Prevention Of Preeclampsia Research Articles

Managing sickle cell disease and related complications in pregnancy: results of an international Delphi panel

AbstractData to guide evidence-based management of pregnant people with sickle cell disease (SCD) are limited. This international Delphi panel aimed to identify consensus among multidisciplinary experts for SCD management during pregnancy. The 2-round Delphi process used questionnaires exploring 7 topics (antenatal care, hydroxyurea use, transfusion, prevention of complications, treatment of complications, delivery and follow-up, and bottlenecks and knowledge gaps) developed by a steering committee. Thirteen panelists (hematologists, physiologists, obstetricians, maternal fetal medicine, and transfusion medicine physicians) from the United States, the United Kingdom, Turkey, and France completed the first survey; 12 panelists completed the second round. Anonymized responses were collected and summarized by a contract research organization (Akkodis Belgium). Consensus and strong consensus were predefined as 75% to 90% (9-10 of 12) and >90% (≥11 of 12) of panelists, respectively, agreeing or disagreeing on a response to a predefined clinical scenario or statement. In several areas of SCD management, consensus was achieved: experts recommended performing at least monthly multidisciplinary antenatal follow-up, administering prophylactic aspirin for preeclampsia prevention between gestational weeks 12 and 36, initiating prophylactic transfusion therapy in certain cases, or choosing automated red blood cell exchange over other transfusion methods for patients with iron overload or severe acute chest syndrome. No consensus was reached on several topics including the prophylactic aspirin dose, indications for starting infection prophylaxis, routine use of prophylactic transfusions, or use of prophylactic transfusions for preventing fetal complications. These recommendations could inform clinical care for patients with SCD who are pregnant in the absence of large clinical trials involving this population; the identified knowledge gaps can orient future research.

627 Does the dosing of low-dose aspirin for preeclampsia prevention alter serum extracellular vesicle characteristics?

627 Does the dosing of low-dose aspirin for preeclampsia prevention alter serum extracellular vesicle characteristics?

527 Differences in LDASA initiation for preeclampsia prevention in at-risk pregnancies between White and non-White patients

527 Differences in LDASA initiation for preeclampsia prevention in at-risk pregnancies between White and non-White patients

Preeclampsia prevention: a survey study on knowledge and practice among prenatal care providers in Ethiopia

BackgroundKnowledge and practice gap among providers has been cited among factors behind underutilization of aspirin for preeclampsia prevention, globally. ObjectiveTo determine the knowledge and practice level of prenatal care providers at a national tertiary referral hospital in Ethiopia and it's catchment health institutions. Study DesignThis was a cross-sectional survey on the knowledge and practice of preeclampsia prevention through ASA prophylaxis among prenatal care providers at St. Paul's Hospital Millennium Medical College (Ethiopia) and it's catchment health institutions. Data were collected prospectively using a structured questionnaire on ODK. The primary objective of our study was determining the knowledge and practice level among the prenatal care providers. Data were analyzed using SPSS version 23. Simple descriptive analysis were employed to analyze the data. Proportions and percentages were used to present the results. ResultsA total of 92 prenatal care providers working at 17 health institutions were approached and 78 of them agreed to participate in the study, constituting a response rate of 84.8%. The mean score of knowledge and practice of prevention for pre-eclampsia using Aspirin was 42.9(±0.13) and 45.8(±0.07) respectively. Most of the providers had poor knowledge (score less than 50%) and poor practice (score less than 50). Only 23.8% (19/78) and 36.3% (29/78) had good knowledge and good practice, respectively. More than half (61.3%, 49/78) of the respondents mentioned “lack of national guidelines for use of aspirin in pregnancy” as the main factor that impacted their practice on Aspirin for preeclampsia prevention in pregnant women. Among the resources utilized as a reference for practice of use of aspirin for pre-eclampsia prevention, FIGO or WHO guidelines (56.3%, 45/78), followed by ACOG (45%, 36/78) and clinical judgment (45%, 36/78) were the most frequently used resources. ConclusionResults of this study support previous reports of significant knowledge-to-practice gap in the use of ASA prophylaxis for prevention of preeclampsia, among prenatal care providers. It underscores the need for immediate action in narrowing this gap among the providers through availing practical national guidelines for prevention of pre-eclampsia and in-service trainings.

