22,885 results on '"Preeclampsia"'
Search Results
2. TikTok Influencer and 3x Preeclampsia Survivor Kelceymarie Warner Kicks off 'Promise Walk Wherever' as Honorary Chair
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Preeclampsia ,Infants (Premature) ,Business ,News, opinion and commentary - Abstract
MELBOURNE, Fla., Aug. 1, 2024 /PRNewswire/ -- Preeclampsia survivors and their supporters from across the United States will hit the pavement on Saturday, August 24, 2024, as part of the [...]
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- 2024
3. OU engineer receives NSF CAREER award for preeclampsia study
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United States. National Science Foundation ,Career development ,Preeclampsia ,College teachers ,Machine learning ,Engineers ,Hypertension ,Banking, finance and accounting industries ,Business ,Insurance ,Business, regional - Abstract
Byline: Journal Record Staff NORMAN Talayah Razzaghi, an assistant professor of industrial and systems engineering at the University of Oklahoma, has been awarded a Faculty Early Career Development Program award [...]
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- 2024
4. After a dangerous brush with preeclampsia, this doctor is raising awareness about the condition among Black women
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Women, Black ,Preeclampsia ,Business ,General interest ,Business, regional - Abstract
Byline: Tom Avril Apr. 1In her 38th week of pregnancy, Madison Cook had good reason to worry that she had developed the life-threatening complication called preeclampsia. Her blood pressure was [...]
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- 2024
5. New Scientific Research Funding Available to Eliminate Pre-Term Deliveries from Preeclampsia
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Research grants ,Preeclampsia ,Company financing ,Business ,News, opinion and commentary - Abstract
MELBOURNE, Fla., June 27, 2024 /PRNewswire/ -- The Preeclampsia Foundation is seeking Letters of Intent for the Peter Joseph Pappas Research Grants funding program, designed to accelerate preeclampsia research. The [...]
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- 2024
6. Preeclampsia Foundation's Take 10 for Preeclampsia Research Program Announced As Top 10 Finalist in NIH Build UP Trust Challenge
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Preeclampsia ,Hypertension ,Business ,News, opinion and commentary - Abstract
Program competes for one of four $200,000 grant prizes in 2025 MELBOURNE, Fla., June 13, 2024 /PRNewswire/ -- The National Institutes of Health (NIH) announced today that the Preeclampsia Foundation's [...]
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- 2024
7. Labcorp Introduces First Trimester Screening Test to Assess Preeclampsia Risk during Pregnancy
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Medical tests ,Pregnancy ,Preeclampsia ,Risk assessment ,Pregnant women ,Medical screening ,Business ,News, opinion and commentary - Abstract
Labcorp is now the only lab that can detect preeclampsia risk across all pregnancy trimesters BURLINGTON, N.C., May 15, 2024 /PRNewswire/ -- https://c212.net/c/link/?t=0&l=en&o=4166938-1&h=1003709747&u=http%3A%2F%2Fwww.labcorp.com%2F&a=Labcorp(NYSE: LH), a global leader of innovative and [...]
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- 2024
8. Preeclampsia Foundation Cuff Kit(TM) Program Receives HHS Office on Women's Health Hypertension Innovator Award
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Women -- Health aspects ,Preeclampsia ,Patient education ,Hypertension ,Business ,News, opinion and commentary - Abstract
The Cuff Kit(TM) program joins 10 other programs honored for innovation in addressing hypertension during pregnancy WASHINGTON, May 10, 2024 /PRNewswire/ -- The U.S. Department of Health and Human Services [...]
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- 2024
9. March of Dimes Launches Low Dose, Big Benefits(TM) Campaign to Combat Preeclampsia and Preterm Birth
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Sanofi S.A. ,Aspirin ,Preeclampsia ,Infants (Premature) ,Pharmaceutical industry ,Business ,News, opinion and commentary - Abstract
11-Time Olympic Medalist & Co-Founder and President of Saysh, Allyson Felix, brings awareness to campaign through her personal experience with preeclampsia and preterm birth Campaign expands upon the organization's It [...]
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- 2024
10. The Foundation for the National Institutes of Health Launches First Public-Private Partnership for Early Detection of Preeclampsia
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United States. Food and Drug Administration ,United States. National Institutes of Health ,Infants -- Patient outcomes ,Mothers -- Patient outcomes ,Public-private sector cooperation ,Preeclampsia ,Pregnant women ,Patient advocacy ,Business ,Business, international - Abstract
Project Addresses High Rate of Maternal Deaths in United States NORTH BETHESDA, Md. -- The Foundation for the National Institutes of Health (FNIH) today announces the launch of a new [...]
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- 2024
11. Preeclampsia Foundation Announces New 2024 Leadership of Board of Directors
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Financial planners ,Preeclampsia ,Boards of directors ,Business ,News, opinion and commentary - Abstract
MELBOURNE, Fla., Jan. 29, 2024 /PRNewswire/ -- The Preeclampsia Foundation welcomed a new group of officers to their https://c212.net/c/link/?t=0&l=en&o=4077927-1&h=3224417002&u=https%3A%2F%2Fpreeclampsia.org%2Fpeople%2Fboard-of-directors&a=2024+Board+of+Directors today. Robyn D'Oria, MA, RNC, APN will serve as the new [...]
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- 2024
12. Comanche Biopharma Closes Oversubscribed $75 Million Series B Financing to Advance Mission to Develop and Make Globally Available the First Treatment Targeting a Root Cause of Preeclampsia
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New Enterprise Associates ,Atlas Venture ,Biological products industry ,Preeclampsia ,Banking, finance and accounting industries ,Business - Abstract
Financing was led by New Enterprise Associates (NEA) and closed with additional new investor Atlas Venture and continued investment by GV and F-Prime Capital Significant investment by top-tier syndicate endorses [...]
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- 2024
13. Preeclampsia Foundation and Society for Maternal-Fetal Medicine Unveil Visual Patient Experience Tools
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Preeclampsia ,Business ,News, opinion and commentary - Abstract
Leading Preeclampsia Advocates Partner to Launch New Educational Resources MELBOURNE, Fla., Jan. 9, 2024 /PRNewswire/ -- Today, the Preeclampsia Foundation (PF) and the Society for Maternal-Fetal Medicine (SMFM) unveiled a [...]
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- 2024
14. Patent Issued for Methods and compositions for assessing patients with preeclampsia-related conditions using MicroRNA (USPTO 12012635).
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EWinger Inc. has been issued a patent for methods and compositions to assess patients with preeclampsia-related conditions using MicroRNA. Preeclampsia is a condition that affects pregnant women and can lead to complications and loss of pregnancy. The patent describes a method for characterizing preeclampsia-related conditions by collecting a non-placental biological sample, extracting microRNA from the sample, quantifying the microRNA, and comparing it to a control sample. This method could potentially allow for early diagnosis and treatment of preeclampsia. The patent also includes a list of specific microRNAs that can be used for assessment and treatment. [Extracted from the article]
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- 2024
15. Thermo Fisher granted FDA approval for preeclampsia blood test, WSJ says
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Thermo Fisher Scientific Inc. ,Blood -- Medical examination ,Scientific equipment and supplies industry ,Preeclampsia ,Business ,News, opinion and commentary - Abstract
Thermo Fisher Scientific has indicated that the blood test to gauge a mother's risk of severe preeclampsia that the company already sells in Europe could be available in the U.S. [...]
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- 2023
16. The Foundation for the NIH Introduces Public-Private Partnership for Early Detection of Preeclampsia
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United States. Food and Drug Administration ,United States. National Institutes of Health ,Mothers -- Patient outcomes ,Public-private sector cooperation ,Preeclampsia ,Pregnant women ,Patient advocacy ,Business ,Business, international ,Telecommunications industry - Abstract
The Foundation for the National Institutes of Health (FNIH) has reported the launch of a new public-private partnership to develop tools to identify pregnant women at high risk of early-onset [...]
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- 2024
17. March of Dimes Launches Low Dose, Big Benefits(TM) Campaign to Combat Preeclampsia and Preterm Birth.
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PREMATURE labor ,PREMATURE infants ,PREECLAMPSIA ,DIME ,INFANTS ,PREGNANT women ,MEDICAL personnel ,DRUG abuse prevention - Abstract
The March of Dimes has launched a campaign called Low Dose, Big Benefits, which aims to combat preeclampsia and preterm birth through the use of low dose aspirin. The campaign seeks to provide families and healthcare providers with educational information and resources to decrease the adverse effects of these conditions. Preeclampsia is a potentially fatal condition that affects pregnant women, and the campaign aims to promote equal access to critical information for all families. The use of low dose aspirin has been shown to reduce the risk of preeclampsia and preterm birth. The campaign will focus on educating healthcare professionals and pregnant individuals about the benefits of low dose aspirin and implementing a preeclampsia screening process. The campaign is supported by various partners and features US Olympian Allyson Felix as a brand ambassador. [Extracted from the article]
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- 2024
18. New preeclampsia blood test available
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Thermo Fisher Scientific Inc. ,Blood -- Medical examination ,Scientific equipment and supplies industry ,Preeclampsia ,Business ,Health care industry - Abstract
Earlier this year, Thermo Fisher Scientific launched the Thermo Scientific B*R*A*H*M*S sFlt-1/PIGF KRYPTOR Test System, the FDA-approved blood test for the risk assessment and clinical management of severe preeclampsia, a [...]
