Severe Pregnancy Complications Research Articles

P-2076. COVID-19 Vaccination Patterns and Timing among Privately Insured Pregnant Persons, 2020-2023

Abstract Background Pregnant people with COVID-19 are at higher risk of severe illness, pregnancy complications, and adverse pregnancy outcomes. While maternal COVID-19 vaccination has been shown to be safe and effective for pregnant people and their infants, vaccine coverage rates during pregnancy are not optimal. Additional data on the receipt and distribution of COVID-19 vaccine prior to and during pregnancy can inform efforts to increase coverage. We describe COVID-19 vaccination patterns and timing of the most recent vaccine dose among pregnant people.Figure 1.Distribution of COVID-19 Vaccination Patterns Prior to and During Pregnancy among Privately Insured Pregnant Persons, December 2020 - July 2023Notes: In 25,890 pregnancy episodes, the most recent COVID-19 vaccination was received during pregnancy and vaccinations were approximately evenly distributed across trimesters. In the remaining 16,647 episodes, the most recent vaccination was received before the start of pregnancy with almost half of the vaccinations occurring 3-6 months before pregnancy. Methods Vaccination data from a large national commercial claims database were supplemented with data from 21 Immunization Information Systems for which we have permission to use data. We calculated the percentage of pregnant people ages 18-55 years identified between June 2020 and July 2023 who received a COVID-19 vaccination between December 2020 and July 2023. We describe timing of most recent dose received in the 6 months prior to pregnancy (3-6 months, 1-3 months, < 1 month before last menstrual period [LMP]) and during pregnancy, by trimester (first, second, third trimester). Results This study included a total of 120,633 pregnancies among 102,311 pregnant people (mean age at LMP = 32 years; standard deviation: 5). About a third (35.3%, n = 42,537) received ≥1 COVID-19 vaccine dose within the 6 months prior to or during pregnancy; of those, 39.1% received ≥1 dose prior to pregnancy, 41.6% received ≥1 dose during pregnancy, and 19.3% received doses both before and during pregnancy. Among those who received the vaccine before pregnancy, 45.8% received the most recent dose 3-6 months, 34.8% 1-3 months, and 19.4% < 1 month before LMP. Receipt of the most recent COVID-19 vaccine dose during pregnancy was distributed almost evenly across the first (30.5%), second (34.9%), and third (34.6%) trimesters. Conclusion This study found that approximately one third of pregnancies included people who were vaccinated with at least 1 dose of COVID-19 vaccine during pregnancy or within 6 months prior to LMP. The most recent dose was not received more frequently at any time before or during pregnancy. Understanding COVID-19 vaccination patterns and timing is important to assess adherence to vaccination recommendations among this high-risk population. Disclosures Wafa Tarazi, PhD, MHPA, UnitedHealth Group: I am an employee at UHG alexandra stone, PhD, United Health Group: Stocks/Bonds (Public Company) Nwanneamaka Ume, MPH, Optum: I am an Employee of Optum, a UnitedHealth Group subsidiary Andrea Steffens, MPH, OPTUM: Employee|UnitedHealth Group: Stocks/Bonds (Public Company) Katherine Andrade, MPH, Optum: Employee|United Health Group: Stocks/Bonds (Public Company) Garrett Gremel, MS, Optum: Employee Ami R. Buikema, MPH, Optum: Employee|UnitedHealth Group: Stocks/Bonds (Public Company) Wenya Grace Yang, MPA, MA, UnitedHealth Group: I am an employee of UHG.|UnitedHealth Group: Stocks/Bonds (Public Company)

Acardiac Twin: A Case Report

Twin pregnancy generally represents a high-risk pregnancy, but monozygous twin pregnancy is a particular challenge for the obstetrician due to the serious complications that may occur during its evolution. A very rare, severe complication of monozygous twin pregnancy, which we recently dealt with in the Obstetrics and Gynecology Department of the Omdurman maternity Hospital Sudan, was a monochorionic monoamniotic twin pregnancy with acardiac twin (TRAP). One of the fetuses (acardiac twin) presented as amorphous mass without any recognizable structure, being transfused by the other fetus with a normal heart (pumping twin). The understanding of these cases is mandatory in order to offer maximum survival and heath chances to the viable fetus.

Prevention of births in Gaza: Where lies the future?

SynopsisThe study highlights the devastating impact of Gaza's healthcare collapse on maternal health, revealing widespread preventable deaths, stillbirths, miscarriages, and severe pregnancy complications.

Decoding the molecular pathways governing trophoblast migration and placental development; a literature review.

