Preeclampsia Pregnancy Research Articles

The Effect of Assessment Mean Arterial Pressure and Body Mass Index as an Early Detection of Pre-Eclampsia

Pre-eclampsia or hypertension in pregnancy is a disease that can be detected early so that prevention can be done so that complications do not occur. One way to detect the presence of eclampsia is to carry out early detection using measurements of Body Mass Index (BMI) and blood pressure of pregnant women on a regular basis. Examination of mean arterial pressure in pregnant women with age in the first trimester as a strong predictor in cases of hypertension in pregnancy and preeclampsia. To determine the effect of the assessment of body mass index and mean arterial pressure as early detection of hypertension in pregnancy in the work area of the Trauma Center Health Center, Samarinda City. The method in this study combines two cross-sectional and prospective cohort time approaches. Sampling technique with Accidental Sampling as many as 50 people. Results: The results of this study indicate that there is an effect of MAP and BMI assessment with the incidence of Pre-Eclampsia and Eclampsia with a value (p-value = 0.000 = 0.05). There is an effect of the assessment of Mean Arterial Pressure (MAP) and Body Mass Index with the incidence of Pre-Eclampsia and Eclampsia in the work area of the Trauma Center Health Center in Samarinda City.

Circulating Transforming Growth Factor-β1 Levels in Preeclamptic Women: a Meta-analysis.

Transforming growthfactor(TGF)-β1, an angiogenic factor in the maternal circulation, has been suggested to be related to preeclampsia. However, the findings from previous studies were inconsistent. Thus, we conducted a meta-analysis to assess the difference in circulating TGF-β1 levels between women with preeclampsia and normal pregnancies. Twenty-four studies including 1748 women with PE and 1404 women with normal pregnancy were included in our study. The results showed that circulating TGF-β1 levels were not different before the time of active disease (standardized mean differences, - 0.46 [95% CI, - 0.16 to 0.15]; P = 0.000). At the time of active disease, women with preeclampsia (n = 1207) had higher circulating TGF-β1 levels than normotensive controls (n = 912; standardized mean differences, 0.94 [95% CI, 0.52 to 1.35]; P = 0.000). Circulating TGF-β1 levels were higher in both early-onset/severe and late-onset/mild types of preeclampsia. No publication biases were found. We conclude that preeclamptic women have higher circulating TGF-β1 than those with normal pregnancy at the time of preeclampsia diagnosis.

Perinatal Outcomes in Pregnancy with Preeclampsia and Eclampsia

One of the causes of infant mortality is preeclampsia in pregnancy. The impact of pregnancy with preeclampsia and eclampsia on perinatal outcomes is associated with increased perinatal mortality and morbidity in developing and developed countries. To determine the perinatal condition of pregnancies with preeclampsia and eclampsia in developing and developed countries based on literature studies. This literature study was done to determine the perinatal condition. The external keywords used were perinatal, preeclampsia, eclampsia. The method used literature review research methods and data collection strategies using PEOS obtained from previous research journals that had been collected as many as 22 journals, consisting of 17 international journals and 5 national journals. The variable was perinatal outcomes in pregnancy with preeclampsia and eclampsia. Based on 22 reviewed journals, 19 journals from developing countries and 3 journals from developed countries were found, which stated that the majority of perinatal outcomes were asphyxia. The majority of perinatal outcomes found in developing and developed countries are asphyxia, while other perinatal outcomes found include: low birth weight (LBW), fetal distress, intrauterine fetal death (IUFD), intrauterine growth restrictions (IUGR), and perinatal mortality.

First trimester serum apolipoproteins in the prediction of late-onset preeclampsia