Роль корекції ендотеліальної дисфункції в комплексній профілактиці гіпертензивних ускладнень вагітності

Purpose - to study the effect of correction of endothelial dysfunction by the introduction of L-arginine in the comprehensive prevention of the development of severe hypertensive disorders in pregnant women. Materials and methods. The division into groups was carried out indiscriminately following the prescribed bath. 27 women reached the 1st group, who, in addition to basic prevention of preeclampsia (small doses of aspirin for 12 days, calcium supplement 1000 mg per dose for 16 years), took Tivortin until conception and p. It's an hour of urgency; up to the 2nd group - 54 women who did not receive basic prevention of preeclampsia. The control group (3) consisted of 16 healthy women with physiological changes in vagusity. Participants of the 1st group, during the hour of stay in the hospital, took L-arginine internally (iv) (4 g) + 2 teaspoons 2 times (4 g) per os per dose 40 minutes before admission, then 3 teaspoons spoons 2 times (6 g per dose). The average intensity of the droplets became 6. The function of the endothelium was evaluated according to the universally recognized non-invasive cuff test method, which is based on the principle of ultrasound assessment of the change in the diameter of the brachial artery in response to the restoration of blood flow in it after short-term compression of the upper limb with a cuff. Physical condition and endurance were assessed using the generally accepted 6-minute walk method. The quality of life in pregnant women who had experienced severe preeclampsia in the past was assessed in stages - according to the health-related quality of life (HRQoL) scale and the scale created by the World Health Organization (WHOQOL-BREF). Results. Arterial hypertension and preeclampsia are based on changes in endothelium-dependent vasodilatation. A positive effect on the function of the endothelium significantly improves indicators of physical well-being and quality of life. When conducting a test with a 6-minute walk in the Group 1, better indicators were found than in the Group 2 (respectively, 409±23 m vs. 381±32 m, p<0.05), this indicator in the control group was 473±32 m (p<0.05 according to the Groups 1 and 2). However, this indicator significantly improved in pregnant women of the Group 1 after intravenous administration of L-arginine: 441±12 m (p<0.05 compared to the indicator before intravenous administration). According to the assessment of the quality of life of pregnant women of the studied groups, it should be noted that the quality of life indicators in all domains are significantly lower in women of the Group 1, which is associated with significantly worse anamnesis data of such women, significant concern about the results of the next pregnancy. When evaluating indicators of endothelium-dependent and endothelium-independent vasodilatation, it was found that in the group of women who received L-arginine preconceptionally, in the 1st trimester, the indicator before intravenous IV administration was 5.09±0.44, and after - 8.21±0.24, which indicates a significant improvement in endothelium-dependent vasodilation indicators (by 49.1%) 28-32 weeks, there are also no births of children with a body weight of less than 1500 g. Conclusions. In the group of high-risk pregnant women, the use of L-arginine in the complex prevention of preeclampsia allows to reduce the risks of early severe preeclampsia, to reduce the medication burden of two- and three-component hypotensive therapy. An increase in physical endurance, quality of life, and improvement in pregnancy outcomes are due to a positive effect on the function of the endothelium through the optimization of endothelium-dependent vasodilatation associated with the provision of the L-arginine substrate for the full synthesis of nitric oxide. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Aspirin for evidence-based preeclampsia prevention trial: effects of aspirin on maternal serum pregnancy-associated plasma protein A and placental growth factor trajectories in pregnancy