Placental development is a multifaceted process critical for a fruitful pregnancy, reinforced by a complex network of molecular pathways that synchronize trophoblast migration, differentiation, and overall placental function. This review provides an in-depth analysis of the key signaling pathways, such as Wnt, Notch, TGF-β, and VEGF, which play fundamental roles in trophoblast proliferation, invasion, and the complicated process of placental vascular development. For instance, the Wnt signaling pathway is essential to balance trophoblast stem cell proliferation and differentiation, while Notch signaling stimulates cell fate decisions and invasive behavior. TGF-β signaling plays a critical role in trophoblast invasion and differentiation, predominantly in response to the low oxygen environment of early pregnancy, regulated by hypoxia-inducible factors (HIFs). These factors promote trophoblast adaptation, ensure proper placental attachment and vascularization, and facilitate adequate fetal-maternal exchange. Further, we explore the epigenetic and post-transcriptional regulatory mechanisms that regulate trophoblast function, including DNA methylation and the contribution of non-coding RNAs, which contribute to the fine-tuning of gene expression during placental development. Dysregulation of these pathways is associated with severe pregnancy complications, such as preeclampsia, intrauterine growth restriction, and recurrent miscarriage, emphasizing the critical need for targeted therapeutic strategies. Finally, emerging technologies like trophoblast organoids, single-cell RNA sequencing, and placenta-on-chip models are discussed as innovative tools that hold promise for advancing our understanding of placental biology and developing novel interventions to improve pregnancy outcomes. This review emphasizes the importance of understanding these molecular mechanisms to better address placental dysfunctions and associated pregnancy disorders.

MiR-155 mediated regulation of PKG1 and its implications on cell invasion, migration, and apoptosis in preeclampsia through NF-κB pathway

BackgroundPreeclampsia (PE) is a severe pregnancy complication characterized by complex molecular interactions. Understanding these interactions is crucial for developing effective therapeutic strategies.MethodsThis study applies a pharmacometabolomics approach to explore the roles of miR-155 and PKG1 in PE, focusing on the regulatory influence of the NF-κB signaling pathway. Blood metabolomic profiles were analyzed, and bioinformatics tools, IHC staining, Western blot (WB) analysis, and immunofluorescence (IF) localization were employed to determine the expression and function of miR-155 and PKG1. Cell invasion, migration, proliferation, and apoptosis assays were conducted to assess miR-155’s modulation of PKG1. Additionally, RT-qPCR and WB analysis elucidated NF-κB-mediated regulation mechanisms.ResultsOur findings indicate significant metabolic alterations associated with miR-155 modulation of PKG1, with NF-κB acting as a critical upstream regulator. The study demonstrates that miR-155 affects cellular functions such as invasion, migration, proliferation, and apoptosis through PKG1 modulation. Furthermore, the NF-κB signaling pathway regulates miR-155 expression, contributing to the pathological processes of PE.ConclusionThis study provides a proof of concept for using pharmacometabolomics to understand the molecular mechanisms of PE, suggesting new therapeutic targets and advancing personalized medicine approaches. These insights highlight the potential of pharmacometabolomics to complement genomic and transcriptional data in disease characterization and treatment strategies, offering new avenues for therapeutic intervention in PE.

Immunoexpression of placental growth factor (PlGF) and soluble FMS-like tyrosine kinase 1 (sFlt-1) in the placental bed of preeclamptic women of African ancestry living with HIV infection

Preeclampsia, a severe pregnancy complication linked to defective placentation, poses significant maternal risks and is characterized by dysregulated angiogenic factors, including placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1). Women with HIV/AIDS and receiving ART may face an increased susceptibility to preeclampsia development due to immunological and angiogenic imbalance. This study investigates the immunoexpression of these factors in the context of HIV-associated preeclampsia, utilizing morphometric image analysis. The study cohort comprised 180 women, including 60 normotensive and 120 preeclamptic participants, further stratified by HIV status and gestational age (early-onset PE [EOPE] < 34 weeks and late-onset PE [LOPE] ≥ 34 weeks). Placental bed tissues were immunostained with mouse anti-human sFlt-1 and PlGF antibodies, and the results were analyzed using Zeiss Axio-Vision and GraphPad Prism software. sFlt-1 levels showed no significant overall difference between preeclamptic and normotensive women (p = 0.8661), though slightly increased in the preeclamptic myometrium, independent of HIV status. However, sFlt-1 levels were significantly higher in EOPE compared to both normotensive and LOPE groups. PlGF immunostaining also showed no significant overall difference (p = 0.7387) but was notably lower in preeclamptic pregnancies and significantly higher in EOPE compared to LOPE. HIV status did not significantly impact sFlt-1 or PlGF levels, although sFlt-1 was slightly higher in HIV-negative women, while PlGF was marginally higher in HIV-positive women. These findings highlight the complex role of angiogenic factors in preeclampsia pathophysiology and suggest that antiretroviral therapies (ARTs) may contribute to the dysregulation of these factors due to a heightened immune milieu.

