Marker For Preeclampsia Research Articles

Immune checkpoint molecules B7-1 and B7-H1 as predictive markers of pre-eclampsia: A case-control study in a Ghana.

Immune tolerance in the fetal-maternal junction is maintained by a balance in the Th1/Th2 system. Th1-type immunity is associated with pro-inflammatory cytokines and immune checkpoint molecules (ICMs) such as B7-H1, while Th2-type immunity is characterized by anti-inflammatory cytokines and ICMs such as B7-1. Any imbalance in the Th1/Th2 immune system may lead to adverse pregnancy outcomes such as pre-eclampsia (PE). Hitherto, the potential of serum B7-1 and B7-H1 proteins as early markers of PE has not been explored in the Ghanaian population. This was a case-control study from May 2020 to April 2022 at the War Memorial and the Upper East Regional Hospitals. The study involved 291 women, including 180 (61.9%) with normotensive pregnancy and 111 (38.1%) with PE. Venous blood samples were collected and assayed for blood cell count, serum interleukins (ILs)-4, -6, -12, -18, and TNF-α as well as serum B7-1 and B7-H1 proteins. The monocyte count (p = .007), the serum levels of IL-18 (p = .035), TNF-α (p = .001), and B7-H1 (p = .006) were significantly higher in PE than in normotensive pregnancy. In addition, the monocyte count (p = .002), the serum levels of IL-12 (p = .029), TNF-α (p = .016), and B7-1 (p = .009) levels were significantly higher in the third trimester than the second trimester PE. In predicting PE, the area under the curve of cytokines and ICMs ranged from 0.51 for IL-6 to 0.62 for TNF-α. PE may be characterized by a dominant Th1-type immunity with higher levels of pro-inflammatory cytokines and B7-H1 proteins, but these variables may not be suitable for predicting PE.

High sensitivity C-reactive protein in pre-eclamptic women living with HIV at a tertiary hospital in Zambia: a preliminary study.

pre-eclampsia affects an estimated 8% of pregnant women and contributes to over 12% of global maternal deaths. High-sensitivity C-reactive protein (hs-CRP) is a potential marker of pre-eclampsia. However, little is known about hs-CRP levels in women with pre-eclampsia in Zambia. This study examined whether hs-CRP levels differ between women who develop pre-eclampsia compared with controls overall and in subgroups of women living with and without HIV. a case-control study was conducted among 40 pregnant women who developed preeclampsia (cases) and 40 normotensive pregnant women (controls) living with (n=20) and without HIV (n=20) at women and newborn hospital from February to May 2022. Standard ELISA kits were used to determine hs-CRP levels. The conditional logistic regression model calculated the odds ratios for hs-CRP and other predictor variables with their 95% confidence intervals. the median hs-CRP levels were higher among the cases than controls (7.84mg/ml vs 6.13mg/ml, p<0.001). Similar hs-CRP levels were observed among pre-eclamptic women living with HIV on antiretroviral therapy (ART) compared to HIV-negative women (7.92mg/ml vs 7.17mg/ml, p=0.862). On the other hand, normotensive women living with HIV on ART had different hs-CRP levels than HIV-negative women (6.60mg/ml vs 3.96mg/ml, p<0.001). Multivariable conditional logistic regression showed that pregnant women with higher levels of hs-CRP (AOR=1.01, 95% CI=1.01, 1.01) were more likely to have pre-eclampsia after adjusting for significant predictors. Pre-eclampsia was less likely among women living with HIV on ART (AOR=0.26, 95% CI=0.07, 0.99), married (AOR=0.15, 95% CI=0.03, 0.71), and multiparous (AOR=0.16, 95% CI=0.03, 0.80). high-sensitivity C-reactive protein levels were higher among the cases than controls. However, similar levels were observed in the subgroup of women living with HIV on ART. Participants with high hs-CRP levels had the highest odds of preeclampsia, suggesting that hs-CRP may be useful in predicting preeclampsia.