BackgroundThe exact mechanism by which aspirin prevents pre-eclampsia (PE) remains unclear. Its effects on serum placental biomarkers throughout pregnancy are also unknown. ObjectiveTo investigate the effects of aspirin on serum pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PlGF) trajectories using repeated measures from women at increased risk of preterm PE. Study DesignThis was a longitudinal secondary analysis of the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-based Preeclampsia Prevention (ASPRE) trial using repeated measures of PAPP-A and PlGF. In the trial, 1,620 women at increased risk of preterm PE were identified using the Fetal Medicine Foundation algorithm at 11-13+6 weeks, of whom 798 were randomly assigned to receive aspirin 150 mg and 822 to receive placebo daily from before 14 weeks to 36 weeks of gestation. Serum biomarkers were measured at baseline and follow-up visits at 19 to 24, 32 to 34, and 36 weeks of gestation. Generalized additive mixed models with treatment by gestational age interaction terms were used to investigate the effect of aspirin on biomarker trajectories over time. ResultsOverall, there were 5,507 PAPP-A and 5,523 PlGF measurements. Raw PAPP-A values increased over time, and raw PlGF increased until 32 weeks of gestation followed by a decline. The multiple of the median (MoM) mean values of the same biomarkers were consistently below 1.0 MoM, reflecting the high-risk profile of the study population. Trajectories of mean PAPP-A and PlGF MoM values did not differ significantly between the aspirin and placebo groups (aspirin treatment by gestational age interaction p-values: 0.259 and 0.335, respectively). ConclusionsIn women at increased risk of preterm PE, aspirin 150 mg daily had no significant effects on PAPP-A or PlGF trajectories when compared to placebo.

The Effect Of Giving Calcium As An Effort To Prevent Preeclampsia: A Literature Review

Preeclampsia is a pregnancy disorder accompanied by hypertension and proteinuria. Efforts to prevent preeclampsia can be made with medical prevention, namely, meeting the calcium needs of pregnant women. This research aims to determine the effect of givingcalcium to prevent preeclampsia. The method used in the literature review is a systematic mapping study obtained from 3 databases, namely Pubmed, Garuda, and Google Scholar, using inclusion and exclusion criteria. Key term used in searching literature: "Calcium for prevention of preeclampsia." from 10 journals, it was found that the correct dose of calcium and timing of giving calcium to pregnant women was found and that calcium had an effect on preventing preeclampsia. Data analysis techniques use Synthesize or compare. Conclusion: Mothers are advised to consume calcium because it can lower blood pressure. By reducing blood pressure in pregnant women, calcium can prevent the occurrence of preeclampsia, especially in pregnant women who have hypertension or a history of preeclampsia.

Maternal social support during and after pregnancy and child cognitive ability: examining timing effects in two cohorts.

Maternal anxiety, depression, and stress during and after pregnancy are negatively associated with child cognitive development. However, the contribution of positive maternal experiences, such as social support, to child cognitive development has received less attention. Furthermore, how maternal experience of social support during specific developmental periods impacts child cognitive development is largely unknown. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC; n = 5784) and the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction study (PREDO; n = 420), we investigated the associations between maternal perceived social support during and after pregnancy and child's general cognitive ability at 8 years of age, assessed with the Wechsler Intelligence Scale for Children (WISC). Bayesian relevant life course modeling was used to investigate timing effects of maternal social support on child cognitive ability. In both cohorts, higher maternal perceived social support during pregnancy was associated with higher performance on the WISC, independent of sociodemographic factors and concurrent maternal symptoms of depression and anxiety. In ALSPAC, pregnancy emerged as a sensitive period for the effects of perceived social support on child cognitive ability, with a stronger effect of social support during pregnancy than after pregnancy on child cognitive ability. Our findings, supported from two prospective longitudinal cohorts, suggest a distinct role of maternal perceived social support during pregnancy for cognitive development in children. Our study suggests that interventions aimed at increasing maternal social support during pregnancy may be an important strategy for promoting maternal and child well-being.

Overview of design and construction of hypertensive disorders of a pregnancy-cohort in Shenzhen

Hypertensive disorder of pregnancy (HDP) involves two major public health issues: mother-infant safety and prevention and controlling major chronic disease. HDP poses a serious threat to maternal and neonatal safety, and it is one of the leading causes of maternal and perinatal morbidity and mortality worldwide, as well as an important risk factor for long-term cardiovascular disease (CVD). In order to explore effective strategies to prevent and control the source of CVD and reduce its risk, we have established a cohort of HDPs in Shenzhen for the primordial prevention of CVD. The construction of the HDP cohort has already achieved preliminary progress till now. A total of 2 239 HDP women have been recruited in the HDP cohort. We have established a cohort data management platform and Biobank. The follow-up and assessment of postpartum cardiovascular metabolic risk in this cohort has also been launched. Our efforts will help explore the pathophysiological mechanism of HDP, especially the pathogenesis and precision phenotyping, prediction, and prevention of pre-eclampsia, which, therefore, may reduce the risk of adverse pregnancy outcomes, and provide a bridge to linking HDP and maternal-neonatal cardiovascular, metabolic risk to promote the cardiovascular health of mothers and their infants.