A prospective observational study on maternal diet pre- and post-GDM diagnosis and pregnancy outcomes in individuals with/without GDM

AimsTo investigate (1) the association between maternal dietary choices during the first and second trimesters and the diagnosis of gestational diabetes mellitus (GDM), (2) the association between a GDM diagnosis and dietary choices during pregnancy, and (3) the differences in pregnancy outcomes between individuals with and without GDM.MethodsA prospective cohort study. Pregnant individuals with singleton pregnancy aged 19 ∼ 44 years, without severe pregnancy complications were enrolled in the study. Dietary data were collected at three time points during routine antenatal appointments: 8 ∼ 12 weeks gestation(n = 993), 20 ∼ 24 weeks gestation(n = 732), and 32 ∼ 36 weeks gestation(n = 536). GDM diagnosis and pregnancy outcomes were collected during follow-up from the electronic medical record (EMR).ResultsA total of 93 participants (12.9%) were diagnosed with GDM. Livestock and poultry meat intake during the second trimester were associated with an increased risk of developing GDM (aOR 1.371, 95%CI 1.070–1.756, P = 0.013), and a GDM diagnosis may lead to decreased intake of cereals and its products (P = 0.001), potatoes and its products (P < 0.001), and fruit (P = 0.002) and increased intake of fish, shrimp and shellfish (P = 0.001), eggs (P = 0.015), and milk and milk products (P = 0.011) in the third trimester. Individuals with GDM related to lower risk of excessive gestational weight gain (aOR 0.384, 95%CI 0.188–0.646, P = 0.001) but may increase the risk of fetal macrosomia (aOR 3.873, 95%CI 1.364–10.996, P = 0.011).ConclusionsUnderstanding maternal dietary choices around GDM diagnosis is crucial for accurate nutritional assessment and effective education programs. While our findings suggest dietary changes may occur post-diagnosis, further research is needed to confirm these patterns and the potential benefits of early dietary counseling for individuals with GDM.

Circular RNA circ_0022707 impedes the progression of preeclampsia via the miR-3135b/GHR/PI3K/Akt axis.

Preeclampsia (PE) is a severe pregnancy complication linked to maternal and fetal health, yet its underlying causes and pathogenesis remain elusive. Circular RNA (circRNA), a form of non-coding RNA, is implicated in the progression of PE; nevertheless, the specific mechanism is not fully elucidated. This study aimed to identify and validate circRNAs that are pivotal in the pathophysiology of PE. Firstly, we constructed a ceRNA network using datasets from the GEO database and identified circ_0022707 as our study target. Then, using qRT-PCR analysis, we validated that circ_0022707 was downregulated in preeclamptic placentas compared to those of normal pregnant women. In situ hybridization assays revealed that circ_0022707 existed in placental villous trophoblast cells. Additionally, Pearson correlation analysis revealed a negative relationship between the expression of circ_0022707 and PE-related indicators (systolic and diastolic blood pressure, along with 24-h proteinuria levels). Furthermore, gain-of-function experiments confirmed that circ_0022707 could promote trophoblast cell proliferation and cell cycle progression while suppressing apoptosis. In vivo experiments using a preeclampsia-like mouse model also demonstrated that circ_0022707 administration could mitigate preeclampsia-like symptoms. Mechanistically, we confirmed that circ_0022707 functions through the miR-3135b/GHR/PI3K/Akt pathway in trophoblast cells. Overall, our study has provided insight into the important function of circ_002707 in the development of PE, enhancing our understanding of the disease's mechanism and proposing a viable therapeutic strategy for PE.

Influence of adiposity on the prevalence of iron deficiency in women of reproductive age: data from the UK National Diet and Nutrition Survey 2008-2019 (NDNS)