КЛИНИЧЕСКИЕ ОСОБЕННОСТИ ТЕЧЕНИЯ ПРЕЭКЛАМПСИИ С УЧЕТОМ ЭТНИЧЕСКОЙ ПРИНАДЛЕЖНОСТИ

Objective. To identify potential risk factors and characteristics associated with the course of preeclampsia in women of European and Asian descent. Materials and Methods. This study was conducted as a two-center comparative analysis. In the Russian center, we analyzed records from 212 pregnant women, including their birth histories and newborn outcomes. In the People's Republic of Vietnam, we examined the pregnancy and birth data of 255 women who were at least 22 weeks gestation and had hypertension at the time of delivery. Results. The Russian and Vietnamese cohorts were comparable in terms of parity and the age of onset of preeclampsia (PE). However, the Vietnamese group exhibited a higher incidence of early (placental) preeclampsia, with rates of 31.3% compared to 19.1% in the Russian group (p=0.0025). Clinical markers of PE varied significantly between the two groups: Vietnamese patients showed more severe arterial hypertension (p&lt;0.0001), while Russian patients had higher rates of proteinuria (p&lt;0.0001). Among Vietnamese patients, maternal life-threatening complications included eclampsia (1.2%), pulmonary edema (0.4%), and HELLP syndrome (3.9%), none of which were observed in the Russian cohort, which had a specific incidence of PONRP at 7.1% (p=0.0061). Conclusion. The differing clinical parameters of preeclampsia in these ethnic groups suggest distinct pathogenetic pathways for the disease, indicating the need for further research.

Detection of serum major histocompatibility complex I (HLA-1) and β2-microglobulin (β2M) in pre-eclampsia using isobaric tags for relative and absolute quantitation (iTRAQ).

The purpose of this preliminary investigation into the pathogenesis of pre-eclampsia was to screen the differential proteins in the serum of pregnant women with normal pregnancy and early-onset pre-eclampsia using isobaric tags for relative and absolute quantitation (iTRAQ), so as to identify serum biomarkers for the early diagnosis of pre-eclampsia. We examined the peripheral serum of 58 normal pregnant women and 42 pregnant women with early-onset pre-eclampsia using iTRAQ; the differentially expressed proteins were screened for bioinformatics analysis; and the expression of candidate proteins human leukocyte antigen-1 (HLA-1) and β2-microglobulin (β2M) in placental tissues was detected using western blot. We identified a total of 63 differential proteins in the serum of patients from the normal control group and the pre-eclampsia group, and this included 24 up-regulated proteins and 39 down-regulated proteins. The western blot results of placental tissue showed reduced HLA-1 expression (1.12 ± 0.23) in the placenta in the pre-eclampsia group as compared with the normal control group (1.34 ± 0.22). Consistent with the results observed in the serum, β2M in the placenta in the pre-eclampsia group was significantly elevated (1.05 ± 0.47) in comparison with the normal group (0.75 ± 0.33) (P < 0.05). In this study, we found that iTRAQ technology was useful for identifying differentially expressed proteins in the peripheral serum of pregnant women with pre-eclampsia, and that HLA-1 and β2M, which may be involved in the occurrence of pre-eclampsia, show promise as predictive markers of pre-eclampsia.

COMPARISON OF OXIDATIVE STRESS LEVELS DURING THE THIRD TRIMESTER IN NORMAL PREGNANCY AND PREECLAMPSIA

Background: The placenta is a complex transiently formed organ which plays a crucial role in the development of the foetus. As the placenta is responsible for maintaining pregnancy placental defects are mainly responsible for pregnancy-related issues. Preeclampsia is a pregnancy-related disorder due to uteroplacental insufficiency resulting from deficient remodelling of spiral arteries causing ischemic reperfusion injury which is finally responsible for the generation of reactive oxygen species and oxidative stress by the placenta. So, this study was planned to determine and compare serum levels of oxidative stress markers (ischemia-modified albumin and malondialdehyde) in preeclampsia and normal pregnancy in the third trimester. Methods: Study design: Cross-sectional comparative study Settings Gynae/Obs Department and Pathology Laboratory, Lahore General Hospital, Lahore. Study population: 42 Pregnant females at 34–36 weeks of gestation were selected. Group 1 compromised 21 normal healthy pregnant females and group 2 included 21 preeclamptic patients. Sampling technique: non-probability purposive sampling. Blood samples were taken at 34–36 weeks of gestation. Serum was stored for ischemia-modified albumin and malondialdehyde. Data was analyzed using SPSS version 20. An Independent t-test was used to compare values between the groups during the third trimester. A p-value of ≤0.05 was considered significant. Results: Comparison of ischemia-modified albumin and malondialdehyde values between group I and group 2 showed a highly significant difference of p-value of &lt;0.001. Conclusion: Oxidative stress markers were higher in preeclamptic patients as compared to normal pregnant females during the third trimester suggesting the role of the placenta in oxidative stress.