Late-onset preeclampsia occurring after 34 weeks of gestation is the most common form of preeclampsia, but little is known about either etiology or prevention. Current detection methods for preeclampsia in early pregnancy have not shown promising results in detecting late-onset preeclampsia. The aim of this study was to assess whether apolipoproteins in combination with maternal medical history and biophysical factors can be used as an early detection method for late-onset preeclampsia. This nested case-cohort study was based at Odense University Hospital, Denmark. Women attending their first trimester scan were invited to participate if they understood Danish or English, were above the age of 18, and had singleton pregnancies. Blood pressure, maternal medical history, uterine artery pulsatility indices, and blood samples were collected at inclusion. Outcome data were collected from participants’ medical files postpartum, and cases were selected when preeclampsia diagnostics were present. Serum samples were analyzed by targeted mass spectrometry using a biomarker panel consisting of 12 apolipoproteins. Logistic regression analyses were performed and finally receiver operating curves were completed. The cohort consisted of 27 cases and 194 normotensive controls, randomized from 340 eligible participants. Significant differences were found between the two groups’ baseline characteristics but none of the apolipoproteins showed significant difference (p < 0.05). The ROC-curve combining maternal characteristics, mean arterial pressure and two apolipoproteins showed the best sensitivity of 55.5% at a 10% false-positive rate and an area under the curve of 0.873. In conclusion, apolipoproteins did not improve the detection of late-onset preeclampsia in a combined screening model.

In utero exposure to per-/polyfluoroalkyl substances (PFASs): Preeclampsia in pregnancy and low birth weight for neonates

Per-/polyfluoroalkyl substances (PFASs) have been linked to preeclampsia with inconsistent directions for outcomes. However, information regarding the joint effects of PFASs mixtures on preeclampsia as well as their associations with the low birth weight (LBW) and small for gestational age (SGA) is nascent. The present study included 82 women with preeclampsia and 169 healthy participants from Hangzhou, China. Fifteen PFASs were analyzed in maternal serum before delivery. PFOA and 6:2Cl-PFESA were associated with higher incidence of preeclampsia both linearly and by tertile. Each log-unit increase in serum PFOA (OR:5.29, 95% CI: 1.05, 26.7, p = 0.044) and 6:2 Cl-PFESA (OR:1.02, 95%CI: 1.00, 1.48, p = 0.045) concentrations were associated with increased risks of preeclampsia. These effects were more profound among primiparous women carrying female fetuses. Both PFOA and PFUnDA concentrations were significantly associated with higher odds of early-onset preeclampsia, but the associations tended to be null for late-onset. In addition, each logarithmic increment in PFOA concentrations were significantly associated with a 0.262 and 0.224 mmHg increase in systolic (95% CI: 0.147, 0.377) and diastolic (95% CI: 0.133, 0.314) blood pressures. Using Bayesian kernel machine regressions (BKMR), the overall effects of PFASs mixture concentrations on preeclampsia showed an increasing trend, with PFOA being the largest contributor. With regard to birth weight, the Cox proportional hazards model indicated that significantly higher risks of the LBW were associated with preeclampsia than normal pregnancy (OR: 4.56, 95% CI: 2.44, 6.68, p = 0.000). Increased LBW risks were found for the higher PFOA exposure both linearly and by tertile. Besides, serum PFOA and PFUnDA concentrations were significantly associated with higher odds of SGA development. Nevertheless 4:2 FTS and ADONA were inversely associated with LBW and SGA incidences. Further adverse birth outcomes should be explored to elucidate the health implications of PFASs exposure and preeclampsia development.

Disrupted placental vitamin D metabolism and calcium signaling in gestational diabetes and pre-eclampsia patients.

Gestational diabetes (GDM) and pre-eclampsia (PE) represents the unrecognized risk factors for reduced bone content in neonates. The present study is planned to explore the components of vitamin D metabolism and calcium transport in placenta of GDM and PE cases and its effect on the neonatal bone mass determination using bone densitometry system. We have collected serum and placenta tissues from GDM (n = 20), PE (n = 20), and healthy pregnancies (n = 20). In the present study, we found mRNA expression of oxidative stress markers, vitamin D metabolic components and calcium channels, calcium channel binding proteins, plasma membrane calcium ATPase, ATP synthase and Ca2+ release genes; Ryanodine receptors genes were assessed by quantitative real-time PCR (qRT-PCR) in placental tissue of GDM, PE, and healthy pregnancies. We observed high level of oxidative stress in both GDM and PE placenta compared to normal pregnancies. CYP2R1 and VDR mRNA expression was significantly downregulated and upregulation of CYP27B1 and CYP24A1 in GDM and PE compared with healthy cases. Similarly, calcium transporters were downregulated in GDM and PE placental tissues. In addition, CYP24A1, VDR, CaBP28K, TRPV5 and PMCA3 mRNA expression were correlated with BMC of neonates. Oxidative stress is probably relevant to disrupted vitamin D homeostasis and calcium transport in the placenta of GDM and PE cases. The altered regulatory mechanism of CYP24A1 and VDR could indicates more pronounced serum 25(OH)D reduction. Additionally, reduced BMC in the neonates of these cases might be as consequences of modified CYP24A1, VDR, CaBP28K, TRPV5 and PMCA3 mRNA expression.