Overweight/obesity and iron deficiency are highly prevalent, particularly in women of reproductive age (WRA)(1). Both can seriously affect women’s health and cause severe complications in pregnancy(1). Obesity is associated with nutritional deficiencies but its influence on iron deficiency is unclear. This study aimed to investigate the influence of adiposity on the prevalence of iron deficiency in UK women of reproductive age.Data from NDNS (years 2008-2019) was used including general characteristics, anthropometry, iron biomarkers; haemoglobin (Hb), ferritin, and C-reactive protein (CRP) as a marker of inflammation. WRA aged 18-49 years with BMI ≥18.5kg/m2 were included. Data were categorised as follows: Anaemia: Hb&lt;120 g/L, Iron Deficiency Anaemia (IDA): Hb&lt;120g/L and ferritin &lt;30 μg/L, Iron Deficiency (ID): ferritin &lt;30 μg/L, Iron Deficiency Without Anaemia (IDWA): Ferritin &lt;30 μg/L and Hb&gt;120 g/L(2). Ferritin was adjusted for CRP (aFerritin)(3). WRA were divided into two adiposity groups: BMI &lt;25 kg/m2 and ≥25 kg/m2, waist circumference (WC) &lt;80cm and ≥80cm, waist-toheight (WHtR) &lt;0.50 and ≥0.50, and waist-to-hip ratio (WHR)&lt;0.85 and ≥0.85 according to guidelines(4,5). Weighting was applied to account for response differences between the surveys. Chi-square was performed to compare iron deficiency prevalence between adiposity groups and multiple logistic regressions adjusting for relevant covariates to evaluate the associations between adiposity and anaemia, IDA, ID and IDWA. P-value &lt;0.05 considered significant.n = 1098 WRA were included, n = 496 with normal weight and n = 602 with overweight/obesity (Ow/Ob). The overall anaemia, IDA, ID, and IDWA prevalence was 9.2%, 5.3%, 49.7%, and 42.9% respectively. Anaemia prevalence was greater in those with higher WHtR and WHR (11.9% vs 5.9% and 16.7% vs 6.5% respectively; both p&lt;0.001). Greater IDA prevalence was observed in those with higher WC, WHtR and WHR (8.5% vs 4.3%, p = 0.005; 9.4% vs 3.3%, p&lt;0.001; and 12.1% vs 4.9%, p&lt;0.001). Overall prevalence of ID was 43% using unadjusted ferritin and 49.7% using aFerritin, both with similar prevalence observed between adiposity groups. IDWA prevalence was higher in the low WC compared to the high WC group (46.5% vs 40.1%, p = 0.030), however, no association was found between ID or IDWA with any adiposity group. Logistic regression analyses showed that higher WHtR and WHR predicted anaemia and IDA (anaemia: WHtR aOR 1.74 p = 0.045, WHR aOR 4.05 p&lt;0.001; IDA: WHtR aOR 2.45 p = 0.011, WHR aOR 3.82 p&lt;0.001).ID prevalence in a representative sample of UK WRA is high, at 43%, with higher rates of 50% observed when ferritin is adjusted for inflammation, indicating the increased sensitivity of aFerritin in ID detection. A greater central adiposity in WRA is a risk factor for IDA. Public health strategies are needed to address the high prevalence of ID in UK WRA, particularly those living with Ow/Ob.

Features of placental angioarchitectonics with favorable and unfavorable outcome after laser coagulation of placental anastomoses

Background. One of the most common and severe complications of monochorionic pregnancy is feto-fetal transfusion syndrome (FFTS). The incidence of transfusion syndrome in monochorial diamniotic twins ranges from 10 to 15%.Objective. To analyze the angioarchitecture of the placenta in FFTS, to determine its features with a favorable and unfavorable outcome after laser coagulation of placental anastomoses (LPCA).Materials and methods. Continuous prospective, cohort, comparative study 90 pregnant women with monochorionic diamniotic twins were examined: in 60 people (the main group) the pregnancy was complicated by FFTS, in 30 patients (the comparison group) the pregnancy was characterized by a normal course; their newborns and afterbirths. The main group was divided into 2 subgroups depending on the outcome of LCPA in order to correct FFTS: subgroup 1 — favorable outcome (n=50), subgroup 2 — unfavorable outcome (n=10). Result. The angioarchitecture of the placenta in FFTS with a favorable outcome of LCPA is characterized by the presence of large arteriovenous placental anastomoses in combination with “central-central” and “central-marginal” variants of umbilical cord attachment. A larger number of anastomoses is recorded in monochorionic twins with FFTS and vascular patterns with two or more arteriovenous anastomoses (“Type B” and “Type D”), in our study they were more common with an unfavorable outcome of laser coagulation of placental anastomoses (OR = 5.23 (95%CI 2.13;12.8);p&lt;0.001).Conclusion. Angioarchitectonics of the placenta in feto-fetal transfusion syndrome with a favorable outcome of laser coagulation of placental anastomoses is characterized by the presence of large arteriovenous placental anastomoses in combination with “central-central” and “central-marginal” variants of umbilical cord confluence.

Changes of coagulation function and platelet parameters in preeclampsia and their correlation with pregnancy outcomes.

