HSegNet algorithm model, and the final accuracy was 97.3%, which had a good consistency with the manual annotation of doctors. Education level was a protective factor for preeclampsia (odds ratio (OR) = 0.535). Body mass index (BMI) and family history of hypertension during pregnancy were independent risk factors for preeclampsia (OR = 1.286, and 2.774, respectively). MCA end-diastolic volume (EDV) of preeclampsia fetuses was higher than that of normal fetuses. The MCA systolic-diastolic ratio (S/D), the pulsatility index (PI), and the resistive index (RI) in the preeclampsia group were significantly lower than those in the normal pregnancy group. The results showed that MCA PI, MCA RI, and MCA S/D had certain predictive values for the occurrence of adverse pregnancy outcomes (P < 0.05). In summary, the intelligent algorithm-based fetal MCA hemodynamic ultrasound image in the study could effectively predict pregnancy outcomes of patients and provide certain theoretical support for the subsequent reduction of adverse pregnancy outcomes in patients with preeclampsia.

Association between maternal serum 25-hydroxyvitamin D concentrations and the risk of pre-eclampsia in central Sudan: a case-control study.

There are few published data on the role of vitamin D concentrations during pregnancy in sub-Saharan Africa. Thus, the aim of the current study was to investigate the association between 25-hydroxyvitamin D (25[OH)]D) levels and pre-eclampsia. A case-control study, with 60 women in each arm, was conducted in Medani Hospital in Sudan. The cases were women with pre-eclampsia and healthy pregnant women as controls. The medical and obstetric history was obtained using a questionnaire. The serum 25(OH)D concentrations were measured using ELISA. The median (IQR) of 25(OH)D concentration was significantly lower in women with pre-eclampsia than in the controls (10.0 [6.5] vs 18.3 [22.1] ng/mL). Fifty-three cases with pre-eclampsia (88%) and 36 cases in the control group (60%) had vitamin D deficiency (25(OH)D level≤20 ng/mL). Multivariate logistic regression showed that the 25(OH)D levels were negatively associated with pre-eclampsia (adjusted OR [AOR]=0.87, 95% CI 0.81 to 0.92). Vitamin D-deficient women were at a higher risk of pre-eclampsia (AOR=4.51, 95% CI 1.70 to 11.94). Low 25(OH)D levels were reported in women with pre-eclampsia and were an independent risk factor for pre-eclampsia.

The Association between Ovarian Hyperstimulation Syndrome and Pregnancy Complications following Fertility Treatments.

This study was aimed to assess the association between ovarian hyperstimulation syndrome (OHSS) and pregnancy complications among women who conceived following fertility treatment. A retrospective population-based cohort study, including all singleton deliveries of patients conceived following ovulation induction (OI) or in vitro fertilization (IVF) between 1988 and 2016, was conducted. All births occurred in a single tertiary medical center. A comparison was performed between deliveries of women who had experienced OHSS at early gestation and subsequently had a pregnancy and women without OHSS. Women lacking prenatal care, multiple gestations, and stillbirths were excluded from the analyses. A multivariable logistic regression model was used to control for confounders. During the study period, 351,373 deliveries met the inclusion criteria, of which 6,748 were deliveries of infants who were conceived by either IVF or OI. Of this study population, 105 cases (1.6%) composed the exposed group, that is, women who had experienced OHSS with a subsequent live birth. In the multivariate analyses, after controlling for confounders, OHSS was not found as an independent risk factor for preeclampsia, gestational diabetes mellitus (GDM), intrauterine growth restriction (IUGR), preterm delivery (both <37 and <34 weeks), low birth weight (LBW), very LBW (VLBW), small for gestational age (SGA), and caesarean delivery. In a subanalysis conducted solely on the IVF population, similar results were found, aside from the association between OHSS and preterm delivery before 34 weeks of gestation which was statistically significant (adjusted odds ratio [AOR] = 2.3 95% confidence interval [CI]: 1.0-5.3, p = 0.049). In our population, OHSS was not found as a risk factor for adverse pregnancy and perinatal outcome. In IVF patients, OHSS is a risk factor for preterm delivery before 34 weeks of gestation. · OHSS is not a risk factor for pregnancy complications.. · Complications investigated were preeclampsia, GDM, prematurity, and others.. · In IVF patients, OHSS is a risk factor for preterm delivery..