Missed opportunity for aspirin prophylaxis for preeclampsia prevention: a cross-sectional study from Sub-Saharan Africa

BackgroundRecent studies show that aspirin for pre-eclampsia prevention is underutilized despite it's effectiveness in preventing pre-eclampsia in patients with moderate and high risk factors. Little is known about this issue in the Sub-Saharan setting, including Ethiopia. ObjectiveTo determine the missed opportunity for ASA prophylaxis among candidates for this preeclampsia preventive intervention at a national tertiary referral hospital in Ethiopia. Study DesignThis was a cross-sectional study on pregnant women complicated by preeclampsia who were managed at St. Paul's Hospital Millennium Medical College (Ethiopia) over 6 months (April 1, 2023-September 30, 2023). Data were collected prospectively using a structured questionnaire. The primary outcome was proportion of women who had an indication for ASA prophylaxis for preeclampsia prevention but were not given the opportunity (missed opportunity for ASA) among all pregnant preeclampsia patients presenting to our hospital. Secondary outcomes were adverse maternal and perinatal outcomes. An intention-to-treat (ITT) analysis was used. Data were analyzed using SPSS version 23. Descriptive statistics were employed to analyze the data. Proportions and percentages were used to present the results. ResultsA total of 427 pregnant women with preeclampsia were screened for inclusion and 32 of them were excluded according to the inclusion and exclusion criteria. Among the 395 preeclamptic pregnant women included in the final analysis, 195(50.6%) had an indication for ASA prophylaxis for the prevention of preeclampsia. The mean systolic and diastolic blood pressures at presentation were 153.8(±12.8) and 100.6(±8.5) mm Hg, respectively. Most patients had proteinuria (51.7% had urine dip-stick protein +2 while another 18.5% (74/395) had urine dip-stick protein +1 and 10.9% had 24-hour urine protein in the pre-eclampsia range). Among these women who had indication for ASA prophylaxis, in only 1.1 % was ASA utilized (the missed opportunity for ASA prophylaxis for preeclampsia prevention was 98.9%). The perinatal morality rate was 11.9 % while neonatal ICU admission rate was 20.5%. The 5th minute low Apgar score rate was 8.9% Eight mothers (2.1%) were complicated by HELLP syndrome while another 3(0.8%) mothers developed pulmonary edema. ConclusionIn this study, the missed opportunity for administration of ASA prophylaxis for the prevention of preeclampsia was unacceptably high though more than half of the study subjects were candidates for this preventive intervention. Preeclampsia was also associated with higher rates adverse perinatal outcomes and serious maternal morbidity.

The importance of using disease causal models in studies of preventive interventions: Learning from preeclampsia research

ObjectiveInterventions aimed at preventing disease are commonly studied as strategies of primary or secondary prevention. Unfortunately, this dichotomy can be misleading, and studies might unknowingly exclude people at high risk of the disease that could benefit from the intervention. Here I use the example of aspirin for prevention of preeclampsia to illustrate this problem. MethodsI use directed acyclic graphs to represent several causal models of aspirin and preeclampsia, each making different assumptions regarding the causal relation between previous preeclampsia, aspirin, and subsequent preeclampsia. Afterwards, I discuss the implications of each model. ResultsAspirin started being recommended to pregnant women that had presented preeclampsia in previous pregnancies, but not to women at high risk due to other factors. Studies started evaluating aspirin in women at high risk due to these other causes and found it also reduced the risk of preeclampsia in them. Thanks to a shift towards risk-based interventions, guidelines started recommending aspirin to all women considered at high risk of preeclampsia. Furthermore, recent studies have begun using blood markers in women without classic risk factors to identify additional women that might benefit from aspirin. With such advances, performing “secondary prevention” once the first event occurred will increasingly represent a failure to intervene on time. ConclusionsExplicitly illustrating disease causal models helps to identify those individuals that are most likely to benefit from risk reduction, regardless of whether they were previously afflicted by the disease. This is beneficial when designing studies and when implementing preventive interventions.

