Elevated Mid-trimester 4-hour Postprandial Triglycerides for Predicting Late-onset Preeclampsia and Gestational Hypertension: a Prospective Screening Study

Abstract Background: Abnormal maternal lipid concentrations are associated with increased risk of preeclampsia. However, previous studies mainly focused on fasting lipid concentrations, scarce data have been published on the relationship between postprandial triglyceride (TG) concentrations in the second trimester and the risk of preeclampsia. Our aim is to evaluate the potential of triglyceride (TG) concentrations at the time of oral lipid tolerance test (OLTT) measurement in the second trimester to predict preeclampsia and to elucidate the lipid metabolic changes related to these diseases. Methods: This is a prospective cohort study of Pregnant women at 12-24 weeks of gestation undergone an OLTT in a university affiliated hospital between May 2019 and January 2020. Data were stratified into binaries according to the OLTT results. The receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal cut-off points of TG, HDL-C, LDL-C, sd-LDL, FFA, and BG for predicting preeclampsia.Results: 438 pregnant women were recruited to undergo an OLTT at 12-24 weeks of gestation. Among these, 24 women developed preeclampsia and 414 women remained normotensive. Women who subsequently developed preeclampsia had higher concentrations of 4-h postprandial TG than those who remained normotensive. In the linear logistic regression analyses of potential confounding factors, mid-trimester 4-h postprandial TG concentrations at the time of OLTT measurement were significantly higher in preeclamptic cases than in controls.Conclusions: Dyslipidemia in the second trimester of pregnancy, particularly postprandial hypertriglyceridemia, appears to be associated with an increased risk of preeclampsia. Mid-trimester 4-h postprandial TG concentration at the time of OLTT measurement may be a potential predictive marker of preeclampsia.

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Maternal and Perinatal Outcomes of White Coat Hypertension During Pregnancy

Hypertension ◽

10.1161/hypertensionaha.119.14627 ◽

2020 ◽

Vol 76 (1) ◽

pp. 157-166 ◽

Cited By ~ 1

Author(s):

Sonia Johnson ◽

Becky Liu ◽

Erkan Kalafat ◽

Basky Thilaganathan ◽

Asma Khalil

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Risk Ratio ◽

Gestational Age ◽

Small For Gestational Age ◽

Gestational Hypertension ◽

White Coat Hypertension ◽

Chronic Hypertension ◽

Increased Risk ◽

Risk Of Preeclampsia

The aim of this meta-analysis is to investigate whether white-coat hypertension (WCH) has an adverse effect on maternal, fetal, and neonatal outcomes. Medline, EMBASE, www.Clinicaltrials.gov , and Cochrane Library databases were searched electronically in December 2019. The outcomes were compared between pregnant women with WCH and normotensive controls, women with chronic hypertension, gestational hypertension or any hypertensive disorder of pregnancy. Twelve studies were eligible for inclusion in the systematic review. Women with WCH enrolled below 20 weeks had a significantly increased risk of preeclampsia (pooled risk ratio [RR], 5.43 [95% CI, 2.00–14.71]). Furthermore, women with WCH had increased risk of delivering a small-for-gestational-age newborn (RR, 2.47 [95% CI, 1.21–5.05], P =0.013) and preterm birth (RR, 2.86 [95% CI, 1.44–5.68], P =0.002). The risk of preeclampsia (risk ratio, 0.43 [95% CI, 0.23–0.78], P =0.005), small-for-gestational-age (RR, 0.46 [95% CI, 0.26–0.82], P =0.008), preterm birth (RR, 0.47 [95% CI, 0.31–0.71], P <0.001) were significantly lower with WCH compared with women with gestational hypertension. Women with WCH delivered ≈1 week later compared with women with chronic hypertension (mean difference, 1.06 weeks [95% CI, 0.44–1.67 weeks]; P <0.001). WCH is associated with a worse perinatal and maternal outcome than normotension, but better outcomes than gestational hypertension and chronic hypertension. Therefore, diagnosis of WCH should be ascertained in pregnant women presenting with hypertension. When the diagnosis is confirmed, these women require monitoring for developing preeclampsia, small-for-gestational-age and preterm birth.

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Genetic Association of ERAP1 and ERAP2 With Eclampsia and Preeclampsia in Northeastern Brazilian Women

10.21203/rs.3.rs-235628/v1 ◽

2021 ◽

Author(s):

LEONARDO CAPISTRANO FERREIRA ◽

CARLOS EDUARDO MAIA GOMES ◽

PRIYA DUGGAL ◽

INGRID DE PAULA HOLANDA ◽

AMANDA SAMARA DE LIMA ◽

...