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- 2023
19. New Scientific Research Funding Available to Eliminate Pre-Term Deliveries from Preeclampsia
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Research grants ,Preeclampsia ,Company financing ,Business ,News, opinion and commentary - Abstract
MELBOURNE, Fla., July 5, 2023 /PRNewswire/ -- The Preeclampsia Foundation is seeking Letters of Intent for the Peter Joseph Pappas Research Grants funding program, designed to accelerate preeclampsia research. The [...]
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- 2023
20. "Catheter For Monitoring Intra-Abdominal Pressure For Assessing Preeclampsia" in Patent Application Approval Process (USPTO 20230414165).
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Inventor Timothy McKinney has filed a patent application for a device and method to monitor intra-abdominal pressure (IAP) through the urinary bladder. This device aims to address limitations of current devices used to measure IAP, such as intermittent readings and the need for constant retrograde insertion of fluid. The new device seeks to provide continuous and accurate pressure measurements without the need for adding water to the bladder. The patent application specifically focuses on the potential use of this device in assessing the occurrence or likelihood of pre-eclampsia, a serious disorder during pregnancy that can have adverse outcomes for both the mother and unborn baby. The invention involves a multi-lumen catheter that can be inserted into the bladder to determine intra-abdominal pressure using a gas-charged chamber and a pressure sensor. The readings can then be transmitted to an external monitor. This new diagnostic testing method aims to reduce adverse outcomes associated with pre-eclampsia. [Extracted from the article]
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- 2024
21. Patent Issued for Methods and systems for determining a pregnancy-related state of a subject (USPTO 11851706).
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Mirvie Inc. has been issued a patent for non-invasive and cost-effective methods to identify and monitor pregnancy-related complications. The methods involve analyzing cell-free biological samples, such as plasma, to detect biomarkers associated with different pregnancy-related states. Trained algorithms are used to analyze the biomarkers and determine the presence or susceptibility of specific complications. The patent also describes a method for administering treatment to pregnant individuals based on the analysis of proteins or polypeptides in cell-free samples. These methods aim to improve maternal and fetal health by providing rapid and accurate diagnostic screenings for pregnancy-related complications. [Extracted from the article]
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- 2024
22. Patent Issued for Methods and systems for determining a pregnancy-related state of a subject (USPTO 11845988).
- Abstract
Mirvie Inc. has been issued a patent for non-invasive and cost-effective methods to determine and monitor pregnancy-related complications. The methods involve analyzing cell-free biological samples, such as plasma, to detect biomarkers associated with different pregnancy-related states. Trained algorithms are used to analyze the biomarkers and determine the presence or susceptibility of the complications. The patent also describes a method for administering treatment to pregnant individuals based on the risk determined through analyzing RNA levels of pregnancy-associated genes. These methods aim to improve maternal and fetal health by providing rapid and accurate diagnostic screenings for pregnancy-related complications. [Extracted from the article]
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- 2024
23. Is lupus nephritis a prognosis factor for pregnancy? Maternal and foetal outcomes
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C. Gobbi, Cintia Otaduy, Paula Alba Moreyra, Alejandro San Martín Álvarez, E. Albiero, and Marcelo Yorio
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medicine.medical_specialty ,medicine.medical_treatment ,Lupus nephritis ,Preeclampsia ,Pre-Eclampsia ,Pregnancy ,Antiphospholipid syndrome ,medicine ,Humans ,Lupus Erythematosus, Systemic ,Caesarean section ,Retrospective Studies ,Cesarean Section ,Obstetrics ,business.industry ,Pregnancy Outcome ,Gestational age ,General Medicine ,medicine.disease ,Lupus Nephritis ,Pregnancy Complications ,Female ,Maternal death ,business ,Live birth - Abstract
Background Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. Objective To evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome. Methods We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. Results 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had Class IV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P = .041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P = .047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress. Conclusions Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.
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- 2022
24. Pregnancy Outcomes in Undifferentiated Connective Tissue Disease Compared to Systemic Lupus Erythematosus: A Single Academic Center's Experience
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Katherine P Kaufman, Nathaniel Harris, Laura Neil, Megan E.B. Clowse, and Amanda M Eudy
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medicine.medical_specialty ,Disease ,Preeclampsia ,Pre-Eclampsia ,Rheumatology ,Pregnancy ,immune system diseases ,Internal medicine ,medicine ,Humans ,Lupus Erythematosus, Systemic ,Prospective Studies ,Undifferentiated Connective Tissue Diseases ,skin and connective tissue diseases ,Pregnancy outcomes ,business.industry ,Infant, Newborn ,Pregnancy Outcome ,Autoantibody ,Undifferentiated connective tissue disease ,Hydroxychloroquine ,medicine.disease ,Connective tissue disease ,Pregnancy Complications ,Female ,business ,medicine.drug - Abstract
Systemic lupus erythematosus (SLE) patients have more pregnancy complications than healthy patients. Data regarding pregnancy outcomes in women with undifferentiated connective tissue disease (UCTD) are more limited, and existing studies are concentrated in Italy and predominantly in patients with a new diagnosis. Our objective was to compare pregnancy outcomes for UCTD and SLE patients with established disease.Between 2008 and 2017, patients with UCTD and SLE at an academic medical center were recruited to a prospective pregnancy registry. UCTD was defined as a positive autoantibody plus connective tissue disease symptoms not meeting criteria for another rheumatic diagnosis. SLE was defined by American College of Rheumatology or Systemic Lupus International Collaborating Clinics classification criteria or by physician diagnosis. Data were collected throughout pregnancy and postpartum. Comparator groups included UCTD, low-activity SLE, and high-activity SLE.A total of 150 SLE and 51 UCTD pregnancies were analyzed. Disease activity was low in most patients, although more patients with SLE had severe activity during pregnancy (12% versus 2%; P = 0.05). The frequencies of prematurity and preeclampsia were significantly lower in UCTD than in high-activity SLE patients (preterm 17% versus 45% [P = 0.004] and preeclampsia 6% versus 34% [P = 0.0008]), although similar to low-activity SLE patients. More infants who were small for gestational age were born to SLE than UCTD patients (33% versus 7% [P = 0.0005]), regardless of disease activity level.Pregnancies in women with UCTD managed by a rheumatologist have a high rate of pregnancy success and fewer risks than those in women with active SLE.
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- 2022
25. Thermo Fisher Scientific Announces FDA Clearance of Breakthrough Immunoassays to Aid in the Risk Assessment of Preeclampsia
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United States. Food and Drug Administration ,Thermo Fisher Scientific Inc. ,Scientific equipment and supplies industry ,Preeclampsia ,Risk assessment ,Business ,Business, international - Abstract
First and only blood-based biomarkers for the risk assessment and clinical management of preeclampsia with severe features WALTHAM, Mass. -- Thermo Fisher Scientific Inc. (NYSE: TMO), the world leader in [...]
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- 2023
26. HUBUNGAN PREEKLAMSIA DENGAN KEJADIAN BERAT BADAN LAHIR RENDAH
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Tria Nopi Herdiani, Ratna Susanti, Mika Oktarina, and Ida Rahmawati
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Contingency table ,medicine.medical_specialty ,education.field_of_study ,Eclampsia ,newborns ,business.industry ,Cross-sectional study ,Obstetrics ,Incidence (epidemiology) ,Birth weight ,Population ,medicine.disease ,Preeclampsia ,preeclampsia ,Low birth weight ,Medicine ,low birth weight ,Public Health ,medicine.symptom ,business ,education ,reproductive and urinary physiology - Abstract
Preeclampsia and eclampsia is a complication in the labor process whose incidence is always high. The purpose of this study was to study the relationship between Birth Weight and the incidence of preeclampsia in RSUD dr. M. Yunus, Bengkulu city in 2017. The type of research used in this study is Survey Analytic using the Cross Sectional method. The population in this study was overall in the hospital of Dr. M. Yunus City of Bengkulu in January to December in 2017 which is 362 babies. The sampling technique in this study was 78 proportional sampling. The data used is secondary data obtained from the patient register at Dr. M Yunus Hospital in Bengkulu. Data were analyzed using univariate and bivariate analysis with Chi-Square test (2) and Contingency Coefficient (C) test. The results obtained: Of the 78 newborns sampled there were 60 infants (76.9%) normal birth weight, 55 people (70.5%) did not experience preeclampsia, there was a significant relationship between preeclampsia and low infant weight in RSUD dr. M. Yunus Bengkulu in the tight category. It is expected that health workers can maintain and improve the quality of their abilities and skills to deal with babies with low birth weight born by preeclampsia patients or other patients.