Stres dan Pengetahuan Mempengaruhi Efikasi Diri Ibu Hamil dalam Pencegahan Preeklampsi

Self-efficacy is very important to determine pregnant women's confidence in taking preeclampsia prevention measures. Pregnant women with high self-efficacy will actively participate in planning care during pregnancy to achieve healthy conditions for the mother and baby, whereas poor self-efficacy results in feelings of frustration and anger during pregnancy. The aim of this study was to determine the relationship between knowledge and stress and the self-efficacy of pregnant women in preventing preeclampsia. This research uses a correlational analytical design with a cross sectional approach. The sample in this study was 60 pregnant women who were at risk of preeclampsia. Samples were selected using purposive sampling technique in accordance with previously determined inclusion and exclusion criteria. Data collection uses a questionnaire. Data analysis used the Spearman correlation test. The results of the analysis show that there is a relationship between knowledge (p: 0.015; r: 0.311) and stress (p: 0.048; r: -0.256) with the self-efficacy of pregnant women in preventing preeclampsia. Based on these results, efforts need to be made to increase knowledge and reduce stress in pregnant women through education and stress management activities so that they can increase the self-efficacy of pregnant women.

Efektifitas Edukasi Kesehatan Tentang Penggunaan Skrining Pre Eklamsia Terhadap Keterampilan Kader Dalam Mendeteksi Ibu Hamil Resiko Tinggi di Posyandu Wilayah Kerja Puskesmas Tanta

One of the causes of MMR and AKB in Indonesia mostly occurs due to hypertension (25%). Prevention of preeclampsia is by screening pre-eclampsia in pregnant women at >20 weeks gestation. The role of cadres is very important in helping midwives to detect high-risk pregnant women. The purpose of the study was to determine the effectiveness of health education on the use of pre-eclampsia screening on cadre skills in detecting high-risk pregnant women in posyandu working areas of Tanta Health Center. This research method includes experimental research using pre-experimental designs type Pretes-Posttest Design. The population is posyandu cadres for pregnant women and toddlers in the Tanta Health Center work area as many as 80 people with sampling techniques with Quota Sampling as many as 40 respondents. The data analysis technique uses the Wilcoxon signed Rank test. The results showed that there was a difference between cadres' skills in detecting high-risk pregnant women before and after health education about the use of pre-eclampsia screening.

Challenges in Conducting Clinical Trials for Preeclampsia.

To review recent data describing the challenges and innovations in therapeutic research focused on the prevention and treatment of preeclampsia. Pregnant individuals have traditionally been excluded from therapeutic research, resulting in a paucity of innovation in therapeutics for pregnancy-specific medical conditions, especially preeclampsia. With the increased awareness of maternal morbidity and mortality, there is significant interest among researchers to expand therapeutic research in pregnancy. Several medications, including aspirin, pravastatin, metformin, and esomeprazole, which are commonly used in non-pregnant populations, are now being investigated for preeclampsia prevention. However, given the historic precedent of exclusion, along with the regulatory, ethical, and feasibility concerns that accompany this population, the study of these and novel medications has been complicated by numerous challenges. While complex, and laden with challenges, there is great ongoing need for therapeutic research to address preeclampsia. Aspirin, pravastatin, metformin, and esomeprazole have all shown promise as potential therapeutic agents; however, their use remains to be optimized, and innovative therapeutics need to be developed.

Independent Prediction of Child Psychiatric Symptoms by Maternal Mental Health and Child Polygenic Risk Scores

