Search

Malaria in pregnancy still constitutes a particular medical challenge in tropical and subtropical regions. Of the five Plasmodium species that are pathogenic to humans, infection with Plasmodium falciparum leads to fulminant progression of the disease with massive impact on pregnancy. Severe anemia of the mother, miscarriage, stillbirth, preterm delivery and intrauterine growth restriction (IUGR) with reduced birth weight are frequent complications that lead to more than 10,000 maternal and 200,000 perinatal deaths annually in sub-Saharan Africa alone. P. falciparum can adhere to the placenta via the expression of the surface antigen VAR2CSA, which leads to sequestration of infected erythrocytes in the intervillous space. This process induces a placental inflammation with involvement of immune cells and humoral factors. Especially, monocytes get activated and change the release of soluble mediators, including a variety of cytokines. This proinflammatory environment contributes to disorders of angiogenesis, blood flow, autophagy, and nutrient transport in the placenta and erythropoiesis. Collectively, they impair placental functions and, consequently, fetal growth. The discovery that women in endemic regions develop a certain immunity against VAR2CSA-expressing parasites with increasing number of pregnancies has redefined the understanding of malaria in pregnancy and offers strategies for the development of vaccines. The following review gives an overview of molecular processes in P. falciparum infection in pregnancy which may be involved in the development of IUGR.

Objectives Evaluate the role of placenta growth factor (PlGF) as a predictor of preeclampsia (PE). Methods Systematic review on Pubmed (february/2014) with descriptor: “(placenta growth factor OR plgf) AND pre-eclampsia/diagnosis”’. A total of 126 articles were found. Items with more than three years of publication, systematic reviews, not related to the topic after reading the abstract and unavailability of the article were excluded. Among the papers which were read in full, three were excluded because they did not use as a predictive factor PlGF, totaling 19 items for the final sample. Results Due to the heterogeneity of the articles found, four groups were defined sorted into 4 groups: Group 1 PlGF isolated Fifteen studies were conducted as a single measure of PlGF and found a decrease in patients with PE; Ten in the first half of pregnancy; five found with lower values when PE early; four found with severe lower PE values Group 2 Relation sFlt-1/PlGF Six studies determined the relationship sFlt-1/PlGF and had an increase in pregnant women with PE values in the second quarter Group 3 Combination of PlGF Doppler velocimetry of uterine arteries Of the eight articles that combined biochemical to biophysical methods, five showed improvement in sensitivity and specificity with the combination, four in the first quarter Group 4 Combination of several biomarkers Three studies investigated various biomarkers, two achieved combination of markers. While Myatt et al. (2012) found increased diagnostic capacity with the association, Myers et al. (2013) did not obtain the same result combining several biomarkers Conclusions It is suggested that PlGF is reduced in PE, alternating the values in the first half of pregnancy, especially early/severe PE. The sFlt-1/PlGF ratio is better in the second trimester of gestation (late when compared to isolated PlGF). Diagnostic ability of PlGF can be extended by associating other methods, especially biophysical. Standardized studies are needed, homogenizing the collection time, cut off values and a way of presentation of the results for the comparison be clear. Disclosures G. Calestini: None. B. Reis: None. D. Labre: None. F. Fuentes: None. F. Sousa: None. L. Wenzel: None. P. Coelho: None. W. Chanwangyen: None. S. Prieto: None. D. Prieto: None. U. Markert: None. N. Sass: None.

Since the discovery of non-coding RNAs, several families of small regulatory molecules have been described including small nucleolar RNAs, piwi-interacting RNAs and microRNAs (miRNAs). MiRNAs are small single-stranded RNA molecules which play an important role in the regulation of gene expression at the transcriptional level. Recent studies demonstrated that about 30% of human genes are regulated by miRNAs and their deregulation has been associated with malignancies and poor outcome. Therefore, it is not surprising that profiling of miRNAs expression and studies on their regulation became a great field of interest in the last decade. However, miRNA-mediated regulation in pregnancy remains poorly investigated although several independent processes associated with placenta development have been shown to be miRNA-regulated. This review provides a general overview of the current data on profiles and functions of microRNAs in the peri-implantation period, embryonic stem cells, placentation and pregnancy, as well as in several pregnancy-related pathologies. We conclude that miRNAs present in the maternal circulation may provide a new promising diagnostic tool for pregnancy disorders.