Are the serum delta neutrophil index and systemic inflammatory index useful as predictive parameters for preeclampsia and HELLP syndrome?

We aimed to determine whether the serum delta neutrophil index and other systemic inflammatory index parameters can have an auxiliary effect in the diagnosis when used with other bio chemical markers in preeclampsia and HELLP syndrome and to determine the role of inflammation in the pathogenesis of these diseases. 121 pregnant women who met the inclusion and exclusion criteria were included in the study. 52 pregnant women diagnosed with preeclampsia and 19 pregnant women diagnosed with HELLP syndrome were included in the study group, and 50 healthy pregnant women were included in the control group. Demographic data, hematological and bio chemical parameters, and inflammatory markers (serum delta neutrophil index - DNI - and systemic inflammatory index parameters) of the groups were recorded and compared between groups. In terms of neutrophil lymphocyte ratio, platelet lymphocyte ratio, and DNI, the HELLP group was different from both groups. The control and preeclampsia groups were similar. In terms of monocyte-to-lymphocyte ratio, the preeclampsia group was different from both groups. The control and HELLP groups were similar. In terms of the systemic inflammatory index, all groups were similar. In our study, we found that when maternal serum DNI values are used together with other bio chemical parameters, it can help in the diagnosis of preeclampsia and HELLP syndrome, and inflammation may play a role in the pathogenesis of these diseases.

Early and late chorioretinal complications of preeclampsia

Preeclampsia remains a serious problem of obstetric practice, the growth of severe forms of this complication of pregnancy is predicted in the future, which determines the scientific interest of specialists in the search for new markers of preeclampsia to prevent the progression of preeclampsia and maternal mortality. The ocular fundus is an area where vessels can be observed in real time, in addition, the structure of the retina predisposes to the development of edema, up to retinal detachment in severe preeclampsia. In the last decade, new diagnostic equipment has become available to study chorioretinal changes at the stage of preclinical manifestations. In order to study early and late complications of pre-eclampsia from the retina and vasculature, we analyzed domestic and foreign scientific sources published in the last five years. According to a number of authors, changes in the visual organ of varying degrees of severity in preeclampsia occur in 100% of cases. It is established that the key role in the pathogenesis of vascular disorders in preeclampsia belongs to endothelial dysfunction. Preeclampsia may be accompanied by hemorrhagic and ischemic retinal infarcts, retinal pigment epithelium detachment, corkscrew-shaped tortuosity of arterioles in the periphery of the retina, retinal detachment, optic disc edema, less frequently vitreous hemorrhages, lesions of the optic nerve, conjunctiva and cerebral cortex in the area of visual centers, which may resolve against the background of therapy when the patient's general condition improves. However, in some women endothelial dysfunction may persist for many years, the most frequent late complications of preeclampsia are retinal detachment and diabetic retinopathy. Along with traditional methods of ophthalmoscopy of the eye fundus for diagnostics of chorioretinal complications OCT for determination of serous retinal detachment, subretinal deposits and other pathologies of the vasculature, USDG of the central retinal artery, posterior short ciliary arteries, ocular artery for diagnostics of ophthalmologic complications of preeclampsia can be used. As a result of the analysis of scientific data, conclusions are drawn about the association of preeclampsia with the development of certain early and distant chorioretinal complications. The search for new, earlier changes on the ocular fundus may serve for early diagnosis of preeclampsia, prevention of severe complications of pregnancy.