Preeclampsia (PE) is a severe pregnancy complication characterized by significant alterations in coagulation function. This study aims to analyze the correlation between coagulation function, platelet parameters, and pregnancy outcomes in PE patients. Clinical data, along with blood and urine samples, were collected from 168 PE patients and 128 healthy pregnant women. General demographic and laboratory testing data were recorded, and maternal and fetal outcomes were followed up. Data were analyzed using Kaplan-Meier and logistic regression analyses. In mild PE patients, thrombin time (p=.000), platelet distribution width (PDW) (p=.000), and clot formation time (p=.000) were increased, while prothrombin time (p=.000) and fibrinogen (p=.045) were reduced. With increasing PE severity, prothrombin time (p=.000), platelet count (PLT) (p=.000), mean platelet volume (MPV) (p=.000), plateletcrit (p=.000), maximum amplitude (MA) (p=.000), and coagulation index (p=.001) decreased, whereas activated partial thromboplastin time (APTT) (p=.000), thrombin time (p=.002), D-dimer (p=.026), and PDW (p=.000) increased. Lower prothrombin time (p=.048), PLT (p=.004), and coagulation index (p=.026) or higher APTT (p=.032), thrombin time (p=.044), D-dimer (p=.023), and PDW (p=.016) were associated with a higher risk of poor pregnancy outcomes. Thrombin time was identified as an independent risk factor (p=.025, OR=2.918, 95% CI: 1.145-7.436), whereas gestational age was an independent protective factor (p=.000, OR=0.244, 95% CI: 0.151-0.395). This study demonstrates that specific coagulation and platelet parameters are significantly associated with PE severity and adverse pregnancy outcomes. These findings highlight the importance of monitoring coagulation function in PE patients to improve clinical management and outcomes.

Polymorphism of Folate Metabolism Genes among Ethnic Kazakh Women with Preeclampsia in Kazakhstan: A Descriptive Study.

Preeclampsia is a severe multifactorial complication of pregnancy. Studies found associations between folate metabolism genes' polymorphisms and preeclampsia. However, investigations in this field are limited among Asian populations. Thus, the study's aim was to evaluate the prevalence of methionine synthase (MTR), methionine synthase reductase (MTRR), and methylenetetrahydrofolate reductase (MTHFR) genes' polymorphisms among ethnic Kazakh women with preeclampsia. This was a retrospective study involving 4246 patients' data for the period of 2018-2022. Identification of MTR, MTRR, and MTHFR genes' polymorphism was performed via PR-PCR. Peripheral blood samples were obtained for the analyses. In total, 4246 patients' data of Kazakh ethnicity with preeclampsia at >20 weeks gestational age who had undergone an investigation to identify polymorphisms of the folate metabolism pathway genes for the period of 5 years were included in this study. The most common and prevalent mutation was the MTRR A66G polymorphism: 24.5% of all tested patients with preeclampsia had the MTRR A66G polymorphism. It was highest among the 35-39 age group participants. The second most prevalent was the MTHFR C677T polymorphism: 9% of women with preeclampsia had the MTHFR C677T mutation. It was highest among women aged 30-34. There was a rare association of the MTR A2756G mutation with preeclampsia among the study participants. The identified levels of MTRR A66G and MTHFR C677T polymorphisms among the study participants suggest the importance of evaluating MTRR and MTHFR polymorphisms in women with preeclampsia. The role of the MTR A2756G polymorphism in the development of preeclampsia needs to be further investigated.