Keyword(s):

Pregnant Women ◽

Genetic Variants ◽

Antigen Processing ◽

P Value ◽

Chronic Hypertension ◽

Ang Ii ◽

Small Peptides ◽

Increased Risk ◽

Genotype C ◽

Risk Of Preeclampsia

Abstract The clinical spectrum of hypertensive disorders of pregnancy (HDP) is determined by the interplay between environmental and genetic factors, most of which remains unknown. ERAP1, ERAP2 and LNPEP genes code for multifunctional aminopeptidases involved with antigen processing and degradation of small peptides such as angiotensin II (Ang II), vasopressin and oxytocin. We aimed to test for associations between genetic variants in aminopeptidases and HDP. A total of 1282 pregnant women (normotensive controls, n=693; preeclampsia, n=342; chronic hypertension with superimposed preeclampsia, n=61; eclampsia, n=74; and HELLP syndrome, n=112) were genotyped for variants in LNPEP (rs27300, rs38034, rs2303138), ERAP1 (rs27044, rs30187) and ERAP2 (rs2549796 rs2927609 rs11135484). We also evaluated the effect of ERAP1 rs30187 on plasma Ang II levels in an additional cohort of 65 pregnant women. The genotype C/C, in ERAP1 rs30187 variant (c.1583T>C, p.Lys528Arg), was associated with increased risk of eclampsia (OR=1.85, p=0.019) whereas ERAP2 haplotype rs2549796(C)-rs2927609(C)-rs11135484(G) was associated with preeclampsia (OR=1.96, corrected p-value=0.01). Ang II plasma levels did not differ across rs30187 genotypic groups (p=0.895). In conclusion, ERAP1 gene is associated with eclampsia whereas ERAP2 is associated with preeclampsia, although the mechanism by which genetic variants in ERAPs influence the risk of preeclampsia and eclampsia remain to be elucidated.

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Development of Late-Onset Preeclampsia in Association with Road Densities as a Proxy for Traffic-Related Air Pollution

Fetal Diagnosis and Therapy ◽

10.1159/000381802 ◽

2015 ◽

Vol 39 (1) ◽

pp. 21-27 ◽

Cited By ~ 7

Author(s):

Meng Wu ◽

Jean-Jacques Ries ◽

Elena Proietti ◽

Deborah Vogt ◽

Sinuhe Hahn ◽

...

Keyword(s):

Air Pollution ◽

Pregnant Women ◽

Late Onset ◽

Epidemiological Studies ◽

Control Group ◽

Main Road ◽

Increased Risk ◽

Hypertensive Disorders In Pregnancy ◽

And Control ◽

Early Late

Introduction: Previous epidemiological studies indicate an association between maternal exposure to air pollution and an increased risk of hypertensive disorders in pregnancy. We analyzed the association between the occurrence of mild/severe and early-/late-onset preeclampsia (PE) and traffic-related air pollution (TRAP). Materials and Methods: Based on retrospective data, 50 pregnant women with PE were selected and matched with a control group of healthy pregnant women according to their age, parity, and number of fetuses. The total length of major roads around the women's home within a radius of 100, 200, 300, and 500 m and the distances from the domicile to the nearest ‘first class' main road and freeway were used as a proxy indicator of TRAP. We compared a PE subgroup and control group in terms of their exposure to TRAP. Results: Late-onset PE cases showed a significantly higher occurrence with density of major roads within a radius of 100-300 m compared to early onset cases (p = 0.006; 0.02; 0.04). In addition, a significantly shorter distance to the nearest ‘first class' main road was observed in late-onset PE cases (p = 0.0078). Conclusions: Exposure to TRAP during pregnancy was associated with an increased risk for the development of late-onset PE.

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Maternal Serum Angiogenic Factor sFlt-1 to PlGF Ratio in Preeclampsia: A Useful Marker for Differential Diagnosis and Prognosis Evaluation in Chinese Women

Disease Markers ◽

10.1155/2019/6270187 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Wei-zhen Lou ◽

Fang Jiang ◽

Jing Hu ◽

Xiao-xu Chen ◽

Ying-na Song ◽

...