Comparison of neutrophil lymphocyte ratio (NLR), mean platelet volume (MPV) and platelet lymphocyte ratio (PLR) in preeclampsia and normotensive pregnancies

The study aimed to compare the NLR (neutrophil lymphocyte ratio), MPV (meanplatelet volume), and PLR (platelet lymphocyte ratio) values in preeclampsiaand normotensive pregnancies. This was a retrospective case-control studyusing medical records of pregnancies between January 1, – December 31, 2019.A total 31 pregnancies with preeclampsia who met the inclusion and exclusioncriteria were involved in the study. As control, 31 normotensive pregnanciesrecruited by simple random sampling were used. The data were presented asmean ± standard deviation (SD) and analyzed by using SPSS program. Receiveroperating characteristic (ROC) curve were used to determine the optimal cutoff point for predicting preeclampsia. The NLR and MPV values of patients withpreeclampsia were significantly higher compare to normotensive pregnancy(p&lt;0.001). Whereas, the PLR value of both groups was not significantlydifferent (p&gt;0.245). The result of AUC analysis showed that the NLR and MPVhave AUC values of 0.758 (95%CI:0.637-0.878; p=0.000) and 0.903 (95%CI:0.816-0.989; p=0.000), respectively. Further analysis showed that the optimal cut-offpoint for NLR was 4.0 (sensitivity of 64.5% and a specificity of 71.0%) and forMPV was 7.55 (sensitivity of 87.1% and specificity of 80.0%). In conclusion, theNLR and MPV values are significantly higher in preeclampsia. However, theMPV value has a better predictive value than NLR for preeclampsia.

Comparative Study of Serum Lipid Profile in Pre-Eclampsia and Normal Pregnancy

Background: Pre-eclampsia is an important cause of fetal and maternal morbidity and mortality worldwide. It is therefore, important to study the lipid profile and risk factors for prevention, management and better prognosis of the disease. Method &amp; Materials: This study was a case control study conducted in the Department of Obstetrics and Gynaecology, Tezpur Medical College and Hospital, Tezpur. A total of 100 (one hundred) were selected, out of which 50 (fifty) normotensive pregnant women served as a control and 50 (fifty) Pre-eclampsia women constituted the study group. Besides baseline routine investigations, estimation of Serum lipid profile was done by collecting blood samples from antecubital vein of every case and control following a fast of 12-14 hours and collected in plain vials and were analysed at department of Biochemistry, Tezpur Medical College and Hospital, Tezpur. Results: The preeclampsia group had a significant rise in Triglyceride (TG), total cholesterol, LDL-C levels and decreased HDL-C levels as compared to the control group. Conclusion: Abnormal lipid profile results during pregnant women plays an important role in development of pre-eclampsia.

Comparison the Presence of Serum Level of Albumin, Uric Acid and Creatinine in Pregnant Women Developed Symptoms of Preeclampsia and Who are Free from Symptoms of Preeclampsia: A Prospective Study