Transcriptomic Profiling of Placental Cells in Preeclampsia as an Effective Tool for Personalized Medicine

At present transcriptomics is one of the fastest developing fields of molecular biology, which allows to obtain detailed information about the functional activity of the genome both in normal and pathological conditions. We used modern transcriptomic technologies to comprehensively characterize the whole genome gene expression profile of human placental syncytiotrophoblast cells (STB) in physiological pregnancy and preeclampsia (PE). As a result of our analysis, we identified 26 differentially expressed genes (DEGs) in the STB cells between healthy and diseased states. The cluster of DEGs contains not only well-known candidate genes identified earlier in many foreign whole genome studies of the placenta (for example, LEP, INHBA and FLT1), but also new genes (AC098613.1, AC087857.1, FCRLB, TENM4, PTP4A1P7, LINC01225, etc.) that can be considered as new biological markers of PE and are of interest for further study. Functional enrichment annotation indicated that most of the DEGs were implicated in the signaling pathways of regulation of hormonal secretion, MAPK cascade, ERK1 and ERK2 cascade, positive regulation of cell adhesion and proliferation of endothelial cells. These processes may be associated with the development of PE at the STB cells level. Additionally, we revealed that alternative splicing of the FLT1 gene indicate the important role of this RNA processing mechanism in the pathogenetics of PE due to a significant increase in the transcriptional diversity of genes in STB cells. The expression level of the transcript encoding the protein isoform FLT-1 e15a was significantly increased in patients with PE compared to the control group. This study expands understanding of the molecular mechanisms involved in PE and can serve as a basis for developing of preventive, prognostic and therapeutic strategies in the field of personalized obstetrics.

Urinary Nephrin Levels Among Pregnant Women With Preeclampsia in Lagos, Southwest Nigeria: An Analytical Cross-Sectional Study.

Hypertensive disorders in pregnancy are one of the leading causes of maternal and perinatal morbidity and mortality worldwide. The clinical utility of urinary nephrin as a diagnostic biomarker of preeclampsia is currently of research interest. However, this is yet to gain significant traction within clinical settings. We evaluated the association between maternal urinary nephrin levels and the occurrence and severity of preeclampsia among pregnant women in Lagos, Nigeria. We conducted an analytical cross-sectional study involving pregnant women diagnosed with preeclampsia as well as their age- and gestational-age-matched normotensive counterparts. We tested the association between high maternal urinary nephrin levels and the occurrence of preeclampsia without and with severe features. P < 0.05 was reported as statistically significant. The study showed that for every unit increase in urinary nephrin levels, the odds of preeclampsia increased by about ninefold (adjusted Odds ratio = 8.9, 95% confidence interval: 2.8-29.2, P < 0.001). The levels of urinary nephrin increased steadily with increasing severity of the disease: 1.9 ± 0.8 ng/mL in preeclampsia without severe features, 2.7 ± 0.7 ng/mL in preeclampsia with at least one severe feature, and 3.3 ±1.1 ng/mL in eclampsia. There was an association between elevated levels of urinary nephrin and preeclampsia and its severe variant. However, there is a need for more robust studies with a longitudinal characterization of urinary nephrin levels to establish causal relationships with preeclampsia, explore other potential risk factors of preeclampsia, and define the clinical usefulness of urinary nephrin as a potentially reliable and accurate predictive marker of preeclampsia among women in low- and middle-income countries (LMIC) settings.

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.

Diagnostic significance of blood lymphocyte activation markers in pre-eclampsia.

The adaptive and innate immune system is important in both initiating and preventing functional disorders during pregnancy, one of which is pre-eclampsia. The research aims to conduct the comparative quantification of selected subpopulations of peripheral blood immunoregulatory cells in pregnant women with pre-eclampsia in the third trimester. The marker receptors CD4, CD8, CD95, CD25, and CD27 and the marker antigen HLA-DR were considered. The screening was performed by flow cytometry with dual phenotyping using phycoerythrin- and fluorescein-isothiocyanate-labeled monoclonal antibodies. Data processing consisted in calculating a likelihood value to assess the statistical significance of the difference between the samples. A statistically significant decrease in the subpopulation titer of T and B lymphocytes with marker receptors CD4, CD8, and CD19 was found in pre-eclampsia patients. In the CD4 carrier T-lymphocyte population, there was an increased expression of the CD25/CD95 activation and apoptosis markers. In the CD8 T-killer population, a decreased representation of the CD27/CD25/CD95 markers of differentiation, activation, and apoptosis was deterministic. The expression pattern of the major histocompatibility complex antigen HLA-DR did not change significantly in normality and pathology. The titer of peripheral natural killer cells carrying the CD56 marker increased in patients with various degrees of disease severity, while the number of CD16 natural killer remained at the level of the control group. The research results suggest that a change in the ratio of the above receptors is a diagnostic indicator for pre-eclampsia.