Modern approach to the treatment of urinary tract infections during pregnancy

Urinary tract infections (UTIs) are an extremely common pathology among pregnant women and women in labor, the manifestation of which occurs during pregnancy. Physiological changes in a woman’s organism form an optimal background for infection or activation of the aggression of one’s own microbial environments – the microflora that colonizes the periurethral area and mostly belongs to the family of enterobacteria and staphylococci.Clinical manifestations of UTIs during pregnancy are extremely variable and do not always correspond to the usual course of the disease, which necessitates the search for modern approaches to diagnosis and treatment. Also, UTI is one of the leading factors that provoke severe pregnancy complications and can lead to adverse obstetric outcomes.The objective: to evaluate the effectiveness of the modern etiopathogenetic approach to the treatment of UTIs during pregnancy.Materials and methods. In the study, which began in 2022 and is ongoing, 1615 pregnant women at gestational ages 6-37 weeks with clinical manifestations of urinary tract infections (UTIs). This work presents the survey results of 615 pregnant women with UTIs at gestational ages from 20 to 28 weeks, both before and one month after treatment initiation. These women were monitored during their pregnancies in prenatal care clinics of municipal non-commercial enterprises across all regions of Ukraine. At the stage of prescribing treatment the examined women are divided into two groups. The main group included 374 pregnant women with established diagnoses of acute urethritis, acute cystitis, gestational pyelonephritis (GP) and asymptomatic bacteriuria (ABU), who have received antibacterial and uroseptic agents for treatment in accordance with current clinical guidelines in combination with a herbal uroantiseptic containing 120 mg of cranberry berry extract and 36 mg each of extracts of goldenseal, lovage root, rosemary, as well as auxiliary substances. The comparison group included 241 pregnant women with established diagnoses of acute urethritis, acute cystitis, GP and ABU, who were treated exclusively with antibacterial and uroseptic agents for UTIs manifestations.The effectiveness of treatment methods was evaluated on the basis of a developed questionnaire with information on the main symptoms characteristic of diseases of the urinary system, before and one month after the prescribed treatment.Results. On the background of addition to the main antibacterial and uroseptic therapy the herbal uroantiseptic, containing 120 mg of cranberry berry extract and 36 mg each of extracts of yarrow, lovage root, rosemary, as well as auxiliary substances already a month after the start of treatment, the absence of complaints was found in the majority of pregnant women in the main group, related:with frequent urination – 354 (94.6%) (comparison group – 208 (86.3%); p&lt;0.05), the need for urgent urination – 374 (99.1%) (comparison group – 232 (96.3%); p&lt;0.05), the feeling of incomplete emptying of the bladder – 348 (93.3%) (comparison group – 202 (83.9%); p&lt;0.05),with pain: during urination – 369 (98.7%) (comparison group – 231 (95.9%); p&lt;0.05), in the lower abdomen, not associated with urination – 366 (97.9%) (comparison group – 230 (95.9%); p&lt;0.05), in the lower back – 369 (98.7%) (comparison group – 229 (95.1%); p&lt;0.05),with discharge from the urethra not related to urination – 374 (100.0%) (comparison group – 233 (96.7%); p&lt;0.05).Conclusions. On the background of the prescribing of a herbal uroantiseptic containing 120 mg of cranberry extract and 36 mg of extracts of yarrow, lovage root, and rosemary, as well as auxiliary substances, additionally to the main antibacterial and uroseptic therapy in pregnant women of the main group, in a significantly greater number of cases the absence of complaints, which are associated with manifestations of urinary tract infections, was determined.The use of the herbal uroantiseptic, containing 120 mg of cranberry berry extract and 36 mg of extracts of yarrow, lovage root, and rosemary, is safe and creates favorable conditions for the course of pregnancy and further childbirth due to the potentiation of the effects of antibacterial and uroseptic therapy and the effective prevention of recurrences of urinary tract infections.

Clinical Study of HELLP Syndrome and It's Outcome at Pravara Rural Hospital, Loni

Background: HELLP syndrome, a severe pregnancy complication characterized by hemolysis, elevated liver enzymes, and low platelet count, occurs in 0.5 to 0.9% of all pregnancies and in 10–20% of severe preeclampsia cases. It poses significant risks to both mother and fetus, presenting diagnostic and therapeutic challenges. Patients often experience epigastric or right upper quadrant pain, hypertension, proteinuria, fatigue, nausea, vomiting, sudden weight gain, and headaches. HELLP syndrome typically occurs in the second and third trimesters (27-37 weeks) and 15–30% of cases present postpartum. The exact causes remain unclear but may involve placental origins, autoimmune factors, gene mutations, or fatty acid oxidation disorders. Aims and Objectives: To analyze the clinical profile of HELLP syndrome cases and to assess maternal and perinatal outcomes, including morbidity and mortality. Material and Methods: This prospective cross-sectional study was conducted in the Obstetrics and Gynecology department at Pravara Rural Hospital, Loni, involving 45 patients with severe preeclampsia and eclampsia above 28 weeks of gestation diagnosed with HELLP syndrome. Patients were admitted to the ICU, and detailed histories and examinations were recorded. Patients were divided into two groups: those with HELLP syndrome (Group A) and those without (Group B). Results: Group A had a higher representation in the 20-22 age bracket, while Group B had more members aged 22-24. Cesarean sections were more common in Group A, whereas vaginal deliveries were more frequent in Group B. Blood pressure readings were higher in Group A. Maternal complications, such as abruption placentae, DIC, hepatic infarction, acute renal failure, and ascites, were more frequent in Group A, as were neonatal complications like IUGR, preterm delivery, neonatal thrombocytopenia, and RDS. Conclusion: The study reveals significant differences between patients with and without HELLP syndrome. Group A included younger patients, more first-time mothers, and a higher incidence of complications and mortality. These findings highlight the need for tailored management strategies for severe preeclampsia/eclampsia, especially in those with HELLP syndrome, to improve maternal and neonatal outcomes.