Background: Preeclampsia, a hypertension condition that develops during pregnancy, is one of the most common causes of premature labour and delivery, perinatal death, and maternal mortality. Preeclampsia and other hypertensive diseases of pregnancy complicate a significant percentage of all pregnancies, necessitating early detection and warning. Objective: The aim of this study is to compare the presence of serum level of albumin, uric acid and creatinine in pregnant women who developed symptoms of preeclampsia and who are free from symptoms of preeclampsia. Method: A prospective study was carried out among 119 pregnant women in the outpatient Department of obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from June 2005 July 2006.Details and data obtained from medical records section were analyzed. Results: Among 119 women, PE developed in 10 patients and 109 patients remain normotensive. Among the study group incidence of PE was 8.4%. The mean age was 25.48±5.26 vs 25.60±3.89 in control vs PE subjects respectively. At booking the mean SBP was 104.40±10.67 vs 121.50±6.26, mean DBP was 65.73±6.41 vs 68.00±5.87, mean MAP was 77.66±5.28 vs 78.62±6.39 respectively in control and PE subjects. The mean serum albumin (gm/dl) of the study groups were as follows: control 2.97±0.55 vs PE 3.73±0.52. Serum creatinine of the study group (0.78±8.5 and 0.79±6.11 in control vs PE) and serum uric acid (2.24±0.71 and 2.65±0.56 in control vs PE) shows no significant difference at booking visit. The sensitivity of S. albumin, uric acid and creatinine area is 50%, 10%, 0%. Specificity of serum albumin is 5.25%, uric acid is 9.09%. But specificity of creatinine is high (97%) positive predictive value of all parameters are low. PPV of serum albumin is 4.76%, serum creatinine is 6.6%. Negative predictive value of creatinine is high (72%). Negative predictive value of serum albumin and serum uric acid are 6.42% and 9.12% respectively. Conclusion: In developing nations, pre-eclampsia is a common cause of maternal and neonatal illness. In maternal serum, many biochemical markers of pre-eclampsia have been identified. Uric acid, creatinine, and albumin are only a few of them. Uncorrelated serum uric acid, serum creatinine, or serum urea readings are insufficient to be considered as reliable predictors of preeclampsia.

Clinical factors associated with preeclampsia recurrence.

Preeclampsia is associated with immediate and long term offspring and maternal morbidities and mortality. Incidence of preeclampsia has increased and recurrent preeclampsia has not decreased in recent decades. The aim of the current study was to identify risk factors for recurrent preeclampsia among women with a history of preeclampsia. A population-based nested case- control study was performed at the Soroka University Medical Center. Included were all women with at least two pregnancies, with preeclampsia diagnosis in their first pregnancy. Cases were defined as women with recurrent preeclampsia and the controls as women with preeclampsia in their first but not in their second pregnancy. First pregnancy characteristics were compared among women with and without recurrent preeclampsia in subsequent pregnancy. A sub-analysis was conducted among women with first pregnancy preeclampsia with early onset. A multivariable logistic model was used to identify independent risk factors for recurrent preeclampsia, and to study whether the risk increased with each additional complication. The models adjusted for maternal age and ethnicity. A total of 2899 women who had preeclampsia in their first pregnancy were included in the study, 496 of them had recurrent preeclampsia (17.1%) in subsequent pregnancy. Maternal age, cesarean and preterm deliveries were significant independent risk factors for recurrent preeclampsia. These factors were not associated with early onset recurrent preeclampsia. Cesarean and preterm deliveries are significant risk factors for recurrent preeclampsia. Different etiologies and risk factors are possibly involved in preeclampsia recurrence following early versus late first preeclampsia onset.

Preeclampsia prediction with blood pressure measurements: A global external validation of the ALSPAC models.

The prediction of preeclampsia in pregnancy has resulted in a plethora of prognostic models. Yet, very few make it past the development stage and most fail to influence clinical practice. The timely identification of high-risk pregnant women could deliver a tailored antenatal care regimen, particularly in low-resource settings. This study externally validated and calibrated previously published models that predicted the risk of preeclampsia, based on blood pressure (BP) at multiple time points in pregnancy, in a geographically diverse population. The prospective INTERBIO-21st Fetal Study included 3,391 singleton pregnancies from Brazil, Kenya, Pakistan, South Africa, Thailand and the UK, 2012-2018. Preeclampsia prediction was based on baseline characteristics, BP and deviation from the expected BP trajectory at multiple time points in pregnancy. The prediction rules from the Avon Longitudinal Study of Parents and Children (ALSPAC) were implemented in the INTERBIO-21st cohort. Model discrimination was similar to the development cohort. Performance was best with baseline characteristics and a BP measurement at 34weeks' gestation (AUC 0.85, 95% CI 0.80-0.90). The ALSPAC models largely overestimated the true risk of preeclampsia incidence in the INTERBIO-21st cohort. After recalibration, these prediction models could potentially serve as a risk stratifying tool to help identify women who might benefit from increased surveillance during pregnancy.

