Soluble Endoglin and Uterine Artery Flow Doppler Ultrasonography as Markers of Progression to Preeclampsia in Women with Gestational Hypertension

2021 ◽  
pp. 1-9
Author(s):  
Carlos José Molina Pérez ◽  
Ana Graciela Nolasco Leaños ◽  
Reyes Ismael Carrillo Juárez ◽  
María Guadalupe Berumen Lechuga ◽  
Irma Isordia Salas ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Doppler Ultrasonography ◽  
Gestational Hypertension ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Soluble Endoglin ◽  
Risk Of Progression ◽  
Artery Flow

<b><i>Introduction:</i></b> Gestational hypertension (GH) pregnancies are at a high risk of developing adverse outcomes, including progression to preeclampsia. Prediction of GH-related adverse outcomes is challenging because there are no available clinical tests that may predict their occurrence. <b><i>Objective:</i></b> The aim of the study was to determine the clinical usefulness of the soluble endoglin (sEng) and parameters of uterine artery flow (UtAF) measured by Doppler ultrasonography as markers of progression to preeclampsia in women with GH. <b><i>Setting:</i></b> Mexico City, Mexico. <b><i>Material and Methods:</i></b> We included 77 singleton pregnant women with GH in a nested case-control study. Cases were women who progressed to preeclampsia (<i>n</i> = 36), and controls were those who did not <b>(</b><i>n</i> = 41). Serum sEng and UtAF measurements were performed at enrollment. The main outcomes measured were progression to preeclampsia and occurrence of preterm delivery (PD) &#x3c;37 and &#x3c;34 weeks of gestation, small for gestational age infant (SGA), and fetal growth restriction (FGR). <b><i>Results:</i></b> Women with sEng values in the highest tertile had higher risk of progression to preeclampsia, preterm delivery &#x3c;34 weeks of gestation, and fetal growth restriction, odds ratios (ORs) ≥3.7. Patients with abnormal UtAF Dopp­ler-pulsatility index had higher risk of progression to preeclampsia, preterm delivery &#x3c;34 weeks of gestation, small for gestational age infant, and fetal growth restriction (ORs ≥3.3). The presence of notch was associated with higher risk of progression to preeclampsia, preterm delivery &#x3c;37 and &#x3c;34 weeks of gestation, SGA infant, and fetal growth restriction (ORs ≥2.9). However, logistic regression analysis revealed that only serum sEng was a significant and independent risk factor for progression of GH to preeclampsia, preterm delivery &#x3c;34 weeks of gestation, and fetal growth restriction (ORs ≥3.1). <b><i>Conclusions:</i></b> In GH pregnancies, UtAF Doppler ultrasonography is associated with increased risk of adverse outcomes and progression to preeclampsia. However, serum sEng concentration appears to be a better predictor to assess the risk of adverse maternal and perinatal outcomes and progression to preeclampsia.

P1040PREGNANCY IN WOMEN WITH DIABETIC NEPHROPATHY: COMPLICATIONS AND OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Elena Prokopenko ◽  
Andrey Vatazin ◽  
Vera Gurieva ◽  
Irina Nikol`skaya ◽  
Fatima Burumkulova ◽  
...  
Keyword(s):  
Diabetic Nephropathy ◽  
Cesarean Section ◽  
Preterm Delivery ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Fetal Macrosomia ◽  
Ckd Stage