Prenatal maternal symptoms of depression and anxiety are associated with an increased risk for child socioemotional and behavioral difficulties, supporting the fetal origins of mental health hypothesis. However, to date, studies have not considered specific genomic risk as a possible confound. The Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (n= 5,546) was used to test if child polygenic risk score for attention-deficit/hyperactivity disorder (ADHD), schizophrenia, or depression confounds or modifies the impact of prenatal maternal depression and anxiety on child internalizing, externalizing, and total emotional/behavioral symptoms from age 4 to 16 years. Longitudinal child and adolescent symptom data were analyzed in the ALSPAC cohort using generalized estimating equations. Replication analyses were done in an independent cohort (Prevention of Preeclampsia and Intrauterine Growth Restriction [PREDO] cohort; n= 514) from Finland, which provided complementary measures of maternal mental health and child psychiatric symptoms. Maternal depression and anxiety and child polygenic risk scores independently and additively predicted behavioral and emotional symptoms from childhood through mid-adolescence. There was a robust prediction of child and adolescent symptoms from both prenatal maternal depression (generalized estimating equation estimate= 0.093, 95% CI 0.065-0.121, p= 2.66× 10-10) and anxiety (generalized estimating equation estimate= 0.065, 95% CI 0.037-0.093, p= 1.62× 10-5) after adjusting for child genomic risk for mental disorders. There was a similar independent effect of maternal depression (B= 0.156, 95% CI 0.066-0.246, p= .001) on child symptoms in the PREDO cohort. Genetically informed sensitivity analyses suggest that shared genetic risk only partially explains the reported association between prenatal maternal depression and offspring mental health. These findings highlight the genomic contribution to the fetal origins of mental health hypothesis and further evidence that prenatal maternal depression and anxiety are robust in utero risks for child and adolescent psychiatric symptoms. Depression and anxiety affect approximately 15% of pregnant women, and children exposed to maternal depression or anxiety during pregnancy are at higher risk of developing mental health problems. However, the degree to which shared genetics explains the association between maternal and child mental health is unknown. In this study the authors generated polygenic risk scores (PRS), which provide a single measure of genetic risk for complex traits, to investigate the impact of shared genetic risk on the development of childhood mental health problems. Utilizing two longitudinal studies (n = 6,060), the authors found that PRS only partially explained the association between prenatal maternal depression and childhood mental health problems. These analyses show prenatal maternal depression remained a significant predictor of childhood mental health problems after accounting for shared genetic risk, further highlighting that prenatal maternal mental health is a robust predictor of child and adolescent mental health problems.

Effects of physical activity on placental analytes in nulliparous persons

IntroductionPhysical activity during pregnancy has long been investigated for its role in preeclampsia prevention. The mechanism of this relationship is unknown, although some studies suggest physical activity may affect placental analytes throughout pregnancy. The objective of this study was to determine the effect of physical activity on preeclampsia-associated placental analytes using a prospective cohort of pregnant nulliparous patients. MethodsThis was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be. Frequency and duration of up to three leisure activities was reported in the first and second trimesters and was analyzed, with participants either meeting or not meeting the recommended exercise of 150 minutes per week. Levels of the following placental analytes, placental growth factor, soluble endoglin, and soluble fms-like tyrosine kinase-1 (sFLT1), were analyzed stratified by the physical activity level. ResultsA total of 1,956 participants were included in the analysis. The level of sFLT1 in the first trimester was lower in the group that had ≥150 minutes per week of physical activity, compared to the group that had <150 minutes (846.3 [821.6, 871,8] versus 893.0 [864.5,922.5], p=0.017). There were no significant sFLT1 changes in the second trimester based on physical activity. After controlling for maternal demographic and clinical factors, sFLT1 levels in the second trimester were significantly lower (p=0.049) in participants that had ≥150 minutes of physical activity per week. DiscussionOur findings of decreased sFLT1 levels suggest this could be the mechanism explaining the association between PA in pregnancy and lower risk of preeclampsia.

Genetically determined lipoprotein(a) levels do not cause an increased risk of preeclampsia - a two-sample Mendelian randomization study