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- 2023
27. High-altitude residence alters blood-pressure course and increases hypertensive disorders of pregnancy
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Anna G. Euser, Kirk A. Bol, Beth Bailey, Colleen G. Julian, and Lorna G. Moore
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Gestational hypertension ,medicine.medical_specialty ,Intrauterine growth restriction ,Blood Pressure ,macromolecular substances ,030204 cardiovascular system & hematology ,Article ,Preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Medicine ,Humans ,reproductive and urinary physiology ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Eclampsia ,business.industry ,Obstetrics ,Altitude ,Infant, Newborn ,Obstetrics and Gynecology ,Infant ,Hypertension, Pregnancy-Induced ,Effects of high altitude on humans ,Hypoxia (medical) ,medicine.disease ,female genital diseases and pregnancy complications ,Blood pressure ,embryonic structures ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,business - Abstract
OBJECTIVES: To determine whether the full spectrum of hypertensive disorders of pregnancy (HDP) -- comprising gestational hypertension; preeclampsia with or without severe features; eclampsia; and Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) Syndrome -- is increased at high (≥2500 m, 8250 ft) compared with lower altitudes in Colorado independent of maternal background characteristics, and if so their relationship to neonatal well-being. METHODS: A retrospective cohort study was conducted using statewide birth-certificate data to compare the frequency of gestational hypertension, preeclampsia (with or without severe features), eclampsia, HELLP Syndrome, or all HDP combined in 617,958 Colorado women who lived at high vs. low altitude (2500 m)- vs. low (
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- 2023
28. Prevalencia de sobrepeso y obesidad preconcepcional en mujeres gestantes, y relación con los resultados maternos y perinatales
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Leila Luján-Barroso, Gloria Seguranyes, Jordi Bellart, Maria Ángels Martínez-Verdú, Ángela Arranz, and Elena González-Plaza
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,Pre pregnancy ,Obstetrics ,medicine.medical_treatment ,General Medicine ,Overweight ,medicine.disease ,Obesity ,Preeclampsia ,Gestational diabetes ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Gestation ,Caesarean section ,030212 general & internal medicine ,medicine.symptom ,business ,Body mass index ,General Nursing - Abstract
Objective To identify the prevalence of pre-pregnancy overweight/obesity in pregnant women and its relationship with socio-demographic factors and to describe the maternal and perinatal outcomes in a Barcelona hospital (Spain). Method A descriptive cross-association study, with retrospective data collection, was performed Barcelona Hospital. The data of 5447 pregnant women who delivered at >=23 weeks of gestation were included. Body Mass Index (BMI) data were categorised into World Health Organization classifications. p values Results The prevalence of pre-pregnancy obesity was 8.4% and 18.9% for overweight. Gestational diabetes was more frequent in pre-pregnancy overweight/obesity (OR 1.92: 95% CI 1.54–2.40 and OR 3.34: 95% CI 2.57–4.33), as were preeclampsia (OR 2.08: 95% CI 1.55–2.79 and OR 3.35: 95% CI 2.38–4.71), induction of labour (OR 1.19: 95% CI 1.02–1.38 and OR 1.94: 95% CI 1.57–2.10), caesarean section (OR 1.41: 95% CI 1.21–1.65 and OR 2.68: 95% CI 2.18–3.29), prematurity (OR 1.28: 95% CI 1–1.65 and OR 1.79: 95% CI 1.32–2.44) and macrosomia (OR 1.87: 95% CI 1.43–2.46 and OR 2.03: 95% CI 1.40–2.93). Conclusions One in four pregnant women had pre-pregnancy overweight or obesity. This study shows the relationship between pre-pregnancy overweight or obesity with adverse maternal and perinatal outcomes.
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- 2022
29. Cardiac output and peripheral vascular resistance during normotensive and hypertensive pregnancy - a systematic review and meta-analysis
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Smj van Kuijk, Mea Spaanderman, S. de Haas, Chahinda Ghossein-Doha, Zenab Mohseni, Eva G. Mulder, F Alsadah, Niklas Schartmann, J. van Drongelen, and F Abo Hasson
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Gestational hypertension ,medicine.medical_specialty ,Cardiac output ,MATERNAL HEMODYNAMICS ,SYMPATHETIC ACTIVATION ,BLOOD ,Pregnancy Trimester, Third ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,PHYSIOLOGICAL ADAPTATION ,Hemodynamics ,Blood Pressure ,PRESSURE ,eclampsia ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Internal medicine ,Heart rate ,medicine ,gestational hypertension ,Humans ,Cardiac Output ,CARDIOVASCULAR HEMODYNAMICS ,Pregnancy ,030219 obstetrics & reproductive medicine ,business.industry ,pre‐ ,Obstetrics and Gynecology ,Hypertension, Pregnancy-Induced ,Stroke volume ,medicine.disease ,Cardiovascular disease ,PREECLAMPSIA ,medicine.anatomical_structure ,BIAS ,VOLUME ,Vascular resistance ,Cardiology ,Gestation ,Female ,Vascular Resistance ,pregnancy ,business ,RESPONSES - Abstract
Contains fulltext : 249888.pdf (Publisher’s version ) (Open Access) BACKGROUND: In-depth insight into haemodynamic changes during normotensive pregnancy may help identify women at risk for gestational hypertensive complications. OBJECTIVES: To determine the magnitude of changes in cardiac output and its determinants stroke volume and heart rate, and total peripheral vascular resistance during singleton normotensive and hypertensive pregnancies. SEARCH STRATEGY: PubMed (NCBI) and Embase (Ovid) databases were searched from their inception up to November 2019. SELECTION CRITERIA: Studies reporting original measurements of haemodynamic parameters during pregnancy together with a non-pregnant reference measurement. Studies including women using antihypertensive medication were excluded. DATA COLLECTION AND ANALYSIS: Pooled mean differences between pregnant and non-pregnant women, and absolute values of haemodynamic parameters were calculated for predefined gestational intervals using a random-effects model in normotensive and hypertensive pregnancy. Meta-regression analysis was used to analyse group differences in adjustments and absolute values during pregnancy. MAIN RESULTS: In normotensive pregnancies, cardiac output increased from the first weeks on, reaching its highest level early in the third trimester (mean difference, 1.41 l·min(1) ; 95% CI 1.18-1.63 l·min). In parallel, vascular resistance decreased progressively until its nadir in the early third trimester (mean difference, -331 dyn·sec(-1) ·cm(-5) ; 95% CI -384 to -277 dyn·sec(-1) ·cm(-5) ) and then increased slightly at term. In hypertensive pregnancies, the initial cardiac output increase was higher and vascular resistance did not change throughout gestation compared with reference values. CONCLUSIONS: Hemodynamic changes in women who eventually develop hypertensive complications are substantially different. Serial monitoring and plotting against developed normograms can identify women at risk and may allow timely intervention. TWEETABLE ABSTRACT: Monitoring haemodynamic changes in pregnancy helps identify women at risk for hypertensive complications.
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- 2022
30. Stroke in Pregnancy
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Erica C.S. Camargo and Aneesh B. Singhal
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medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,Eclampsia ,business.industry ,Encephalopathy ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Reversible cerebral vasoconstriction syndrome ,Preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Paradoxical embolism ,Internal medicine ,medicine ,Cardiology ,cardiovascular diseases ,030212 general & internal medicine ,Cerebral venous sinus thrombosis ,business ,Stroke - Abstract
Pregnancy confers a substantially increased risk of stroke, especially during the third trimester and until 6 weeks postpartum. Hypertensive disorders of pregnancy and gestational hypercoagulability are important contributors to obstetric stroke. Preeclampsia and eclampsia confer risk for future cardiovascular disease. Hemorrhagic stroke is the most common type of obstetric stroke. Ischemic stroke can result from cardiomyopathy, paradoxical embolism, posterior reversible encephalopathy, reversible cerebral vasoconstriction syndrome, and dissections. Cerebral venous sinus thrombosis is a frequent complication of pregnancy.
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- 2023
31. Research Funding Available for Preeclampsia and Related Pregnancy Disorders
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Research grants ,Medical research ,Medicine, Experimental ,Pregnancy ,Preeclampsia ,Pregnant women ,Hypertension ,Business ,News, opinion and commentary - Abstract
Preeclampsia Foundation Canada makes announcement at 2023 SMFM Pregnancy Meeting SAN FRANCISCO, Feb. 8, 2023 /PRNewswire/ -- Preeclampsia Foundation Canada announced today at the Society for Maternal-Fetal Medicine's (SMFM) 43[sup.rd] [...]
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- 2023
32. Predictive value of maternal serum podocalyxin in the diagnosis of preeclampsia: a prospective case-control study
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Bahar Sarııbrahım Astepe, Fulya Uzun, Ebru Kale, and Navdar Doğuş Uzun
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medicine.medical_specialty ,biology ,business.industry ,Obstetrics ,Case-control study ,Obstetrics and Gynecology ,medicine.disease ,Predictive value ,female genital diseases and pregnancy complications ,Preeclampsia ,chemistry.chemical_compound ,Obstetrics and gynaecology ,Podocalyxin ,chemistry ,Sialoglycoprotein ,biology.protein ,Gestation ,Medicine ,business ,reproductive and urinary physiology ,Biomedical sciences - Abstract
Objective s : There is a need for markers to facilitate the diagnosis of preeclampsia, one of the most chief causes of maternal and infant mortality. Preeclampsia causes damage to the glomeruli and vascular endothelium in pregnant women. Podocalyxin is a sialoglycoprotein found in both glomeruli and vascular endothelium. In this study, we investigated the levels of podocalyxin in preeclampsia, and studied its potential to predict preeclampsia. Material and methods: Women admitted to the Health Sciences University Derince Training and Research Hospital, Department of Obstetrics and Gynecology between February–November 2018 due to high direct blood and diagnosed with preeclampsia according to the 2013 American College of Obstetricians and Gynecologists criteria were included in the study. The control group consisted of healthy volunteers having similar demographic features (gestational week, gravida, parity, and age) with the preeclampsia group. The main outcome variable was serum podocalyxin levels. Results: The mean (± SD) podocalyxin levels of the study and control groups were 124.15 ± 39.63 ng/mL and 71.47 ± 16.86 ng/mL, respectively (t = 7.845, p < 0.001). Using a cut-off of 91.7123, podocalyxin could predict preeclampsia with 90% sensitivity and 98% specificity. Furthermore, podocalyxin levels were significantly higher than the normotensive participants in both early (143.81 ± 51.96 ng/mL vs. 75.35 ± 19.36 ng/mL) and late-onset (110.22 ± 19.11 ng/mL vs 68.26 ± 14.13 ng/mL) preeclampsia (p < 0.001). Conclusions: Serum podocalyxin levels increase in preeclampsia. We conclude that podocalyxin is a candidate for predicting preeclampsia.