Abstract Background and Aims Pregnancy in patients with diabetic nephropathy (DN) is characterized by an increased incidence of complications and adverse outcomes. The aim of the study was to determine the nature and incidence of pregnancy complications and maternal and fetal outcomes in women with DN. Method 61 pregnant women with diabetes mellitus (DM) type 1 and CKD 1-4 stages: 1 st. –29 patients, 2 st. - 19, 3-4 st. – 13 (age 29.7±4.9 years, DM duration 18.6 ± 5,3 years) and 72 pregnant patients with pre-existing (type 1) DM without CKD (age 28.2±4.8 years, DM duration 11.4 ±3.7 years) observed in 2010-2017 were included. The incidence of chronic arterial hypertension (AH), preeclampsia (PE), fetal macrosomia, fetal growth restriction, preterm delivery, cesarean section, stillbirth and the effect of pregnancy on kidney function were evaluated. Results Chronic AH was detected in 19.4% of women w/o CKD, in 10.3% – CKD 1 st, 17.6% – CKD2, 61.3% – CKD 3-4 (p &lt 0.05 CKD3-4 vs CKD1). The incidence of PE in patients w/o CKD was 12.5% (2-3% for general population), with CKD 1 – 24.1%, CKD 2 – 41.2%, CKD 3-4 – 38.5% (p &lt 0.001 when comparing all groups). Macrosomia was common in pregnant diabetic women w/o CKD (30.6%), patients with CKD 1 (41.4%) and CKD 2 (52.9%), but was not observed in CKD 3-4 (0%). In contrast, the incidence of fetal growth restriction was highest with CKD 3-4 (61.5%) compared women w/o CKD (5.6%) and with CKD1(13.8%) and CKD2 (11.8%), p &lt 0.05.Preterm delivery was more common in women with CKD, and its frequency increased with increasing severity of CKD: w/o CKD – 18.1%, CKD 1 – 48.3%, CKD2 – 61.3%, CKD 3-4 –84.6% (p &lt 0.05). Incidence of cesarean section was high and did not differ significantly between groups: w/o CKD – 62.5.1%, CKD 1 – 55.2%, CKD2 – 82.4%, CKD 3-4 –92.3% (p &gt 0.05). Stillbirth was observed only with CKD stage 3-4 in 15.4% of cases.Four out of 13 (30.8%) patients with pre-existing CKD 3-4 and none of the patients with CKD1-2 reached stage 5 CKD and started regular hemodialysis with a median follow-up period of 43.3 months (min 29.7 - max. 81.5). Conclusion DN has a negative effect on pregnancy outcomes, increasing the frequency of preeclampsia, fetal growth restriction, preterm birth and stillbirth, however, fetal macrosomia practically does not occur with CKD 3-4. The rapid achievement of CKD 5D after delivery is typical for diabetic women with advanced stages of CKD.

scholarly journals Metabolomics for predicting fetal growth restriction: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022743 ◽  
Author(s):  
Debora Farias Batista Leite ◽  
Aude-Claire Morillon ◽  
Elias F Melo Júnior ◽  
Renato T Souza ◽  
Ali S Khashan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Fetal Growth ◽  
Gestational Age ◽  
Fetal Growth Restriction ◽  
Case Reports ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Sample Collection

IntroductionFetal growth restriction (FGR) is a relevant research and clinical concern since it is related to higher risks of adverse outcomes at any period of life. Current predictive tools in pregnancy (clinical factors, ultrasound scan, placenta-related biomarkers) fail to identify the true growth-restricted fetus. However, technologies based on metabolomics have generated interesting findings and seem promising. In this systematic review, we will address diagnostic accuracy of metabolomics analyses in predicting FGR.Methods and analysisOur primary outcome is small for gestational age infant, as a surrogate for FGR, defined as birth weight below the 10th centile by customised or population-based curves for gestational age. A detailed systematic literature search will be carried in electronic databases and conference abstracts, using the keywords ‘fetal growth retardation’, ‘metabolomics’, ‘pregnancy’ and ‘screening’ (and their variations). We will include original peer-reviewed articles published from 1998 to 2018, involving pregnancies of fetuses without congenital malformations; sample collection must have been performed before clinical recognition of growth impairment. If additional information is required, authors will be contacted. Reviews, case reports, cross-sectional studies, non-human research and commentaries papers will be excluded. Sample characteristics and the diagnostic accuracy data will be retrieved and analysed. If data allows, we will perform a meta-analysis.Ethics and disseminationAs this is a systematic review, no ethical approval is necessary. This protocol will be publicised in our institutional websites and results will be submitted for publication in a peer-reviewed journal.PROSPERO registration numberCRD42018089985.

scholarly journals Risk of adverse outcomes for small fetuses not meeting consensus criteria for fetal growth restriction

2022 ◽  
Vol 226 (1) ◽  
pp. S504-S505
Author(s):  
Jennifer E. Powel ◽  
Emily W. Zantow ◽  
Matthew F. Bialko ◽  
Lauren G. Farley ◽  
Tracy M. Tomlinson
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Adverse Outcomes ◽  
Growth Restriction

Multifetal Reduction Increases the Risk of Preterm Delivery and Fetal Growth Restriction in Twins

1997 ◽  
Vol 52 (9) ◽  
pp. 537-539
Author(s):  
Richard K. Silver ◽  
Ann Ragin ◽  
Brian T. Helfand ◽  
John S. Sholl ◽  
Tanya L. Russell ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction

scholarly journals The Association Between Hypertension in Pregnancy and Preterm Birth with Fetal Growth Restriction in Singleton and Twin Pregnancy: Use of Twin Versus Singleton Charts

2020 ◽  
Vol 9 (8) ◽  
pp. 2518
Author(s):  
Erkan Kalafat ◽  
Aisha Abiola ◽  
Basky Thilaganathan ◽  
Amar Bhide ◽  
Asma Khalil
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Gestational Hypertension ◽  
Growth Restriction ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertension In Pregnancy ◽  
Subgroup Analyses ◽  
Strength Of Association ◽  
Twin Pregnancies ◽  
Singleton Pregnancies