Abstract Introduction High blood levels of lipoprotein(a) [Lp(a)] were suggested to increase the risk of preeclampsia. Because excessive coagulation is involved in preeclampsia and Lp(a) is a known pro-coagulative protein, the hypothesis that Lp(a) is causally involved in preeclampsia seems to be consistent. Nevertheless, the exact impact and causal role of Lp(a) on preeclampsia was not well elucidated. Because the levels of Lp(a) are widely recognized to be highly genetics-dependent, we chose Mendelian Randomization [MR] as a tool to determine the impact of Lp(a) on the incidence of preeclampsia. Purpose To determine whether Lp(a) levels have impact on incidence of preeclampsia. Methods A two-sample MR study was conducted. Summary statistics were extracted from publicly available datasets. UK Biobank was the source of correlations for Lp(a) levels and FinnGen was used as the source of genetic correlations for preeclampsia. We restricted the variants used to LPA gene region. Inverse-variance-weighted mean was used as a primary analysis. Secondary analyses were performed using weighted median, mode, and MR-Egger methods. Sensitivity analysis was performed by leaving out random 30% of the variants as well as by using previously published variants correlated with Lp(a) levels. Results Summary statistics regarding genetic determinants of Lp(a) levels were retrieved for 318922 participants, while data regarding pre-eclampsia were available for 5922 cases and 176113 controls. Genetic associations of included variants with Lp(a) levels (horizontal axis) and with preeclampsia (vertical axis) are presented in Figure. Primary [p=0.562] and secondary analyses [median p=0.825; mode p=0.717; MR-Egger p=0.765] indicated that Lp(a) levels have no impact on the incidence of preeclampsia. Selected variants did not show appreciable pleiotropy as indicated by MR-Egger intercept test [p=0.898]. Sensitivity analysis did not yield statistically significant results [leave-30%-out analysis IVM p-values: 0.313-0.964]. Conclusions Genetically determined Lp(a) levels were not correlated with and do not appear to have a causal role in preeclampsia. Therefore, Lp(a) screening provides no information as to patients' risk of preeclampsia and Lp(a) reduction is not a promising strategy aimed at preeclampsia prevention. It is nevertheless possible that Lp(a) is involved in the pathogenesis of preeclampsia without a causal, level-dependent role. Irrespectively, the effect of Lp(a) in recurrent pregnancy loss or intrauterine growth restriction needs to be further investigated.

Indication-based administration of low dose aspirin for the prevention of preeclampsia: A retrospective study in Northern Greece

Introduction: Preeclampsia is a multisystem progressive disorder characterized by vascular abnormalities and coagulation disorders. The administration of low-dose aspirin is recommended before 16 weeks to delay or even avoid the onset of preeclampsia, based on screening tests. This study aimed to investigate the targeted or non-targeted administration of low-dose aspirin in pregnancies, according to the indications for its administration. Material and methods: This was a retrospective cohort study from the medical records of the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, including pregnant women that were screened for preeclampsia. The parametric or non-parametric distribution of the data was examined using the Shapiro-Wilk test. The association between the intake and the indication for aspirin intake was examined by the x2 independence test for each medical society’s guidelines. The sensitivity, specificity, and positive and negative predictive values of the different criteria were calculated and compared by applying One-Way ANOVA. All results with a p-value &lt; 0.05 were considered statistically significant. Results: In total, 2,716 women were included in the study; a statistically significant relationship between patients’ aspirin-taking behavior and the indication for aspirin according to the FMF, ACOG and NICE criteria was found. Sensitivity was the highest based on NICE criteria (78.6%), while specificity and positive predictive value (PPV) were the highest based on FMF criteria (89.9% and 61.1%, respectively). Conclusion: Applying the FMF criteria for the use of aspirin results in its more targeted administration achieved high sensitivity, specificity and PPV. Examining the number of patients receiving low-dose aspirin in pregnancy without indication could have clinical implications, highlighting the need for better targeting of the population to which it is administered.

Incidence of Maternal and Perinatal Morbidity in Sickle Cell Disease and Sickle Cell Trait Patients during Pregnancy