Expression of androgen receptor in human placentas from normal and preeclamptic pregnancies

Background: Human placenta is a diary of all the prenatal events and it’s study may provide valuable insight into pathophysiology of many diseases. One such disease preeclampsia (PE) is a leading contributor of maternal/fetal mortality and morbidity. In a quest to improve the treatment protocols, newer etiologies are researched, the latest being Androgen Receptor (AR) expression in PE placentae. Methodology: Study was conducted in a tertiary care hospital in Bengaluru over a period of 18 months. Placentae (15) from singleton pregnancies with PE formed the study group while placentae (5) from normotensive pregnancies were the control group. Gross and histopathological findings followed by immunohistochemistry of AR was performed on all placentae and categorized based on the percentage of villi stained. Intracellular localisation and the type of cells staining were also recorded. Results: Mean age was 28 years, majority (73%) of PE were in 28-32 weeks gestation group, with 46% being primigravidae. Past history of PE was observed in 75% while 53% had family history of PE. Decreased placental weight, increased syncytial knots, accelerated villous maturation and stromal fibrosis, fibrinoid necrosis and mural hypertrophy of arterioles were statistically significant findings in PE group. AR staining was seen in 16/20 (80%) with 11/15 PE cases showing 2+ and 3+ staining. Cytoplasmic staining was commonly seen in Syncytiotrophoblast, Cytotrophoblast &amp; stromal cells in both groups. Conclusion: AR expression was seen both in PE and non-PE placentae, although AR expression is increased in the former. Stillbirths were associated with positive AR despite clinically classified as mild PE, while negative AR was associated with live births. AR expression could be a new marker for PE with adverse outcome especially in recurrent cases.

Association between expression levels of p53, miRNA-21, and lncRNA-TCL6 and the risk of preeclampsia in pregnant women

BackgroundPreeclampsia is a hypertensive pregnancy-related disorder. The etiology of preeclampsia is still not fully elucidated. Genetic factors are suggested to play a vital role. AimThe association between p53, miRNA-21, and lncRNA-TCL6 expression levels and the risk of preeclampsia and its onset and severity in pregnant women was evaluated. MethodExpression levels of the analyzed RNAs were assessed in the serum samples from 75 preeclamptic pregnant women and 75 volunteer pregnant women with an uncomplicated pregnancy. ResultsCases showed upregulated p53, lnc-TCL6, and downregulated miRNA-21. P53 expression and preeclampsia severity were substantially correlated, while miRNA-21 and lnc-TCL6 were not. None of them was associated with preeclampsia onset. In diagnosing preeclampsia, p53 had the best sensitivity (98.67 %), followed by miRNA-21 (97.33 %) and lnc-TCL6 (92 %). P53 had the highest sensitivity (68.42 %) for distinguishing mild from severe cases. Lnc-TCL6 exhibited 52.63 % sensitivity, while miRNA-21 had 52.63 % sensitivity. Finally, for discriminating early and late-onset cases, miRNA-21 demonstrated the highest sensitivity (66 %), followed by p53 (62 %) and lnc-TCL6 (54 %). P53 expression was inversely correlated with proteinuria. Parity, TLC, platelet count, AST, and ALT were positively correlated, while lnc-TCL6 expression was negatively correlated with miRNA-21 expression. However, parity negatively correlated with lnc-TCL6 expression. ConclusionP53, miRNA-21, and lnc-TCL6 were dysregulated in preeclampsia compared to normal pregnancy, highlighting the role of apoptosis in its development. P53 can be a prognostic marker for preeclampsia, discriminating between mild and severe cases.