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- 2022
33. Demographic and Clinical Predictors of Postpartum Blood Pressure Screening Attendance
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Alexa Campbell, Naima T Joseph, Kaitlyn K Stanhope, Sheree L. Boulet, Marissa Platner, and Denise J Jamieson
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Gestational hypertension ,medicine.medical_specialty ,Pregnancy ,Obstetrics ,business.industry ,Postpartum Period ,Attendance ,Blood Pressure ,Maternal morbidity ,Hypertension, Pregnancy-Induced ,General Medicine ,medicine.disease ,Postpartum Hypertension ,Preeclampsia ,Cohort Studies ,Blood pressure ,Pre-Eclampsia ,medicine ,Humans ,Female ,business ,Demography - Abstract
Background: Hypertensive disorders of pregnancy (HDP) cause substantial preventable maternal morbidity and mortality. Postpartum hypertension that worsens after women are discharged is particularly...
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- 2022
34. Reduced urinary angiotensinogen excretion in preeclampsia
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Thomas J. Kuehl, Syeda H. Afroze, Roksana Akter, A.H.M. Zuberi Ashraf, Ahmed F. Pantho, Mohammad N. Uddin, and Natalie S. Colόn
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Adult ,medicine.medical_specialty ,Urinary system ,Rat model ,Angiotensinogen ,Enzyme-Linked Immunosorbent Assay ,Preeclampsia ,Excretion ,chemistry.chemical_compound ,Urinary excretion ,Pre-Eclampsia ,Pregnancy ,Internal medicine ,Internal Medicine ,Animals ,Humans ,Medicine ,reproductive and urinary physiology ,Creatinine ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Angiotensin II ,female genital diseases and pregnancy complications ,Rats ,Endocrinology ,ROC Curve ,chemistry ,Case-Control Studies ,embryonic structures ,Female ,Plasma angiotensin ii ,business ,Biomarkers - Abstract
OBJECTIVE This study evaluated urinary angiotensinogen in preeclampsia. METHODS Normal pregnant (n = 57) and preeclamptic patients (n = 31); Normal pregnant (n = 10) and preeclamptic rats (n = 10) were studied. Urinary angiotensinogen and plasma angiotensin II were assayed by enzyme-linked immunosorbent assay (ELISA). RESULTS Urinary angiotensinogen in preeclampsia patients (2.0 ± 1.1 ng/mg creatinine) was suppressed (*p
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- 2022
35. Shedding Light on the Pathophysiology of Preeclampsia-Syndrome in the Era of Cardio-Obstetrics: Role of Inflammation and Endothelial Dysfunction
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Daniel Bia, Claudio Sosa, Yanina Zócalo, María M Pereira, and Juan Torrado
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medicine.medical_specialty ,Inflammation ,030204 cardiovascular system & hematology ,Systemic inflammation ,Preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Early prediction ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Endothelial dysfunction ,Intensive care medicine ,business.industry ,Infant, Newborn ,medicine.disease ,Pathophysiology ,Obstetrics ,Female ,medicine.symptom ,Complication ,business - Abstract
Background: Preeclampsia (PE) is a pregnancy complication with serious maternal and neonatal consequences worldwide. Our understanding of PE pathophysiology has significantly evolved over the last decades by recognizing that endothelial dysfunction and systemic inflammation, with an associated angiogenic imbalance, are key pieces of this incomplete puzzle. In the present era, where no single treatment to cure or treat this obstetric condition has been developed so far, PE prevention and early prediction are the most useful clinical approach to reduce the PE burden. Introduction: Although most PE episodes occur in healthy nulliparous women, the identification of specific clinical conditions that increase the risk of PE dramatically provides a critical opportunity to improve outcomes by acting on potentially reversible factors, and also contributes to better understand this pathophysiologic enigma. Methods: Pertinent studies were searched in PubMed/Medline and Google Scholar (updated August 2020) using common keywords applied in the field of preeclampsia, inflammation and endothelial dysfunction. Given the design of this work as a narrative review, no formal criteria for study selection or appraisal were utilized. Conclusion: In this review, we highlight major clinical contributors of PE and shed light on their potential link with endothelial dysfunction and inflammation.
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- 2022
36. Safe in the womb? Effects of air pollution to the unborn child and neonates
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Dunia Waked, Paulo Hilário Nascimento Saldiva, and Mariana Matera Veras
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medicine.medical_specialty ,Air pollution ,Intrauterine growth restriction ,Preeclampsia ,Pregnancy ,Air Pollution ,Environmental health ,Epidemiology ,medicine ,Humans ,Air Pollutants ,Fetus ,business.industry ,Uterus ,Infant, Newborn ,Pregnancy Outcome ,Infant, Low Birth Weight ,Fetal development ,medicine.disease ,Gestational diabetes ,Low birth weight ,Pediatrics, Perinatology and Child Health ,Premature Birth ,Gestation ,Female ,medicine.symptom ,business - Abstract
Objective In this brief review, the authors focus on the effects of gestational exposures to urban air pollution on fetal development and neonatal outcomes. Source of data In this review the authors used PubMed, Web of Science and SciELO research platforms, analyzing papers from the last 30 years. Summary of the findings Epidemiological and experimental evidence agree that gestational exposure to air pollution in urban increases the risks for low birth weight, preterm birth, congenital malformation, intrauterine growth restriction, and neonatal mortality. Furthermore, exposures are associated with increased risks for preeclampsia, hypertension, gestational diabetes. Conclusions Therefore, it is time for greater involvement and engagement of the health sector in the discussion of public policies that may affect the quality of the environment, and that directly or indirectly impact the health of those who were not yet born.
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- 2022
37. Serum S100B protein concentrations in SGA/FGR newborns
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Barbara Strzalko, Agata Karowicz-Bilińska, Marcin Kesiak, Bozena Kociszewska-Najman, Krystyna Wyka, and Paweł Krajewski
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medicine.medical_specialty ,Pregnancy ,business.industry ,Obstetrics ,Central nervous system ,Obstetrics and Gynecology ,Umbilical artery ,Hypoxia (medical) ,medicine.disease ,female genital diseases and pregnancy complications ,Preeclampsia ,medicine.anatomical_structure ,medicine.artery ,Cord blood ,medicine ,Small for gestational age ,Biomarker (medicine) ,medicine.symptom ,business ,reproductive and urinary physiology - Abstract
Objectives: Fetal growth restriction is associated with chronic fetal hypoxia, poor perinatal outcome and increased perinatal mortality. There are no reliable methods to detect cell damage in the central nervous system (CNS) in these patients. The findings of increased an acidic calcium-binding protein (S100B) concentration in biological fluids of infants after brain injury have supported the use of S100B as a biochemical marker of CNS damage. The purpose of the study was to assess blood S100B concentrations in small for gestational age (SGA) and appropriate for gestational age (AGA) newborns and to evaluate the usefulness of S100B for early detection of hypoxia. Material and methods: The investigation was carried out between November 2011 and April 2014. Serum S100B protein level was assessed in cord blood collected from newborns after birth. Medical records of mothers of neonates studied were reviewed for pregnancy induced hypertension (PIH), preeclampsia, maternal smoking during pregnancy and abnormalities in umbilical artery (UA) Doppler ultrasound examination. Results: The study was carried out in 88 SGA neonates and 80 AGA neonates. The median value of S100B protein concentration in the SGA study group was significantly higher than in AGA controls (p < 0.001). Cord blood serum S100B concentration in SGA neonates with prenatal normal UA Doppler ultrasound findings (n = 32) did not differ from that SGA neonates with abnormal prenatal UA Doppler findings (n = 25) (p = 0.74), but was significantly higher than in AGA newborns (p < 0.001). Conclusions : Elevated S100B protein levels in cord blood collected from SGA newborns may be helpful in detecting infants at higher risk of postnatal neurologic disturbances at an early stage.
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- 2022
38. Peripartum echocardiographic changes in women with hypertensive disorders of pregnancy
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Veronica Giorgione, Conrado Milani Coutinho, C. Di Fabrizio, B. Thilaganathan, Jamie M. O’Driscoll, Asma Khalil, and Rajan Sharma
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medicine.medical_specialty ,Longitudinal study ,Hemodynamics ,Ventricular Function, Left ,Preeclampsia ,Muscle hypertrophy ,Pre-Eclampsia ,Pregnancy ,Internal medicine ,Peripartum Period ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Mass index ,Longitudinal Studies ,Prospective Studies ,Ejection fraction ,Ventricular Remodeling ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,Hypertension, Pregnancy-Induced ,General Medicine ,medicine.disease ,Reproductive Medicine ,Echocardiography ,Cardiology ,Female ,business ,Postpartum period - Abstract
Women with hypertensive disorders of pregnancy (HDP) present with evidence of significant myocardial dysfunction on echocardiographic assessment at the time of diagnosis. Birth not only cures the syndrome of HDP, but is also associated with a reduction in cardiovascular (CV) volume and resistance load in the mother due to the delivery of the fetoplacental unit. The impact of this physiological change on maternal myocardial function in women with HDP has not been systematically evaluated. The aim of this study is to compare echocardiographic findings immediately before and after childbirth in women with HDP. In this prospective longitudinal study, 30 women with a diagnosis of HDP underwent two consecutive transthoracic echocardiography (TTE) examinations: the first prepartum and the second in the early postpartum period. Paired comparisons of these assessments were performed. Left ventricular (LV) concentric remodelling or hypertrophy were found in 21 (70%) patients and there were no significant differences in cardiac morphology indices: LV mass index (78.9±16.3 g/m vs 77.9 ±15.4 g/m , p=0.611) and relative wall thickness (0.45±0.1 vs 0.44±0.1, p=0.453). LV diastolic function did not demonstrate any peripartum variation: left atrial volume (52.40±15.3 vs 50.97±15.6, p=0.433); lateral E' (0.12±0.03 vs 0.12±0.03, p=0.307) and E/E' ratio (7.88±2.19 vs 7.91±1.74, p=0.934). Systolic function indices such as LV ejection fraction (57.5±4.4% vs 56.4±2.1%, p=0.295) and global longitudinal strain (-15.3±2.6% vs -15.1±3.1%, p=0.715) also remained unchanged. Maternal hemodynamic changes associated with birth did not significantly influence peripartum TTE indices in women with HDP. Suboptimal maternal echocardiographic findings in HDP are likely to be the consequence of chronic pregnancy CV load changes or pre-existing maternal CV impairment. Severity and persistence of myocardial dysfunction into the postpartum period may be related to the long-term maternal CV disease legacy of HDP. This article is protected by copyright. All rights reserved. [Abstract copyright: This article is protected by copyright. All rights reserved.]