Background: Sickle cell disease (SCD) patients have a higher risk of maternal and neonatal morbidity during pregnancy than the general population. Pregnancy in SCD is associated with increased metabolic demands, a hypercoagulable state, endothelial dysfunction, severe anemia, and increased vaso-occlusive episodes. We designed a study to retrospectively review the clinical outcomes of pregnant patients with SCD and SCD trait to examine the incidence of maternal and perinatal morbidity and mortality. We hypothesized that SCD patients should have a higher morbidity during pregnancy and SCD trait patients should not have higher morbidity. Methods: We conducted a retrospective cohort study and reviewed 29,822 patient encounters. Pregnant patients with the SCD genotype - Hb SS, Hb S beta 0 thalassemia, Hb S beta + thalassemia and Hb SC disease, and sickle cell trait (SCD trait) - Hb AS were included. Maternal clinical outcome variables for the entire pregnancy duration were vaso-occlusive crisis (VOC), deep vein thrombosis (DVT), pulmonary embolism (PE), infections - sepsis, septic shock, asymptomatic bacteriuria, acute pyelonephritis, and urinary tract infection (UTI), cerebrovascular accident (CVA), myocardial infarction (MI) and transient ischemic attack (TIA). Clinical outcome variables for pregnancy complications were preeclampsia, gestational diabetes mellitus (GDM), and C-section rate. Clinical outcome variables for neonatal complications included preterm birth and low birth weight. ICD 9 and ICD 10 codes were used to search for the pregnancy, SCD, sickle cell trait, maternal and neonatal outcomes. Data was collected from the Health Facts Database, which contains de-identified information from electronic medical records (EMR) of hospitals in which Cerner© has a data use agreement. The categorical clinical outcome variables were analyzed using Chi-square test. Results: There were 29,822 patient encounters reviewed. Patients with SCD had higher percentages for C-section rates, CVA, preeclampsia, sepsis, septic shock, and VOC compared to those with SCD trait. C-section rates were higher in SCD patients with 76.43% versus 13.76% in SCD trait patients. CVA was higher in SCD patients with 73.78% versus 0% in SCD trait patients. Preeclampsia was higher in SCD patients with 75.92% in SCD patients versus 5.43% in SCD trait patients. Sepsis and septic shock were higher in SCD patients with 73.75% in SCD patients versus 0% in SCD trait patients. VOC was evident in SCD patients with 0.06% versus 0% in SCD trait patients. Patients with SCD trait had higher percentages for asymptomatic bacteriuria, GDM, low birth weight, preterm birth, and UTI compared to patients with SCD. Asymptomatic bacteriuria was higher in SCD trait patients with 0.25% versus 0.08 in SCD patients. GDM was higher in SCD trait patients with 3.09% versus 0% in SCD patients. Low birth weight was higher in SCD trait patients with 0.61% versus 0.17% in SCD patients. Preterm birth was higher in SCD trait patients with 0.78% versus 0.44% in SCD patients. UTI was noted in SCD trait patients with 0.02% versus 0% in SCD patients. There were no findings for DVT, PE, acute pyelonephritis, MI, and TIA in both SCD and SCD trait patients. Conclusion: Pregnant patients with SCD were more likely to have C-sections, CVA, preeclampsia, sepsis, septic shock, and VOC. Pregnant patients with SCD trait were more likely to have asymptomatic bacteriuria, GDM, low birth weight, preterm birth, and UTI. Our findings indicate that prevention and management of CVA, preeclampsia, sepsis, and septic shock is important for pregnant patients with SCD to prevent adverse maternal and neonatal outcomes. The higher rate of C-sections may have been to reduce the severity of maternal and perinatal morbidity in SCD patients. Our study has significant limitations - retrospective nature and use of ICD9 and ICD10 codes for clinical outcome variables. Certain clinical outcome variables, such as CVA, sepsis or septic shock, may have been overestimated as these diagnoses may have been recorded prior to the start of pregnancy in the EMR. Nevertheless, SCD patients have higher maternal and perinatal morbidity that needs to be addressed.

Research progress on the correlation between gut microbiota and preeclampsia: microbiome changes, mechanisms and treatments.

Preeclampsia is a specific disease during pregnancy and is a significant factor in the increased mortality in perinatal women. Gut microbiota, an intricate and abundant microbial community in the digestive tract, is crucial for host metabolism, immunity, and nutrient absorption. The onset and progression of preeclampsia are closely correlated with the changes in maternal gut microbiota. Research purpose was to compile the existing bits of present scientific data and to close the gap in the knowledge of changes in gut microbiota in preeclampsia and their association with preeclampsia. We searched studies from two electronic databases (PubMed and Web of Science) included from 2014 to 2023. This review is divided into three parts. In the first part, the author elaborates longitudinal differences of maternal gut microbiota during different gestation periods. In the second part, we discuss that gut microbiota can lead to the occurrence of preeclampsia by systemic immune response, influencing the release of active peptides, short-chain fatty acids, trimethylamine-N-oxide (TMAO) and other metabolites, vascular factors and Microorganism-immune axis. In the third part, we proposed that a high-fiber diet combined with drugs and microecological regulators may be therapeutic in enhancing or preventing the emergence and evolution of preeclampsia, which needs further exploration. Although the pathogenesis of preeclampsia is still nebulous and there is no clear and valid clinical treatment, our study provides new ideas for the pathogenesis, prevention and treatment of preeclampsia.