MiR-135b-5p targets ADAM12 to suppress invasion and accelerate trophoblast apoptosis in preeclampsia

IntroductionPreeclampsia was a serious complication often leaded to adverse pregnancy outcomes. Abnormal placental miR-135b-5p expression in preeclampsia was observed in our preliminary investigation. However, the role of miR-135b-5p in preeclampsia was unclear. MethodsWe determined the miR-135b-5p expression pattern at the fetomaternal interface and levels in placental tissue and exosomes. MiR-135b-5p expression in the trophoblast cell line HTR8/SVneo was manipulated by transient agomir or antagomir transfection or establishment of HTR8/SVneo cell line stably overexpressing miR-135b or miR-135b-5p-sponger. Then the function of miR-135b-5p on the motility of HTR8/SVneo cells, and its effects on cell viability was determined. Finally, we confirmed the relationship between miR-135b-5p and ADAM12. ResultsMiR-135b-5p exclusively expressed in the villous cytotrophoblast, and extravillous trophoblast. Significant miR-135b-5p upregulation was observed in the placenta and peripheral plasma exosomes in preeclampsia, and could be a highly sensitive molecular marker for preeclampsia. Elevated miR-135b-5p expression significantly promoted apoptosis and inhibited HTR8/SVneo cell invasion and migration. Binding of miR-135b-5p to the ADAM12 mRNA 3ʹ-untranslated region was predicted by bioinformatics analysis and confirmed using a dual-luciferase reporter assay. High miR-135-5p levels inhibit the invasion and migration of trophoblastic cells, possibly by directly binding to the 3ʹ-UTR of DADM12 and suppressing its translation efficiency, thereby nullifying the promotion of trophoblast invasion and migration via ADAM12. DiscussionAbnormal upregulation of miR-135b-5p may be involved in preeclampsia through triggering trophoblast apoptosis and impeding trophoblast invasion and migration by targeting ADAM12.

Diagnostic Serum Markers for Pre-eclampsia – An Overview

Pre-eclampsia, a hypertensive disorder of pregnancy, remains a major global health concern due to its potential for adverse maternal and fetal outcomes. Early and accurate diagnosis is crucial for effective management. Serum markers have emerged as valuable tools in this regard, offering insights into the pathophysiology and severity of pre-eclampsia. This comprehensive review explores the diagnostic utility of serum markers in pre-eclampsia. We examine the physiological basis and rationale for using specific markers, including serum uric acid, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), 24-hour urine protein, and serum prolactin, among others. Additionally, we discuss the challenges and limitations associated with these markers, considering factors influencing marker levels and diagnostic interpretation. Serum markers, when integrated into clinical practice, enhance early diagnosis, risk stratification, and individualized care for pregnant individuals. They facilitate the identification of high-risk cases, prompt timely interventions, and reduce maternal and fetal complications associated with pre-eclampsia. Furthermore, clinical guidelines from authoritative bodies endorse the incorporation of serum markers in pre-eclampsia assessment. Serum markers represent a promising frontier in pre-eclampsia diagnosis, offering the potential to revolutionize prenatal care. While challenges exist, ongoing research, standardization efforts, and larger-scale studies will further refine the clinical utility of serum markers. Their integration aligns with established guidelines and holds the promise of improving maternal and fetal outcomes, making a significant impact on global maternal healthcare.

Combining the triglyceride-glucose index and glycated hemoglobin A1c to assess the risk of preeclampsia in women with normal glucose tolerance: a cross-sectional study.

This study aimed to explore the relationship between the triglyceride-glucose (TyG) index, glycated hemoglobin A1c (HbA1c), and preeclampsia in pregnant women without gestational diabetes mellitus (GDM). This retrospective study included pregnancies with normal oral glucose tolerance tests (OGTTs) from March 2018 to February 2019. During the second trimester, serum lipids, fasting plasma glucose (FPG), and HbA1c were measured, and OGTTs were performed. Participants were classified into four groups based on their TyG index and HbA1c levels. Logistic regression analysis was done to determine the odds ratios (ORs), and receiver operating characteristic (ROC) curve analysis was used to evaluate the ability of the TyG index and HbA1c to predict the risks of preeclampsia. Patients with preeclampsia exhibited higher TyG index and HbA1c levels (all p < 0.001). The incidence of preeclampsia increased with elevated TyG index and HbA1c levels individually. Furthermore, the highest incidence of preeclampsia was observed when both the TyG index and HbA1c levels were elevated. ROC curve analysis revealed that the combined TyG index and HbA1c displayed an area under the curve (AUC) of 0.689 in predicting the risk of preeclampsia. Even after adjusting for potential confounding factors, the risk of developing preeclampsia remained significantly higher. These associations were especially prominent in women aged ≥ 35 years or those with a normal BMI. The findings of this study indicate that increased TyG index and HbA1c levels are associated with a higher incidence and risk of preeclampsia in women with normal glucose tolerance during pregnancy. The TyG index and HbA1c levels may serve as potential markers for preeclampsia in individuals with normal OGTT results.