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- 2022
39. Should angiogenic markers be included in diagnostic criteria of superimposed pre‐eclampsia in women with chronic hypertension?
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Erkan Kalafat, Petra Pateisky, Julia Binder, Pilar Palmrich, and Asma Khalil
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Adult ,Placental growth factor ,medicine.medical_specialty ,Hypertension in Pregnancy ,Preeclampsia ,Pre-Eclampsia ,Pregnancy ,Risk Factors ,Prenatal Diagnosis ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Placenta Growth Factor ,Retrospective Studies ,Vascular Endothelial Growth Factor Receptor-1 ,Radiological and Ultrasound Technology ,Receiver operating characteristic ,business.industry ,Obstetrics ,Pregnancy Outcome ,Area under the curve ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,medicine.disease ,Reproductive Medicine ,Hypertension ,Female ,business ,Biomarkers ,Kidney disease - Abstract
Although the most recent guidance from the International Society for the Study of Hypertension in Pregnancy (ISSHP) has highlighted the role of angiogenic marker assessment in the diagnosis of pre-eclampsia (PE) in women with chronic hypertension, the ISSHP has withheld recommending its implementation due to the limited available evidence in this group of women. Therefore, we aimed to investigate the value of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) assessment in women with chronic hypertension and suspected superimposed PE.This was a retrospective analysis of prospectively collected data recorded in an electronic database between January 2013 and October 2019. Women with chronic hypertension and singleton pregnancy who had suspected superimposed PE were included. Superimposed PE was suspected in women presenting with worsening hypertension, epigastric pain, new-onset edema, dyspnea or neurological symptoms. The exclusion criteria were delivery within 1 week after assessment for reasons other than PE, chronic kidney disease, history of cardiac disease, fetal aneuploidy, genetic syndrome or major structural anomaly and missing pregnancy outcome. Maternal serum angiogenic markers (sFlt-1, PlGF and sFlt-1/PlGF ratio) were measured. The primary outcome was the utility of angiogenic markers in the prediction of superimposed PE. Predictive accuracy was assessed for superimposed PE diagnosed at different timepoints, including within 1 week after assessment and any time before birth. The secondary outcome was comparison of adverse maternal and perinatal outcomes between women with superimposed PE diagnosed according to the traditional ISSHP criteria and those diagnosed according to extended criteria including angiogenic markers. The predictive accuracy of each angiogenic marker was assessed using receiver-operating-characteristics-curve analysis. Area under the curve (AUC) values were compared using De Long's test. A sensitivity analysis was planned for gestational age at assessment. The association of various variables with composite adverse maternal and perinatal outcomes was assessed using binomial regression.The study included 142 pregnant women with chronic hypertension and suspected superimposed PE, of whom 25 (17.6%) developed PE within 1 week after assessment, 52 (36.6%) developed PE at any timepoint before birth and 90 (63.4%) delivered without PE. Maternal serum angiogenic imbalance was associated significantly with superimposed PE diagnosed according to the ISSHP criteria within 1 week or at any time after assessment (P 0.001 for both). The predictive accuracy of maternal serum sFlt-1/PlGF ratio for superimposed PE diagnosed within 1 week after assessment was superior to that of maternal serum PlGF level (AUC, 0.91 vs 0.86; P = 0.032). The addition of angiogenic imbalance to the traditional ISSHP diagnostic criteria was associated with an increase in the detection rate (35.1% increase; 95% credible interval (CrI), 16.6-53.6%) and positive (9.6% increase; 95% CrI, 0.0-20.6%) and negative (3.1% increase; 95% CrI, 1.3-4.9%) predictive values for composite adverse maternal outcome, with high posterior probabilities of an increase in each predictive accuracy parameter ( 99.9%, 95.6% and 99.9%, respectively), without a meaningful decrease in specificity. The addition of angiogenic imbalance improved the detection rate for composite adverse perinatal outcome (20.6% increase; 95% CrI, 0.0-42.2%), with a high posterior probability (96.9%). There was a corresponding drop in specificity (5.7% decrease; 95% CrI, -2.3% to 13.6%), with a posterior probability of 91.8%.In women with chronic hypertension and suspected superimposed PE, addition of maternal serum angiogenic markers to the traditional diagnostic criteria for superimposed PE improved significantly the sensitivity for the prediction of both maternal and perinatal adverse outcomes. Implementation of angiogenic marker assessment in the evaluation of pregnant women with chronic hypertension should therefore be considered. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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- 2022
40. Preeclampsia has two phenotypes which require different treatment strategies
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L. Foo, Giulia Masini, Ian B. Wilkinson, Christoph Lees, Herbert Valensise, Wilfried Gyselaers, and J. Tay
- Subjects
hypertensive disease of pregnancy ,BASAL METABOLIC-RATE ,Hemodynamics ,BLOOD-PRESSURE ,Blood Pressure ,hemodynamics ,Bioinformatics ,fetal growth restriction ,0302 clinical medicine ,Pre-Eclampsia ,Heart Rate ,Pregnancy ,GROWTH RESTRICTION ,030212 general & internal medicine ,Cardiac Output ,reproductive and urinary physiology ,Subclinical infection ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,Obstetrics & Gynecology ,Obstetrics and Gynecology ,arterial function ,Phenotype ,medicine.anatomical_structure ,embryonic structures ,Hypertensive disease of pregnancy ,Female ,ARTERIAL STIFFNESS ,Life Sciences & Biomedicine ,Pulse Wave Analysis ,Preeclampsia ,preeclampsia ,03 medical and health sciences ,MATERNAL CARDIAC-FUNCTION ,medicine ,Humans ,Obstetrics & Reproductive Medicine ,cardiovascular function ,Antihypertensive Agents ,Science & Technology ,vascular resistance ,VASCULAR-RESISTANCE ,business.industry ,WORKING GROUP ,Trophoblast ,medicine.disease ,BIRTH-WEIGHT ,GESTATIONAL HYPERTENSION ,Blood pressure ,Vascular resistance ,1114 Paediatrics and Reproductive Medicine ,Endothelium, Vascular ,business - Abstract
The opinion on the mechanisms underlying the pathogenesis of preeclampsia still divides scientists and clinicians. This common complication of pregnancy has long been viewed as a disorder linked primarily to placental dysfunction, which is caused by abnormal trophoblast invasion, however, evidence from the previous two decades has triggered and supported a major shift in viewing preeclampsia as a condition that is caused by inherent maternal cardiovascular dysfunction, perhaps entirely independent of the placenta. In fact, abnormalities in the arterial and cardiac functions are evident from the early subclinical stages of preeclampsia and even before conception. Moving away from simply observing the peripheral blood pressure changes, studies on the central hemodynamics reveal two different mechanisms of cardiovascular dysfunction thought to be reflective of the early-onset and late-onset phenotypes of preeclampsia. More recent evidence identified that the underlying cardiovascular dysfunction in these phenotypes can be categorized according to the presence of coexisting fetal growth restriction instead of according to the gestational period at onset, the former being far more common at early gestational ages. The purpose of this review is to summarize the hemodynamic research observations for the two phenotypes of preeclampsia. We delineate the physiological hemodynamic changes that occur in normal pregnancy and those that are observed with the pathologic processes associated with preeclampsia. From this, we propose how the two phenotypes of preeclampsia could be managed to mitigate or redress the hemodynamic dysfunction, and we consider the implications for future research based on the current evidence. Maternal hemodynamic modifications throughout pregnancy can be recorded with simple-to-use, noninvasive devices in obstetrical settings, which require only basic training. This review includes a brief overview of the methodologies and techniques used to study hemodynamics and arterial function, specifically the noninvasive techniques that have been utilized in preeclampsia research.