Childhood school outcomes for infants born to women with hypertensive disorders during pregnancy.

To investigate the childhood school outcomes for infants born to women with hypertensive disorders during pregnancy. A retrospective population-based cohort study linking perinatal data from 2003 to 2013 to developmental scores at preparatory school and educational scores at school grades 3, 5, and 7 in Victoria, Australia. Exposures of interest were the presence of hypertensive disorders during pregnancy and iatrogenic delivery for preeclampsia. Multivariable logistic regression and generalised estimating equation models were employed. In total, 682,386 births ≥32weeks' gestation were linked to 175,665 child developmental results and 412,834 with at least one educational result. Compared to infants born to women without a hypertensive disorder, infants born to women with a hypertensive disorder had no increased risk of poorer developmental outcomes at school entry but a significantly increased risk of poorer educational outcomes across grades 3, 5, and 7. Compared to infants born to women without preeclampsia, infants born to women iatrogenically delivered for preeclampsia had no increased risk of poorer developmental outcomes (aOR=1.12, 95% CI: 0.98-1.28) but a significantly increased risk of poorer educational outcomes at grades 3 (aOR=1.23, 95% CI: 1.09-1.38), 5 (aOR=1.27, 95% CI: 1.13-1.43), and 7 (aOR=1.24, 95% CI: 1.09-1.43). The presence of maternal hypertension in pregnancy, particularly where preeclampsia was the indication for iatrogenic delivery, is associated with impaired school educational outcomes.

Methylation-based epigenetic studies and gene integration analysis of preeclampsia.

Preeclampsia (PE) is a multi-factor and multi-mechanism disease, which may jeopardize the life safety of affected pregnant women and fetuses. Our study aimed to detect the potential molecular indicators of PE that might be helpful for its diagnosis and treatment. Methylation assay of PE and normal pregnancies placental biopsies was analyzed using the Illumina Human Methylation-27 Assay. Differentially expressed genes (DEGs) were analyzed using R-DESeq2 software. Subsequently, the relationship between DNA methylation genes and DEGs were evaluated. Furthermore, immunohistochemical (IHC) and quantitative reverse transcription polymerase chain reaction (qRT-PCR) validation analyses were conducted for the hub genes. These hub genes (including PLXNB1, PMCH, PPARG, GOPC, CD79A, and MME) were found to be differentially methylated genes and DEGs. Further analysis revealed that PPARG, CD79A, and PLXNB1 may be diagnostic gene markers for PE; down-regulation of PPARG expression was closely correlated with the development of PE. The IHC analysis demonstrated that the expression levels of PLXNB1, PMCH, GOPC, CD79A, and MME genes were increased, whereas that of PPARG was decreased in PE tissues. The PCR results showed that PLXNB1, PMCH, GOPC, CD79a, and MME were upregulated, whereas PPARG was downregulated. The results of the 2 experiments were consistent with those of bioinformatics analysis. The molecular indicators identified in this study could facilitate the development of potential biomarkers and therapeutic targets for PE.

Circulating cardiovascular biomarkers during and after preeclampsia: Crosstalk with placental function?

Cardiovascular disease (CVD) is the leading cause of death in women, yet sex-specific risk factors remain understudied. Preeclampsia and other adverse pregnancy outcomes imply an increased maternal cardiovascular risk. We hypothesized that cardiac troponin T (cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) are increased in such pregnancies and correlate with markers of placental dysfunction. We also investigated these cardiovascular biomarkers 1 or 3years postpartum. Prior to delivery, we included serum from 417 pregnant women: 55 early-onset preeclampsia (EO-PE), 63 late-onset preeclampsia (LO-PE), 30 gestational hypertension (GH) and 269 healthy controls. Postpartum, we included 341 women 1 or 3years after delivery: 26 EO-PE, 107 LO-PE, 61 GH, and 147 healthy pregnancies. Prior to delivery, median cTnT and NT-proBNP concentrations were higher in women with EO-PE, LO-PE, or GH than in controls. Median GDF-15 was higher in EO-PE and LO-PE compared to controls. Postpartum, GDF-15 was elevated in women with previous EO-PE. Markers of placental dysfunction correlated with CVD biomarkers in pregnancy, but not postpartum. Our findings underscore the cardiovascular burden of hypertensive disorders of pregnancy and the crosstalk with placental function. The upregulation of circulating GDF-15 following early-onset preeclampsia is in line with the epidemiological excessive risk of premature CVD in this group of women. GDF-15 may be explored for targeting postpartum women with most to gain from intensified preventive follow-up for CVD.