The Effect of Preeclampsia in Pregnant Women on The Incidence of Maternal Mortality: Literature Review

Preeclampsia is a severe pregnancy complication characterized by elevated blood pressure and often occurs after 20 weeks of gestation. This condition can lead to significant morbidity and mortality for both the mother and the fetus. This study aims to identify the risk factors associated with preeclampsia in pregnant women, a condition that remains prevalent in Indonesia and globally. The research employed a comprehensive literature review method, examining ten articles sourced from databases such as Google Scholar, PubMed, and Elsevier. The inclusion criteria for the literature review involved studies focused on the causes and consequences of preeclampsia, published within the last ten years, and providing substantial data on maternal mortality. The results of the literature review indicated that pregnant women with a history of hypertension or previous preeclampsia are at a significantly higher risk of developing preeclampsia. Additionally, severe cases of preeclampsia, such as those involving HELLP syndrome, eclampsia, and high diastolic blood pressure, were strongly linked to increased maternal mortality. The review also highlighted the crucial role of efficient referral systems and timely medical interventions in managing severe preeclampsia and reducing maternal deaths. This study concludes that early detection and continuous monitoring are essential for managing preeclampsia effectively. The findings underscore the need for standardized treatment protocols, improved healthcare access, and comprehensive prenatal services to mitigate the risks associated with preeclampsia. Future research should aim to include a broader range of studies and explore the long-term implications of preeclampsia on maternal and fetal health. These insights are critical for developing effective strategies to reduce the incidence and severity of preeclampsia and enhance maternal health outcomes.

Genetic Insights and Neonatal Outcomes in Preeclampsia and Eclampsia: A Detailed Analysis of the RS5707 Genotype.

Preeclampsia (PE) and eclampsia (E) are severe pregnancy complications with significant maternal and neonatal health impacts. This study explores the association of the rs5707 polymorphism in the renin-angiotensin system (RAS) with PE/E and related neonatal outcomes. We conducted a cross-sectional study involving 400 mother-newborn dyads at the "Pius Brinzeu" Emergency Clinical Hospital Timisoara. Participants were divided into a control group (254 normotensive women) and a PE/E group (146 women with PE/E). Genotyping for the rs5707 polymorphism was performed using real-time PCR, and statistical analyses assessed associations with maternal body mass index (BMI) and neonatal outcomes. The AA genotype of rs5707 was significantly associated with a reduced risk of PE/E and more favorable neonatal outcomes, including higher Apgar scores, greater birth weights, and longer gestational ages. Conversely, the AC genotype correlated with increased maternal BMI and adverse neonatal outcomes. Odds ratios highlighted the protective effect of the AA genotype against PE/E and the increased risk associated with the AC genotype. This study revealed the critical role of the rs5707 polymorphism in PE/E development and neonatal health. Genetic screening for rs5707 could enhance early identification and personalized intervention strategies, improving outcomes for both mothers and neonates. Further research is needed to validate these findings across diverse populations and to uncover the underlying mechanisms.

Outcomes of Placental Abruption Depending on Severity of Pre-Eclampsia: A Multicentre Cohort Observational Retrospective Study

Aim. Placental abruption is a severe complication of pregnancy, which is often accompanied by pre-eclampsia and early delivery. Here we aimed to study maternal and neonatal outcomes in patients with placental abruption depending on the severity of pre-eclampsia.Materials and Methods. The study included 509 patients with placental abruption and pre-eclampsia from 22 medical centers in 16 regions of the Russian Federation, which were divided into two groups: patients with placental abruption and severe pre-eclampsia (n = 369) and patients with placental abruption and moderate pre-eclampsia (n = 140).Results. Regardless of the severity of pre-eclampsia, average term of placental abruption was 34 weeks of pregnancy. Among the adverse maternal outcomes in patients with placental abruption and severe pre-eclampsia were coagulopathy (OR = 5.01; 95% CI = 1.17–21.46) and near miss proportion (OR = 2.95; 95% CI =1.22 –7.08) which were significantly more common as compared to a moderate pre-eclampsia. Neonatal outcomes were accompanied by a high perinatal mortality (12.8%) and neonatal morbidity due to a high prevalence of premature birth (65%), asphyxia (64%), and small for gestational age (40%). Groups with severe and moderate pre-eclampsia had no statistically significant differences in neonatal outcomes, excepting congenital malformations which were found less frequently (OR = 0.32; 95% CI 0.13–0.79) in severe pre-eclampsia.Conclusion. Severity of pre-eclampsia did not affect neonatal outcomes in women with placental abruption. Maternal outcomes were significantly worse in patients with severe pre-eclampsia in comparison with those with moderate pre-eclampsia.