SERUM ACTIVIN A &amp; INHIBIN A: POSSIBLE BIOCHEMICAL MARKERS OF PREECLAMPSIA &amp; PREGNANCY INDUCED HYPERTENSION

Objective: The objective of this study was to compare the levels of Serum Activin A and Inhibin A in Pregnancy induced hypertension, Preeclampsia &amp; Normal Pregnancy Material and Methods: An analytical, cross-sectional study conducted at Chemical Pathology Laboratory Collaborating with Gynae/Obstetric Department of Pakistan Railway Teaching Hospital, Rawalpindi over the period of one year (18 Sep 2019 to 18 March 2020). The study started after the approval of Ethical Review Committee, Riphah International University Islamabad. The sample size was calculated using WHO sample size calculator. Taking Prevalence of PIH and PE is 8%.3 Non probability convenient sampling technique was used. An overall 100 pregnant women with gestation of 20 – 25 weeks, were included. Patients of UTI, Carcinomas, Diabetes Mellitus and other chronic disorders were not included. The subjects were divided into three groups. Group I PIH: This group included 30 pregnant women of PIH; 20 - 25 weeks of gestation, BP: ≥140/90 mmHg on two separate occasions without proteinuria. Group II PE: This group included 20 pregnant women of preeclampsia; 20 - 25 weeks of gestation, BP: ≥140/90 mmHg on two separate occasions with proteinuria (&gt;0.3 g protein/24 hours Urine). Group III Control Group: This group included 50 pregnant women with gestational age of 20 – 25 weeks without any complication as healthy controls. Results: It was determined that Serum Activin A and Serum Inhibin A levels were significantly increased in PIH and PE groups as compared to healthy group. Mean of Serum Activin A in PIH, PE and Control group was (251.53+200.23 pg/ml), (466.95 + 237.40 pg/ml) and (43.35 + 85.22 pg/ml) respectively. Similarly Mean and Standard Deviation of Serum Inhibin A levels in PIH, PE and Control group was (194.78 + 173.00 pg/ml), (349.20 + 190.30 pg/ml) and (17.27 + 44.33 pg/ml) respectively. One-way ANOVA and post-hoc Tukey analysis was conducted to compare the mean of Serum Activin A and Serum Inhibin A levels among three different groups i.e Group 1(PIH and PE), Group 2(PIH and Control) and Group 3 (PE and Control). p-value&lt; 0.05 was considered as statistically significant. Conclusion: It can be concluded that Serum Activin A and Serum Inhibin A can be used as biochemical markers of PIH and PE. Estimation of Serum Activin A and Inhibin A at an early stage can detect PIH and PE early and further prevents their complications such as Eclampsia and HELLP syndrome. Keywords: Pregnancy induced hypertension (PIH), Pre-eclampsia (PE), HELLP syndrome (H – Hemolysis, EL- Elevated Liver Enzymes, LP – Low platelets count), Serum activin A, Serum inhibin A.

The role and expression of pro/antiangiogenic factors and microRNAs in gestational hypertension and pre-eclampsia