Objective: To compare the rates of fetal growth restriction (FGR) in singleton and twin pregnancies using singleton and twin-specific birthweight standards. Methods: The study included liveborn twin and singleton pregnancies between January 2000 and January 2019. Hypertensive disorders of pregnancy (HDP) included gestational hypertension and pre-eclampsia. The study outcomes were FGR or small-for-gestational-age (SGA) at birth as assessed using singleton and twin reference charts. Results: The analysis included 1473 twin and 62,432 singleton pregnancies. In singleton pregnancies the risk of PTB <34 weeks without HDP (OR 2.82, p < 0.001), delivery ≥34 weeks with HDP (OR 2.38, p < 0.001), and PTB <34 weeks with HDP (OR 13.65, p < 0.001) were significantly higher in the pregnancies complicated by FGR compared to those without. When selective fetal growth restriction (sFGR) was assessed using the singleton standard, the risk of PTB <34 weeks without HDP (OR 1.03, p = 0.872), delivery ≥34 weeks with HDP (OR 1.36, p = 0.160) were similar in the pregnancies complicated by sFGR compared to those without, while the risk of PTB <34 weeks with HDP (OR 2.41, p = 0.025) was significantly higher in the pregnancies complicated by sFGR compared to those without. When sFGR was assessed using the twin-specific chart, the risk of PTB <34 weeks without HDP (OR 3.55, p < 0.001), delivery ≥34 weeks with HDP (OR 3.17, p = 0.004), and PTB <34 weeks with HDP (OR 5.69, p < 0.001) were significantly higher in the pregnancies complicated by sFGR compared to those without. The stronger and more consistent association persisted in the subgroup analyses according to chorionicity. The strength of association in dichorionic twin pregnancies resembles that of the singletons more closely and consistently when the FGR was diagnosed using the twin-specific charts. Conclusion: FGR in twin pregnancies has a stronger and more consistent association with HDP and PTB when using twin-specific rather than singleton charts. This study provides further evidence supporting the use of twin-specific charts when assessing fetal growth in twin pregnancies.

Fetal growth restriction and perinatal adverse outcomes associated with extremely high values of the sFlt-1/PlGF ratio

2019 ◽  
Vol 17 ◽  
pp. S28-S29
Author(s):  
C. Villalaín ◽  
L. Valle ◽  
M. Mendoza ◽  
M. Vázquez-Fernández ◽  
A. Fernández Oliva ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Plgf Ratio

scholarly journals Risk of Stillbirth, Preterm Delivery, and Fetal Growth Restriction Following Exposure in a Previous Birth

2018 ◽  
Vol 73 (6) ◽  
pp. 339-340
Author(s):  
E. Malacova ◽  
A. Regan ◽  
N. Nassar ◽  
C. Raynes-Greenow ◽  
H. Leonard ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Previous Birth

scholarly journals Circulating C19MC MicroRNAs in Preeclampsia, Gestational Hypertension, and Fetal Growth Restriction

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Ilona Hromadnikova ◽  
Katerina Kotlabova ◽  
Marketa Ondrackova ◽  
Andrea Kestlerova ◽  
Veronika Novotna ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Perinatal Outcome ◽  
Pulsatility Index ◽  
Gestational Hypertension ◽  
Clinical Signs ◽  
Growth Restriction ◽  
Cerebroplacental Ratio ◽  
Severity Of The Disease ◽  
Ultrasound Parameters

The objective of the study was to identify the profile of circulating C19MC microRNAs (miR-516-5p, miR-517*, miR-518b, miR-520a*, miR-520h, miR-525, and miR-526a) in patients with established preeclampsia (n=63), fetal growth restriction (n=27), and gestational hypertension (n=23). We examined the correlation between plasmatic concentrations and expression levels of microRNAs and the severity of the disease with respect to clinical signs, requirements for the delivery, and Doppler ultrasound parameters. Using absolute and relative quantification approaches, increased extracellular C19MC microRNA levels (miR-516-5p,P=0.037,P=0.009; miR-517*,P=0.033,P=0.043; miR-520a*,P=0.001,P=0.009; miR-525,P=0.026,P=0.01; miR-526a,P=0.03,P=0.035) were detected in patients with preeclampsia. The association analysis pointed to no relationship between C19MC microRNA plasmatic concentrations and expression profile and identified risk factors for a poorer perinatal outcome. However, the dependence between the levels of plasmatic C19MC microRNAs and the pulsatility index in the middle cerebral artery and the values of cerebroplacental ratio was demonstrated. The study brought the interesting finding that the upregulation of miR-516-5p, miR-517*, miR-520a*, miR-525, and miR-526a is a characteristic phenomenon of established preeclampsia.

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