Revealing ANXA6 as a Novel Autophagy-related Target for Pre-eclampsia Based on the Machine Learning

Background: Preeclampsia (PE) is a severe pregnancy complication associated with autophagy. Objective: This research sought to uncover autophagy-related genes in pre-eclampsia through bioinformatics and machine learning. Methods: GSE75010 from the GEO series was subjected to WGCNA to identify key modular genes in PE. Autophagy genes retrieved from the THANATOS overlapped with the modular genes to yield PErelated autophagy genes. Furthermore, the crucial step involved the utilization of two machine learning algorithms (LASSO and SVM-RFE) for dimensionality reduction. The candidate gene was further verified by quantitative reverse transcription polymerase chain reaction, western blot, and immunohistochemistry. Preliminary experiments were conducted on HTR-8/SVneo cell lines to explore the role of candidate genes in autophagy regulation. Results: WGCNA identified 291 genes from 5 hubs, and after overlapping with 1087 autophagy-related genes obtained from THANATOS, 42 PE-related ARGs were identified. ANXA6 was recognized as a potential target through SVM-RFE and LASSO analyses. The mRNA and protein expression of ANXA6 were verified in placenta samples. In HTR8/SVneo cells, modulating ANXA6 expression altered autophagy levels. Knocking down ANXA6 resulted in an anti-autophagy effect, which was reversed by treatment with CAL101, an inhibitor of PI3K, Akt, and mTOR. Conclusion: We observed that ANXA6 may serve as a possible PE action target and that autophagy may be crucial to the pathogenesis of PE.

Evaluation of Morbidity and Mortality of Eclampsia at Brahmanbaria Medical College and Hospital

Background: Eclampsia is a severe and life-threatening complication of pregnancy, characterized by the onset of seizures in a woman with preeclampsia. This hypertensive disorder of pregnancy is associated with a range of maternal complications, presenting a significant challenge in obstetric care. Maternal complications of this nature can significantly affect both maternal and perinatal health, potentially leading to higher rates of mortality and morbidity. Objective: This study was aimed to evaluate the morbidity and mortality of eclampsia in Brahmanbaria Medical College and Hospital. Methods: This cross-sectional observational study was conducted at Brahmanbaria Medical College and Hospital, Brahmanbaria, Bangladesh, from January 2021 to December 2021. The study included 56 pregnant women with eclampsia purposively. Demographic and clinical information was recorded, and data analysis and dissemination were carried out using MS Office tools. Results: Regarding perinatal outcomes, 80% of cases resulted in live births, with a 57% survival rate. Among live births, 4% experienced post-birth mortality, and 11% faced early neonatal death. Among live births (n=45), a significant 69% experienced intrauterine growth restriction (IUGR). Maternal complications included abruptio placenta in 32% of cases, HELLP syndrome in 5%, and maternal death occurred in 5% of cases. Conclusions: Eclampsia assessment shows complex perinatal and maternal outcomes. Live births are common, but survival is challenging. High post-birth and neonatal mortality highlight newborn vulnerability. Intrauterine growth restriction (IUGR) worsens newborn health concerns. Maternal issues like abruptio-placenta, HELLP syndrome, and maternal death further complicate matters. J Rang Med Col. March 2024; Vol. 9, No. 1: 39-43

Exploiting sweet relief for preeclampsia by targeting autophagy-lysosomal machinery and proteinopathy

The etiology of preeclampsia (PE), a severe complication of pregnancy with several clinical manifestations and a high incidence of maternal and fetal morbidity and mortality, remains unclear. This issue is a major hurdle for effective treatment strategies. We recently demonstrated that PE exhibits an Alzheimer-like etiology of impaired autophagy and proteinopathy in the placenta. Targeting of these pathological pathways may be a novel therapeutic strategy for PE. Stimulation of autophagy with the natural disaccharide trehalose and its lacto analog lactotrehalose in hypoxia-exposed primary human trophoblasts restored autophagy, inhibited the accumulation of toxic protein aggregates, and restored the ultrastructural features of autophagosomes and autolysosomes. Importantly, trehalose and lactotrehalose inhibited the onset of PE-like features in a humanized mouse model by normalizing autophagy and inhibiting protein aggregation in the placenta. These disaccharides restored the autophagy-lysosomal biogenesis machinery by increasing nuclear translocation of the master transcriptional regulator TFEB. RNA-seq analysis of the placentas of mice with PE indicated the normalization of the PE-associated transcriptome profile in response to trehalose and lactotrehalose. In summary, our results provide a novel molecular rationale for impaired autophagy and proteinopathy in patients with PE and identify treatment with trehalose and its lacto analog as promising therapeutic options for this severe pregnancy complication.