ObjectivePre-eclampsia and gestational hypertension are two common hypertensive disorders of pregnancy with pre-eclampsia accounting for high foetal and maternal morbidity and mortality rate. These disorders have an unknown aetiology and their hypertensive and end-organ pathophysiology may present too late in pregnancy. This makes the identification of early detection and differentiation markers vital. MicroRNAs have strongly been associated with pregnancy and their imbalance has been associated with the angiogenic dysregulation seen in pre-eclampsia. This study assesses the expression of pro- and antiangiogenic factors and their corresponding microRNAs in the maternal circulation of patients with pre-eclampsia and gestational hypertension. Study designWe analyzed angiogenic factors expression (sEng, TGF-β, VEGF) normalized against housekeeping gene β-actin and microRNAs (miRs: 210, 29B, 126) normalized against miR U6, potentially associated with pre-eclampsia and gestational hypertension using the targeted qPCR technique. These analytes were examined from early-onset (<34 weeks) (EOPE) (n = 12), late-onset (>34 weeks) (LOPE) (n = 12) pre-eclampsia, gestational hypertension (GH) (n = 12) and two gestationally matched normotensive groups (NG1 and 2) (n = 12) each in South African women of African ancestry. Group comparisons of experimental vs. control groups were assessed using t-test analysis for significance and represented as fold change expression. ResultsThe relative expression in group comparisons showed significant (p < 0.05) fold change of VEGF, TGF-β, sEng and miR126 in the EOPE vs. NG1. The GH vs. NG1 exhibited significant changes in VEGF, TGF-β, miR126, miR210 and miR29B. The LOPE vs. NG2 showed significant relative expression in all the angiogenic factors (VEGF, TGF-β and sEng). The GH vs. NG2 showed significant expression in VEGF and miR29B. The LOPE vs. EOPE showed significant fold changes in VEGF and miR210. Finally, only the GH vs. EOPE showed significant differences in miR210 and miR29B (p < 0.05). ConclusionThis study provides better insights into angiogenic factors and microRNAs specificity to the subtypes of gestational hypertensive disorders in pregnancy. Relative expression analysis of angiogenic factors and microRNAs showed possible novel characteristics of gestational hypertension, and potential common molecular and pathological profiles with pre-eclampsia. Furthermore, we postulate that sEng and miR29B could be early detection markers for pre-eclampsia and gestational hypertension, respectively.

Hemodynamic maladaptation of a pregnant woman as an early marker of preeclampsia

Prediction of a risk group and early diagnostics of preeclampsia (PE) are crucial for a comprehensive follow-up of women to improve maternal and fetal outcomes. This review presents current data regarding PE prognosis. We have substantially progressed in understanding PE pathogenesis and in the field of angiogenic markers, but not a single test meets the criteria to serve as an optimal biomarker. It has been increasingly emphasized that the role of maternal hemodynamics may be important in predicting PE risk. The cerebral and ophthalmic arteries, blood volume, potential echocardiographic markers to predict PE as well as a marker of heart failure, brain natriuretic peptide (BNP), are actively investigated. The analysis summarizes the data on contemporary markers for PE prognosis by focusing on impaired pregnancy-related maternal cardiovascular adaptation. Assessing hemodynamics represents a potential prognostic marker for impaired maternal cardiovascular adaptation.

Associations between Maternal sFlt-1/PlGF Ratio and Perinatal and Neonatal Outcomes in Newborns Born to Mothers with Preeclampsia

Purpose: The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) is considered a predictive marker of preeclampsia. However, the relationship between the sFlt-1/PlGF ratio and perinatal and neonatal outcomes remains unknown. This study aimed to determine the associations of the sFlt-1/PlGF ratio with perinatal and neonatal outcomes in newborns born to mothers with preeclampsia.Methods: This retrospective cohort study reviewed singleton neonates born to mothers with preeclampsia who underwent testing for the sFlt-1/PlGF ratio. We investigated the relationship between maternal sFlt-1/PlGF ratios and gestational age (GA), birth weight (Bwt), Bwt z-score, morbidities, and mortality of neonates born to mothers tested for the sFlt-1/PlGF ratio. Maternal sFlt-1/PlGF ratios examined within 30 days before delivery were used for analysis. Neonatal morbidities and mortality were investigated only in preterm infants born earlier than 32 weeks GA.Results: A total of 225 neonates were included, of which 163 (72.4%) were preterm infants. GA (&lt;i&gt;R&lt;/i&gt;=– 0.577, &lt;i&gt;p&lt;/i&gt;&lt;0.001), Bwt (&lt;i&gt;R&lt;/i&gt;=–0.713, &lt;i&gt;p&lt;/i&gt;&lt;0.001), and Bwt z-score (&lt;i&gt;R&lt;/i&gt;=–0.608, &lt;i&gt;p&lt;/i&gt;&lt;0.001) exhibited significant negative correlations with the sFlt-1/PlGF ratios. Among the 50 preterm infants born earlier than 32 weeks GA, neonatal morbidities were not significantly associated with the sFlt-1/PlGF ratio after adjusting for GA and Bwt.Conclusion: In mothers with preeclampsia, a higher sFlt-1/PlGF ratio was associated with the delivery of newborns with lower GA and lower Bwt. However, this ratio was not associated with increased morbidity or mortality in premature infants born earlier than 32 weeks GA.