Determinan Insiden Preeklamsia pada Ibu Primigravida

Background: Preeclampsia is a complication in pregnancy that has three main symptoms, namely gestational hypertension &gt; 140/90 mmHg, edema, and protein in the urine &gt; 3 grams and often occurs during pregnancy, childbirth and even in postpartum women. In the Sustainable Development Goals (SDGs), the MMR target is 70 per 100,000 live births in 2030. The problem of this research is the factors associated with the incidence of preeclampsia in pregnant women. This study aims to determine the factors that cause the incidence of preeclampsia in pregnant women. Method : used in this study is a literature review by analyzing a number of specified articles. In this study, 10 articles were used on preeclampsia and pregnancy. Results : from of the literature review analysis, it was concluded that there are many factors that cause preeclampsia in pregnant women, namely age, parity, primigravida and multiparous pregnancies, obesity, BMI, history of PEB and hypertension, and irregular ANC visits. influence the occurrence of preeclampsia in pregnant women. Conclusion: With this factor, it is expected to be a screening in handling cases of preeclampsia in the field and improving maternal health in reducing MMR in Indonesian.

Intertwin growth discordance throughout gestation and hypertensive disorders of pregnancy

Previous studies have established the association between intertwin birthweight discordance and hypertensive disorders of pregnancy. However, longitudinal fetal size discordance concerning gestational hypertension or preeclampsia remains unclear. This study aimed to compare the patterns of estimated fetal weight discordance throughout gestation among normotensive women, women with gestational hypertension, and women with preeclampsia and to evaluate the association between crown-rump length discordance at 11 to 14 weeks of gestation and hypertensive disorders of pregnancy. This was a retrospective cohort study of women with twin pregnancies who had antenatal care visits and delivered at a tertiary hospital between January 2013 and June 2021. The crown-rump length was measured at 11 to 14 weeks of gestation. Estimated fetal weight was calculated based on ultrasound examinations of fetal biometrics at 16 to 18, 20 to 24, 28 to 32, and ≥34 weeks of gestation, respectively. Crown-rump length and estimated fetal weight discordances were calculated: (larger crown-rump length- smaller crown-rump length)/larger crown-rump length× 100% and (larger estimated fetal weight- smaller estimated fetal weight)/larger estimated fetal weight× 100%, respectively. Multiple imputation was used to handle missing data, and all models accounted for the imputation. Multilevel model analysis was used to compare the differences in estimated fetal weight discordances throughout gestation among normotensive women, women with gestational hypertension, and women with preeclampsia. Generalized linear models were used to evaluate the association between crown-rump length discordance and hypertensive disorders of pregnancy, assuming a Poisson distribution. The possible nonlinear relationship between continuous crown-rump length discordance and hypertensive disorders of pregnancy was examined by generalized additive models. All analyses were stratified by chorionicity. Of the 3280 women with twin pregnancies who met the inclusion criteria, 187 (5.7%) developed gestational hypertension, and 436 (13.3%) developed preeclampsia, including 125 (3.8%) early-onset preeclampsia and 311 (9.5%) late-onset preeclampsia. In women with dichorionic twin pregnancies, compared with normotensive women, a substantial progression of estimated fetal weight discordance throughout pregnancy was identified in women who developed preeclampsia, and a large progression of estimated fetal weight discordance in late pregnancy was identified in women who developed gestational hypertension. In women with monochorionic twin pregnancies, estimated fetal weight discordances were more progressive from 20 to 24 weeks of gestation onward in women who developed preeclampsia than in normotensive women. Crown-rump length discordance at 11 to 14 weeks of gestation was associated with an increased risk of preeclampsia (relative risk, 1.03; 95% confidence interval, 1.00-1.05), particularly early-onset preeclampsia (relative risk, 1.09; 95% confidence interval, 1.04-1.13). A crown-rump length discordance of ≥10% had 1.2 times the increased risk of developing early-onset preeclampsia (relative risk, 2.27; 95% confidence interval, 1.28-4.03). This association was identified in dichorionic twins, but not in monochorionic twins. Our study demonstrated distinct growth discordant patterns among normotensive women, women with gestational hypertension, and women with preeclampsia in twin pregnancies. Intertwin crown-rump length discordance at 11 to 14 weeks of gestation was associated with an increased risk of preeclampsia, especially early-onset preeclampsia in dichorionic twin pregnancies, with a dose-response pattern.