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- 2022
41. The diagnostic value of angiogenic and antiangiogenic factors in differential diagnosis of preeclampsia
- Author
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Lisa-Antonia Dröge and Stefan Verlohren
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medicine.medical_specialty ,Hypertension in Pregnancy ,Pregnancy Complications, Cardiovascular ,Disease ,Preeclampsia ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Adverse effect ,reproductive and urinary physiology ,Placenta Growth Factor ,Vascular Endothelial Growth Factor Receptor-1 ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,female genital diseases and pregnancy complications ,Confidence interval ,Hypertension ,Female ,Differential diagnosis ,business ,Biomarkers ,Kidney disease - Abstract
The definition of preeclampsia is changing. However, with the addition of organ symptoms to the presence of hypertension in pregnancy instead of relying only on proteinuria, a more precise detection of women at risk of preeclampsia-associated adverse events has not been achieved. Instead, under the new definitions of the American College of Obstetricians and Gynecologists and of the International Society for the Study of Hypertension in Pregnancy, more women are classified as preeclamptic, with a tendency to milder disease. Furthermore, angiogenic and antiangiogenic factors have emerged as essential tools for predicting and diagnosing preeclampsia at high accuracies. Next to being rooted in the pathophysiology of the disease, they have been proven to be reliable tools for predicting and diagnosing the disease. In addition, 2 cutoffs have been evaluated for the clinical setting. As shown in the Prediction of Short-Term Outcome in Pregnant Women With Suspected Preeclampsia Study, at the soluble fms-like tyrosine kinase-1-to-placental growth factor ratio cutoff of 38, a preeclampsia can be ruled out for 1 week with a negative predictive value of 99.3% (95% confidence interval, 97.9-99.9) and ruled in with a positive predictive value of 36.7% (95% confidence interval, 28.4-45.7). The diagnostic cutoff of 85 has been shown to accurately identify women with preeclampsia, with a sensitivity of up to 88% and a specificity of 99.5%. In this review, we highlight the central role of angiogenic and antiangiogenic factors in the differential diagnosis of women presenting at high risk of the disease, such as patients with chronic hypertension or chronic kidney disease. We will focus on their ability to predict preeclampsia-associated adverse fetal and maternal outcomes. This is only possible when critically reviewing the evolution of the definition of "preeclampsia." We show how changes in this definition shape our clinical picture of the condition and how angiogenic and antiangiogenic biomarkers might be included to better identify women destined to develop preeclampsia-related adverse outcomes.
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- 2022
42. Soluble CD146 is increased in preeclampsia and interacts with galectin-1 to regulate trophoblast migration through VEGFR2 receptor
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Ahmad Joshkon, Alexandrine Foucault-Bertaud, Wael Traboulsi, Christophe Demattei, Françoise Dignat-George, Nadia Alfaidy, Richard Bachelier, Odile Paulmyer-Lacroix, Jean-Christophe Gris, Aurélie S. Leroyer, Marcel Blot-Chabaud, Sylvie Bouvier Pharm, V. Letouzey, Nathalie Bardin, Mathieu Fortier, Sandra M. Blois, Marie Nollet, Eve Mousty, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Vascular research center of Marseille (VRCM), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie [CHU Nîmes] (BESPIM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Mécanisme de l’Angiogenèseet des BarrièresBiologiques (MAB2), BioSanté (UMR BioSanté), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA), Sechenov First Moscow State Medical University, Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM), Université de Montpellier (UM), Institut de Recherches en Technologies et Sciences pour le Vivant (IRTSV), and GRIS, Jean-Christophe
- Subjects
[SDV.MHEP.HEM] Life Sciences [q-bio]/Human health and pathology/Hematology ,Galectin 1 ,MESH: Pre-Eclampsia ,MESH: Trophoblasts ,CD146 Antigen ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Preeclampsia ,Andrology ,MESH: Pregnancy ,Pre-Eclampsia ,Trophoblast migration ,Pregnancy ,Galectin-1 ,Blocking antibody ,Soluble CD146 could be proposed as a biomarker in preeclampsia and a potential therapeutic target ,medicine ,Humans ,Prospective Studies ,Receptor ,reproductive and urinary physiology ,MESH: Galectin 1 ,MESH: Humans ,Eclampsia ,business.industry ,Trophoblast ,[SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology ,medicine.disease ,Trophoblasts ,MESH: Prospective Stufies ,carbohydrates (lipids) ,[SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,medicine.anatomical_structure ,CD146/sCD146 ,Female ,Signal transduction ,MESH: CD146 Antigen ,business ,MESH: Female - Abstract
International audience; Objective: To explore the regulatory role of soluble CD146 (sCD146) and its interaction with galectin-1 (Gal1) in placenta-mediated complications of pregnancy.Design: Prospective pilot and experimental studies.Setting: University-affiliated hospital and academic research laboratory.Patient(s): One hundred fifteen women divided into three groups: 30 healthy, nonpregnant women, 50 women with normal pregnancies, and 35 with placenta-mediated pregnancy complications.Intervention(s): Wound-healing experiments were conducted to study trophoblast migration.Main outcome measure(s): Quantification of sCD146 and Gal1 by enzyme-linked immunosorbent assay. Analysis of trophoblast migration by wound closure.Result(s): Concomitant detection of sCD146 and Gal1 showed lower sCD146 and higher Gal1 concentrations in women with normal pregnancies compared with nonpregnant women. In addition, follow-up of these women revealed a decrease in sCD146 associated with an increase in Gal1 throughout pregnancy. In contrast, in women with preeclampsia, we found significantly higher sCD146 concentrations compared with women with normal pregnancies and no modification of Gal1. We emphasize the opposing effects of sCD146 and Gal, since, unlike Gal1, sCD146 inhibits trophoblast migration. Moreover, the migratory effect of Gal1 was abrogated with the use of an anti-CD146 blocking antibody or the use of small interfering RNA to silence VEGFR2 expression. This suggests that trophoblast migration is mediated though the interaction of Gal1 with CD146, further activating the VEGFR2 signaling pathway. Significantly, sCD146 blocked the migratory effects of Gal1 on trophoblasts and inhibited its secretion, suggesting that sCD146 acts as a ligand trap.Conclusion(s): Soluble CD146 could be proposed as a biomarker in preeclampsia and a potential therapeutic target. Clinical trial registration number: NCT 01736826.Trial registration: ClinicalTrials.gov NCT01736826.
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- 2022
43. Imbalances in circulating angiogenic factors in the pathophysiology of preeclampsia and related disorders
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Sarosh Rana, S. Ananth Karumanchi, and Suzanne D. Burke
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Vascular Endothelial Growth Factor A ,Placenta Diseases ,Hydrops Fetalis ,Intrauterine growth restriction ,Twin-to-twin transfusion syndrome ,Bioinformatics ,Preeclampsia ,chemistry.chemical_compound ,Pre-Eclampsia ,Pregnancy ,Placenta ,medicine ,Humans ,Fetal Death ,reproductive and urinary physiology ,Bronchopulmonary Dysplasia ,Placenta Growth Factor ,Fibrin ,Vascular Endothelial Growth Factor Receptor-1 ,Proteinuria ,business.industry ,Obstetrics and Gynecology ,Placentation ,Fetofetal Transfusion ,Puerperal Disorders ,Prognosis ,medicine.disease ,Up-Regulation ,Vascular endothelial growth factor ,medicine.anatomical_structure ,chemistry ,Cardiovascular Diseases ,embryonic structures ,Female ,medicine.symptom ,business ,Biomarkers - Abstract
Preeclampsia is a devastating medical complication of pregnancy that can lead to significant maternal and fetal morbidity and mortality. It is currently believed that there is abnormal placentation in as early as the first trimester in women destined to develop preeclampsia. Although the etiology of the abnormal placentation is being debated, numerous epidemiologic and experimental studies suggest that imbalances in circulating angiogenic factors released from the placenta are responsible for the maternal signs and symptoms of preeclampsia. In particular, circulating levels of soluble fms-like tyrosine kinase 1, an antiangiogenic factor, are markedly increased in women with preeclampsia, whereas free levels of its ligand, placental, growth factor are markedly diminished. Alterations in these angiogenic factors precede the onset of clinical signs of preeclampsia and correlate with disease severity. Recently, the availability of automated assays for the measurement of angiogenic biomarkers in the plasma, serum, and urine has helped investigators worldwide to demonstrate a key role for these factors in the clinical diagnosis and prediction of preeclampsia. Numerous studies have reported that circulating angiogenic biomarkers have a very high negative predictive value to rule out clinical disease among women with suspected preeclampsia. These blood-based biomarkers have provided a valuable tool to clinicians to accelerate the time to clinical diagnosis and minimize maternal adverse outcomes in women with preeclampsia. Angiogenic biomarkers have also been useful to elucidate the pathogenesis of related disorders of abnormal placentation such as intrauterine growth restriction, intrauterine fetal death, twin-to-twin transfusion syndrome, and fetal hydrops. In summary, the discovery and characterization of angiogenic proteins of placental origin have provided clinicians a noninvasive blood-based tool to monitor placental function and health and for early detection of disorders of placentation. Uncovering the mechanisms of altered angiogenic factors in preeclampsia and related disorders of placentation may provide insights into novel preventive and therapeutic options.