Pregnancy in Paroxysmal Nocturnal Hemoglobinuria - a Systematic Review

Background Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, clonal disorder of hematopoietic stem cells, characterized by complement-mediated intravascular hemolysis, thrombosis, and bone marrow failure. Pregnancy exacerbates the clinical features of PNH, increasing maternal and fetal morbidity and mortality. Pregnancy in patients with PNH has traditionally been discouraged. Terminal complement inhibition with eculizumab gained regulatory approval in 2007 and has revolutionized the management of PNH. Limited data suggest that eculizumab is also safe and efficacious during pregnancy. Owing to the rarity of PNH and the inability to conduct randomized controlled trials on this population, most reports are small case series, with even the largest retrospective studies including well below 100 patients. We therefore present the first comprehensive systematic review and meta-analysis of outcomes in 190 pregnancies from 135 women with PNH. We compare pregnancy complications between those receiving eculizumab and those not, since complement blockade is not universally available. For the first time we demonstrate that eculizumab is associated with a lower risk of fetal loss. Methods The PubMed (Medline) database was searched for studies reporting primary data on pregnancy outcomes in the context of classical hemolytic PNH, diagnosed through flow cytometry, acid Ham's or sucrose lysis (Figure 1). Women with evidence of recurrent hemolytic episodes including serum lactate dehydrogenase >1.5 times the upper limit of normal, and typical PNH symptoms were included. We excluded papers where there was insufficient information for meaningful downstream analysis, or where cases were duplicated elsewhere in the literature. The search was restricted to English language papers. Two reviewers independently screened articles for inclusion with a third opinion sought where there was disagreement. References of included papers and review articles were screened to identify further papers. Thirty-six papers published between 1968 to 2021 were selected for inclusion. The majority were small case series or single case studies. There were two larger retrospective studies reporting on 45 and 75 pregnancies respectively. There was one prospective study (n=15 pregnancies). Results Eculizumab was used in 130 pregnancies. No maternal deaths were reported in patients on eculizumab. One woman who had never received eculizumab died at 12 weeks postpartum from intra-abdominal sepsis following a severe episode of acalculous cholecystitis. A higher rate of fetal survival was observed in pregnancies where eculizumab was used (82%) than in pregnancies when it was not (69%) (Table 1). Thrombosis occurred at a higher rate than in the healthy pregnant population but did not significantly differ in incidence between treatment groups (Table 1). The incidence of pre-eclampsia was high in this population. There was a trend towards a reduced risk of pre-eclampsia and infection in eculizumab pregnancies, but this did not reach statistical significance (Table 1). No Neisserial infections were observed in patients treated with eculizumab. The rate of spontaneous miscarriage (<24 weeks') was nearly twice as high in women who had not received eculizumab (18.6%) compared to those who received it (9.7%). The rate of intrauterine death did not significantly differ between treatment groups (Table 1). Fetal structural anomalies occurred in three cases, none of which had been exposed to eculizumab, supporting the notion that the drug does not have a teratogenic effect. Intrauterine growth restriction (IUGR) occurred in just over 8% of pregnancies that progressed beyond 20 weeks and did not differ between treatment groups (Table 1). IUGR was associated with pre-eclampsia in eight cases (61%). 148 pregnancies progressed to delivery, the majority by vaginal delivery. Premature birth (<37 weeks' gestation) was observed in 32% of eculizumab pregnancies and 44% of non-eculizumab pregnancies. Premature delivery was usually iatrogenic due to maternal or fetal complications, with spontaneous premature labor in only eight cases (15%). Conclusion Eculizumab appears to be safe and provide a benefit in pregnancy in PNH. There were less premature births and spontaneous miscarriages and greater fetal survival when eculizumab was given. A tendency to fewer cases of pre-eclampsia and maternal infections was also seen. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Association between Pre-Eclampsia and Spontaneous Prelabour Rupture of Membrane (Prom) in Pregnancy

Background: Pre-eclampsia and other hypertensive disorder in pregnancy are among the top causes of maternal and perinatal death globally. About 10% of all pregnancies have pre labor (premature) rupture of membranes (PROM), of which 7%–8% occur after 37–42 weeks. The objective of the study was to observe if pre-eclampsia is associated with spontaneous PROM. Method: Eighty (80) eligible pregnant women with gestational age ≥20 weeks were included in this study. They were divided into 2 equal case and control groups; 40 pregnant women with Pre-eclampsia and 40 pregnant women with normal blood pressure. The association of the risk of spontaneous PROM was assessed among these groups. Results: In this study 87.5% of the Pre-eclampsia case group and 75% of the normotensive control group were primigravida. There was a significant association between the gestational age of 82.5% of the Pre-eclampsia group and 70% of the normotensive group being full term (p=0.034). In the Pre-eclampsia group, there were 29(72.5%) PROM with a significant association (p=0.010), whereas in the normotensive group, there were 4 (10%) PROM with no significant association. The risk of PROM was found among Pre-eclampsia patients. Conclusion: In this study, we concluded that Pre-eclampsia is associated with the risk of spontaneous PROM.

Screening for preeclampsia in twin pregnancies.

Twin pregnancies are an important risk factor for preeclampsia, a hypertensive disorder of pregnancy that is associated with a significant risk of maternal and perinatal morbidity. Given the burden of preeclampsia, the identification of women at high risk in early pregnancy is essential to allow for preventive strategies and close monitoring. In singleton pregnancies, the risk factors for preeclampsia are well established, and a combined first-trimester prediction model has been shown to adequately predict preterm disease. Furthermore, intervention with low-dose aspirin at 150mg/day in those identified as high-risk reduces the rate of preterm preeclampsia by 62%. In contrast, risk factors for preeclampsia in twin pregnancies are less established, the proposed screening models have shown poor performance with high false-positive rates, and the benefit of aspirin for the prevention of preeclampsia is not clearly demonstrated. In this review, we examine the literature assessing prediction and prevention of preeclampsia in twin pregnancies.

Blood biomarkers to predict the onset of pre-eclampsia: A systematic review and meta-analysis

Pre-eclampsia is one of the most common pregnancy complications, and a major cause of fetal and maternal morbidity and mortality globally. Diagnosis currently takes place in the third trimester based on clinical symptoms. This systematic review and meta-analysis sought to determine the blood biomarkers that are associated with pre-eclampsia, and in particular, the biomarkers that could predict pre-eclampsia in early pregnancy. We searched the electronic databases (Medline, Embase, Cochrane Library) from inception up to March 2022. Prospective studies with 1000 or more participants that measured blood biomarkers to predict or diagnose pre-eclampsia have been included in this systematic review. Biomarkers’ measurements were considered from the first up to the third trimester, but not during labor. Data concerning pre-eclampsia, biomarker measurements and study characteristics were extracted. Meta-analysis was performed when possible. We found a total of 43 studies (assessing 62 different biomarkers in 18,170 pregnancies, have been included in this systematic review, and a total of 6 studies (assessing 2 biomarkers have been included in the meta-analysis). Statistical analysis was performed for PlGF and sFlt-1. Mean difference in PlGF levels between pre-eclampsia and healthy pregnancies, appear to increase as the pregnancy progresses. Results of sFlt-1 meta-analysis were inconclusive. No significant publication bias was identified. This is the most comprehensive and up to date systematic review and meta-analysis on this important topic on blood biomarkers for the early prediction of pre-eclampsia. Further This research highlights the urgent needed for further discovery research to identify blood biomarkers that could predict the development of pre-eclampsia.