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- 2022
44. Prospective Evaluation of International Prediction of Pregnancy Complications Collaborative Network Models for Prediction of Preeclampsia: Role of Serum sFlt-1 at 11–13 Weeks’ Gestation
- Author
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Wen Shan Sim, Shuk Yi Annie Hui, Mahesh Choolani, Runmei Ma, Noppadol Chaiyasit, Daljit Singh Sahota, Tuangsit Wataganara, Piya Chaemsaithong, Liona C. Poon, and Y. M. Wah
- Subjects
Adult ,Placental growth factor ,medicine.medical_specialty ,Mean arterial pressure ,Blood Pressure ,Preeclampsia ,Pre-Eclampsia ,Pregnancy ,medicine.artery ,Internal Medicine ,medicine ,Humans ,Prospective Studies ,Uterine artery ,reproductive and urinary physiology ,Placenta Growth Factor ,Vascular Endothelial Growth Factor Receptor-1 ,Obstetrics ,business.industry ,Gestational age ,medicine.disease ,female genital diseases and pregnancy complications ,Pregnancy Trimester, First ,Blood pressure ,embryonic structures ,Gestation ,Female ,business ,Biomarkers - Abstract
The study aimed to investigate whether serum sFlt-1 (soluble fms-like tyrosine kinase-1) at 11-13 weeks’ gestation in pregnancies that subsequently developed preeclampsia was different from those without preeclampsia and compare screening performance of the International Prediction of Pregnancy Complications (IPPIC) reported models, which include various combinations of maternal factors, systolic blood pressure, diastolic blood pressure, PlGF (placental growth factor) and sFlt-1 and the competing risk (CR) models, which include various combinations of maternal factors, mean arterial pressure (MAP) and PlGF for predicting any-onset, early-onset, and late-onset preeclampsia. This was a prospective multicenter study in 7877 singleton pregnancies. The differences of the predictive performance between the IPPIC and CR models were compared. There were 141 women (1.79%) who developed preeclampsia, including 13 cases (0.17%) of early-onset preeclampsia and 128 cases (1.62%) of late-onset preeclampsia. In pregnancies that developed preeclampsia compared to unaffected pregnancies, median serum sFlt-1 levels and its MoMs were not significantly different ( p >0.05). There was no significant association between gestational age at delivery and log 10 sFlt-1 and log 10 sFlt-1 MoM ( p >0.05). The areas under the curve of CR models were significantly higher than the IPPIC models for the prediction of any-onset and late-onset preeclampsia but not for early-onset preeclampsia. In conclusion, there are no significant differences in the maternal serum sFlt-1 levels at 11-13 weeks’ gestation between women who subsequently develop preeclampsia and those who do not. Moreover, the CR models for the prediction of any-onset and late-onset preeclampsia perform better than the IPPIC reported model.
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- 2022
45. An update on COVID-19 and pregnancy
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Denise J. Jamieson and Sonja A. Rasmussen
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medicine.medical_specialty ,COVID-19 Vaccines ,Coronavirus Disease 2019 (COVID-19) ,perinatal infection ,Disease ,Severity of Illness Index ,Preeclampsia ,law.invention ,Pre-Eclampsia ,Pregnancy ,Risk Factors ,newborn ,law ,medicine ,Humans ,pneumonia ,Healthcare Disparities ,Pregnancy Complications, Infectious ,Risk factor ,Adverse effect ,Fetus ,SARS-CoV-2 ,Obstetrics ,business.industry ,COVID-19 ,preterm birth ,Obstetrics and Gynecology ,Stillbirth ,medicine.disease ,Intensive care unit ,Infectious Disease Transmission, Vertical ,fetus ,maternal death ,Premature Birth ,Female ,vertical transmission ,Maternal death ,Disease Susceptibility ,fetal death ,Expert Review ,business - Abstract
Physiologic, mechanical and immunologic alterations in pregnancy could potentially affect susceptibility to and severity of COVID-19 during pregnancy. Due to lack of comparable incidence data and challenges with disentangling differences in susceptibility from different exposure risks, data are insufficient to determine whether pregnancy increases susceptibility to SARS-CoV-2 infection. Data support pregnancy as a risk factor for severe disease associated with COVID-19; some of the best evidence comes from the Centers for Disease Control and Prevention’s (CDC’s) COVID-19 surveillance system, which reported that pregnant persons were more likely to be admitted to an intensive care unit (ICU), require invasive ventilation, require extracorporeal membrane oxygenation, and die compared with nonpregnant women of reproductive age. Although intrauterine transmission of SARS-CoV-2 has been documented, it appears to be rare, possibly related to low levels of SARS-CoV-2 viremia and decreased co-expression of angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) needed for SARS-CoV-2 entry into cells in the placenta. Evidence is accumulating that SARS-CoV-2 infection during pregnancy is associated with a number of adverse pregnancy outcomes including preeclampsia, preterm birth, and stillbirth, especially among pregnant persons with severe COVID-19 disease. In addition to the direct impact of COVID-19 on pregnancy outcomes, there is evidence that the pandemic and its effects on healthcare systems have had adverse effects on pregnancy outcomes, such as increased stillbirths and maternal deaths. These trends may represent widening disparities and an alarming reversal of recent improvements in maternal and infant health. All three COVID-19 vaccines currently available under an Emergency Use Authorization by the United States Food and Drug Administration can be administered to pregnant or lactating persons, with no preference for vaccine type. Although safety data in pregnancy are rapidly accumulating and no safety signals in pregnancy have been detected, additional information about birth outcomes, particularly among persons vaccinated earlier in pregnancy, are needed.
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- 2022
46. Serum biomarkers for the prediction and diagnosis of preeclampsia: A meta-analysis
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Ruqaiya Shahid, Mehwish Hussain, and Muhammad Furqan Bari
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Placental growth factor ,Oncology ,medicine.medical_specialty ,Medicine (General) ,Preeclampsia ,chemistry.chemical_compound ,High-density lipoprotein ,R5-920 ,Pregnancy ,Internal medicine ,Diagnosis ,Medicine ,Risk factor ,reproductive and urinary physiology ,Adiponectin ,business.industry ,Leptin ,General Medicine ,Endoglin ,medicine.disease ,Meta-analysis ,chemistry ,embryonic structures ,business ,Pre-eclampsia ,Biomarkers - Abstract
الملخص: أهداف البحث: تسمم الحمل هو عامل خطر رئيس لوفيات ومراضة الأمهات والجنين. كانت هناك جهود هائلة لتحديد المؤشرات الحيوية في المصل، والتي يمكن أن تتنبأ بشكل موثوق بتسمم الحمل. تهدف الدراسة إلى تقييم المؤشرات الحيوية التي لها أفضل فائدة في تشخيص تسمم الحمل. طرق البحث: تم إجراء بحث منهجي في قاعدة بيانات ''بب ميد'' وتم استرداد المراجع المتسلسلة. تم تضمين المقالات البحثية الأصلية التي تضم ضوابط الحالة، والأتراب، وتجارب التحكم العشوائية، والدراسات المقطعية. تضمنت المتغيرات المسجلة تصميم الدراسة ونوعها وسنة ومكان الدراسة وقيمة المتوسط ± الانحراف المعياري للعلامات في المرضى والضوابط والوحدة وحجم عينة مجتمع الدراسة. تم تفسير النتائج بناء على قيم فرق المتوسط المعيارية. النتائج: تم استرجاع ما مجموعه ٣٨٩ دراسة من قاعدة بيانات ''بب ميد''. وأدى التحليل الإضافي ٨٩ دراسة لهذه المراجعة. تم تضمين ٤٧ دراسة إضافية من سلسلة المراجع. في وقت لاحق، تمت مراجعة ١٣٦ مقالة ذات نص كامل بالتفصيل وتم إدخال البيانات. أخيرا، تم اختيار ٢٥ دراسة لهذا التحليل التلوي، وقيمت ١٣ واصما حيويا في مصل الدم. كانت الواسمات المولدة للأوعية والتيروزين كيناز، وعامل النمو المشيمي، والإندوغلين مرتفعة بشكل ملحوظ في المرضى الذين يعانون من تسمم الحمل مقارنة بالضوابط العادية للحوامل. وكان عامل النمو المشيمي والعلامات الحيوية الدهنية عالية الكثافة والأديبونكتين منخفضة بشكل ملحوظ. في حين أن الدهون الثلاثية، وصميم البروتين ب، واللبتين كانت مرتفعة في مرضى مقدمات الارتعاج مقارنة بالضوابط العادية للحوامل. الاستنتاجات: في دراستنا، أظهرت قيم المؤشرات الحيوية في المصل؛ الواسمات المولدة للأوعية وعامل النمو المشيمي والدهون عالية الكثافة والأديبونكتين واللبتين والدهون الثلاثية وصميم البروتين ب، اختلافات كبيرة بين المرضى والضوابط. تتطلب هذه النتائج تقييما متقدما للواسمات الحيوية من أجل الفحص التشخيصي لمقدمات الارتعاج. Abstract: Objective: Preeclampsia is a major risk factor for maternal and foetal mortality and morbidity. There have been tremendous efforts to identify serum biomarkers which can reliably predict the occurrence of preeclampsia. The study aims to assess the biomarkers that have the greatest utility in the diagnosis of preeclampsia. Methods: A systematic search was performed on the PubMed literature database, and chain references were retrieved. Original research articles composed of case controls, cohorts, randomised control trials, and cross-sectional studies were included. The recorded variables included each study's design, type, year, and location; the value (mean ± standard deviation) of the markers in the patients and the pregnant controls; and the p-value, unit of measurement, and the sample size of each study. The results were interpreted based on the standardised mean difference (SMD) values. Results: A total of 398 studies were retrieved from the PubMed database. After further analysis, 89 studies were selected for this review. An additional 47 studies were included based on chain referencing. Later, 136 full-text articles were reviewed in detail and their data were entered. Finally, 25 studies, in which 13 serum biomarkers were assessed, were selected for this meta-analysis. The levels of the angiogenic markers fms-like tyrosine kinase (sFlt), sFlt/placental growth factor (PlGF), and endoglin were significantly higher in patients with preeclampsia than in the pregnant controls. The levels of PlGF and the lipid biomarkers high density lipoprotein (HDL) and adiponectin were significantly lower, while the levels of triglycerides, apolipoprotein B (APO-B), and leptin were elevated in the preeclamptic patients compared to the pregnant controls (p
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- 2022
47. Impacto económico asociado a eventos obstétricos en mujeres en edad fértil con artritis psoriásica, artritis reumatoide, espondiloartritis axial y psoriasis en España
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Julia Martínez-Barrio, Onica Armijo, Miguel Ángel Casado, Nuria Martinez, Olga Villar, Natalia Marin Huarte, María Mareque, and María del Carmen Pacheco Castellanos
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030203 arthritis & rheumatology ,Pregnancy ,medicine.medical_specialty ,Obstetrics ,business.industry ,media_common.quotation_subject ,Fertility ,medicine.disease ,Preeclampsia ,Miscarriage ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Rheumatology ,Rheumatoid arthritis ,Psoriasis ,medicine ,030212 general & internal medicine ,Neonatology ,business ,media_common - Abstract
Objective To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System. Methods A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (€, 2019) were obtained from national, local databases. Results During fertility and conception, an annual cost per patient of €229 was estimated for a preconception consultation in a patient with PSO, of €3,642 for a preconception consultation in patients with PsA, RA and axSpA and €4,339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of €1,214 for a miscarriage in the first trimester, €4,419 for a late miscarriage in the second trimester, €11,260 for preeclampsia €3,188 for restricted intrauterine growth and €12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of €120,364, €44,709, and €5,507 were estimated associated with admissions to neonatology of premature infants of Conclusions This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.
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- 2022
48. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance
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Michal Fishel Bartal, Marshall D. Lindheimer, and Baha M. Sibai
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Gestational hypertension ,medicine.medical_specialty ,Urinalysis ,Preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Diabetes mellitus ,medicine ,Humans ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,030219 obstetrics & reproductive medicine ,Proteinuria ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Hypertension, Pregnancy-Induced ,medicine.disease ,female genital diseases and pregnancy complications ,Blood pressure ,Hypertension ,Gestation ,Female ,medicine.symptom ,business ,Glomerular Filtration Rate ,Kidney disease - Abstract
Qualitative and quantitative measurement of urine protein excretion is one of the most common tests performed during pregnancy. For more than 100 years, proteinuria was necessary for the diagnosis of preeclampsia, but recent guidelines recommend that proteinuria is sufficient but not necessary for the diagnosis. Still, in clinical practice, most patients with gestational hypertension will be diagnosed as having preeclampsia based on the presence of proteinuria. Although the reference standard for measuring urinary protein excretion is a 24-hour urine collection, spot urine protein-to-creatinine ratio is a reasonable "rule-out" test for proteinuria. Urine dipstick screening for proteinuria does not provide any clinical benefit and should not be used to diagnose proteinuria. The classic cutoff cited to define proteinuria during pregnancy is a value of >300 mg/24 hours or a urine protein-to-creatinine ratio of at least 0.3. Using this cutoff, the rate of isolated proteinuria in pregnancy may reach 8%, whereas preeclampsia occurs among 3% to 8% of pregnancies. Although this threshold is widely accepted, its origin is not based on evidence on adverse pregnancy outcomes but rather on expert opinion and results of small studies. After reviewing the available data, the most important factor that influences maternal and neonatal outcome is the severity of blood pressures and presence of end organ damage, rather than the excess protein excretion. Because the management of gestational hypertension and preeclampsia without severe features is almost identical in frequency of surveillance and timing of delivery, the separation into 2 disorders is unnecessary. If the management of women with gestational hypertension with a positive assessment of proteinuria will not change, we believe that urine assessment for proteinuria is unnecessary in women who develop new-onset blood pressure at or after 20 weeks' gestation. Furthermore, we do not recommend repeated measurement of proteinuria for women with preeclampsia, the amount of proteinuria does not seem to be related to poor maternal and neonatal outcomes, and monitoring proteinuria may lead to unindicated preterm deliveries and related neonatal complications. Our current diagnosis of preeclampsia in women with chronic kidney disease may be based on a change in protein excretion, a baseline protein excretion evaluation is critical in certain conditions such as chronic hypertension, diabetes, and autoimmune or other renal disorders. The current definition of superimposed preeclampsia possesses a diagnostic dilemma, and it is unclear whether a change in the baseline proteinuria reflects another systemic disease such as preeclampsia or whether women with chronic disease such as chronic hypertension or diabetes will experience a different "normal" pattern of protein excretion during pregnancy. Finally, limited data are available regarding angiogenic and other biomarkers in women with chronic kidney disease as a potential aid in distinguishing the worsening of baseline chronic kidney disease and chronic hypertension from superimposed preeclampsia.
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- 2022
49. An integrated model of preeclampsia: a multifaceted syndrome of the maternal cardiovascular-placental-fetal array
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Debra Goldman-Wohl, Simcha Yagel, and Sarah M. Cohen
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Gestational hypertension ,Placenta ,Pregnancy Complications, Cardiovascular ,Physiology ,Vascular Remodeling ,Preeclampsia ,Extracellular Vesicles ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Decidua ,medicine ,Humans ,030212 general & internal medicine ,Exercise ,reproductive and urinary physiology ,Fetus ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Trophoblast ,medicine.disease ,Adaptation, Physiological ,Placentation ,Trophoblasts ,Killer Cells, Natural ,medicine.anatomical_structure ,embryonic structures ,Female ,business ,Soluble fms-like tyrosine kinase-1 ,Signal Transduction - Abstract
Maternal tolerance of the semiallogenic fetus necessitates conciliation of competing interests. Viviparity evolved with a placenta to mediate the needs of the fetus and maternal adaptation to the demands of pregnancy and to ensure optimal survival for both entities. The maternal-fetal interface is imagined as a 2-dimensional porous barrier between the mother and fetus, when in fact it is an intricate multidimensional array of tissues and resident and circulating factors at play, encompassing the developing fetus, the growing placenta, the changing decidua, and the dynamic maternal cardiovascular system. Pregnancy triggers dramatic changes to maternal hemodynamics to meet the growing demands of the developing fetus. Nearly a century of extensive research into the development and function of the placenta has revealed the role of placental dysfunction in the great obstetrical syndromes, among them preeclampsia. Recently, a debate has arisen questioning the primacy of the placenta in the etiology of preeclampsia, asserting that the maternal cardiovascular system is the instigator of the disorder. It was the clinical observation of the high rate of preeclampsia in hydatidiform mole that initiated the focus on the placenta in the etiology of the disease. Over many years of research, shallow trophoblast invasion with deficient remodeling of the maternal spiral arteries into vessels of higher capacitance and lower resistance has been recognized as hallmarks of the preeclamptic milieu. The lack of the normal decrease in uterine artery resistance is likewise predictive of preeclampsia. In abdominal pregnancies, however, an extrauterine pregnancy develops without remodeling of the spiral arteries, yet there is reduced resistance in the uterine arteries and distant vessels, such as the maternal ophthalmic arteries. Proponents of the maternal cardiovascular model of preeclampsia point to the observed maternal hemodynamic adaptations to pregnancy and maladaptation in gestational hypertension and preeclampsia and how the latter resembles the changes associated with cardiac disease states. Recognition of the importance of the angiogenic-antiangiogenic balance between placental-derived growth factor and its receptor soluble fms-like tyrosine kinase-1 and disturbance in this balance by an excess of a circulating isoform, soluble fms-like tyrosine kinase-1, which competes for and disrupts the proangiogenic receptor binding of the vascular endothelial growth factor and placental-derived growth factor, opened new avenues of research into the pathways to normal adaptation of the maternal cardiovascular and other systems to pregnancy and maladaptation in preeclampsia. The significance of the "placenta vs heart" debate goes beyond the academic: understanding the mutuality of placental and maternal cardiac etiologies of preeclampsia has far-reaching clinical implications for designing prevention strategies, such as aspirin therapy, prediction and surveillance through maternal hemodynamic studies or serum placental-derived growth factor and soluble fms-like tyrosine kinase-1 testing, and possible treatments to attenuate the effects of insipient preeclampsia on women and their fetuses, such as RNAi therapy to counteract excess soluble fms-like tyrosine kinase-1 produced by the placenta. In this review, we will present an integrated model of the maternal-placental-fetal array that delineates the commensality among the constituent parts, showing how a disruption in any component or nexus may lead to the multifaceted syndrome of preeclampsia.
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- 2022
50. The role of statins in the prevention of preeclampsia
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Devin D. Smith and Maged M. Costantine
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Placental growth factor ,Pregnancy ,030219 obstetrics & reproductive medicine ,biology ,business.industry ,Obstetrics and Gynecology ,Inflammation ,Disease ,medicine.disease ,Bioinformatics ,Article ,Preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,embryonic structures ,HMG-CoA reductase ,medicine ,biology.protein ,030212 general & internal medicine ,medicine.symptom ,Endothelial dysfunction ,business ,Pravastatin ,medicine.drug - Abstract
Preeclampsia is a common hypertensive disorder of pregnancy associated with considerable neonatal and maternal morbidities and mortalities. However, the exact cause of preeclampsia remains unknown; it is generally accepted that abnormal placentation resulting in the release of soluble antiangiogenic factors, coupled with increased oxidative stress and inflammation, leads to systemic endothelial dysfunction and the clinical manifestations of the disease. Statins have been found to correct similar pathophysiological pathways that underlie the development of preeclampsia. Pravastatin, specifically, has been reported in various preclinical and clinical studies to reverse the pregnancy-specific angiogenic imbalance associated with preeclampsia, to restore global endothelial health, and to prevent oxidative and inflammatory injury. Human studies have found a favorable safety profile for pravastatin, and more recent evidence does not support the previous teratogenic concerns surrounding statins in pregnancy. With reassuring and positive findings from pilot studies and strong biological plausibility, statins should be investigated in large clinical randomized-controlled trials for the prevention of preeclampsia.
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- 2022
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