Keyword(s):

Differential Diagnosis ◽

Early Onset ◽

Late Onset ◽

Gestational Hypertension ◽

Angiogenic Factor ◽

Chronic Hypertension ◽

Control Groups ◽

Roc Curve Analysis ◽

And Control ◽

Plgf Ratio

The ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) is elevated and proved to be useful in preeclampsia (PE) diagnosis. Its value in differential diagnosis with other pregnancy complications and prediction of pregnancy duration has yet to be clarified in Chinese population. We retrospectively analyzed 118 singleton pregnancies with suspected or diagnosed PE at the Peking Union Medical College Hospital (PUMCH) in China. Among these, 62 pregnancies were diagnosed as PE (48 early onsets and 14 late onsets, with 39 and 5 severe PE, respectively), 12 gestational hypertension (GH), 15 chronic hypertension (chrHTN), 16 autoimmune diseases, and 13 pregnancies with uncomplicated proteinuria. And 76 normal pregnancies were included as control. The results showed (1) the sFlt-1/PlGF ratio in early onset PE subgroup was significantly higher than that in GH, chrHTN, and control groups; the sFlt-1/PlGF ratio in late onset PE subgroup was significantly higher than that in chrHTN and control groups, but similar as GH group; the sFlt-1/PlGF ratio was similar among GH, chrHTN, and control groups. (2) The sFlt-1/PlGF ratio was significantly increased in the PE group compared with autoimmune disease and uncomplicated proteinuria pregnancies. (3) By ROC curve analysis, the cutoff value of the sFlt-1/PlGF ratio was less than 21.5 to rule out PE and higher than 97.2 to confirm the diagnosis of PE. (4) The sFlt-1/PlGF ratio was higher in PE pregnancies delivering within 7 days than those more than 7 days, either in early onset PE or severe PE. In conclusion, we show that maternal sFlt-1/PlGF ratio is an efficient biomarker in the diagnosis and differential diagnosis of PE. This ratio can be used to predict the timing of delivery for PE pregnancies.

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Association between risk of preeclampsia and maternal plasma trimethylamine-N-oxide in second trimester and at the time of delivery

10.21203/rs.3.rs-18239/v1 ◽

2020 ◽

Author(s):

Xin Huang ◽

Zuodong Li ◽

Zhou Gao ◽

Dapeng Wang ◽

Xiaohui Li ◽

...

Keyword(s):

Case Control Study ◽

Late Onset ◽

Maternal Plasma ◽

Second Trimester ◽

Spearman Correlation ◽

The Mean ◽

Nested Case Control ◽

Control Study ◽

Risk Of Preeclampsia

Abstract Background: The data on the association between the microbiota-dependent metabolite trimethylamine-N-oxide (TMAO) during pregnancy and risk of preeclampsia (PE) is limited. Methods: We, therefore, conducted a prospective nested case control study during Sep 2017 to Dec 2018 to examine the association between plasma TMAO measured during pregnancy and the risk of PE. Total of 17 patients diagnosed with EOPE (early onset PE), 49 with LOPE (late onset PE) and 198 healthy controls were enrolled. Blood samples were collected at 15-23 gestational weeks and time at delivery. The Logistic regression model was used to assess the odds ratio (OR) and 95% confidence interval (CI) for TMAO and risk of PE, EOPE, LOPE, mild PE, and severe PE. Results: We found that the mean TMAO levels of overall subjects in the second trimester (T2) and at the time of delivery (TD) were 90.39 µg/m 3 (SD=45.91) and 175.01 µg/m 3 (SD=160.97), respectively. No significant spearman correlation was found between the TMAO in those two periods ( p > 0.05). T2 TMAO was not significantly associated with risk of PE or risk of any PE subtypes ( p >0.05). However, TD TMAO was significant associated with risk of PE, EOPE and severe PE (adjusted OR and 95%CI were 1.24(1.09, 1.40), 1.62(1.29, 2.03), and 1.41(1.17, 1.70)) per 50µg/m 3 increment, respectively). Conclusion: Our study found that plasma TMAO level would alter over the course of pregnancy. The major role of TMAO in PE development might be in the accelerating process not in the initiation.

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Perinatal and neonatal outcomes of pregestational diabetes mellitus: a retrospective study

10.21203/rs.3.rs-555135/v1 ◽

2021 ◽

Author(s):

Giampiero Capobianco ◽

Alessandra Gulotta ◽

Giulio Tupponi ◽

Francesco Dessole ◽

Giuseppe Virdis ◽

...

Keyword(s):

Diabetes Mellitus ◽

Pregnant Women ◽

Gestational Hypertension ◽

Diabetes Mellitus Type 1 ◽

Diabetes Mellitus Type ◽

Control Group ◽

Growth Disorders ◽

Pregestational Diabetes ◽

Increased Risk ◽

History Of

Abstract BackgroundThe aim of the study was to evaluate maternal-foetal and neonatal clinical outcomes in a group of patients with pregestational diabetes mellitus (PGDM) such as diabetes mellitus type 1 (DM1), diabetes mellitus type 2 (DM2), and maturity onset diabetes of the young (MODY).MethodsOverall, 174 pregnant women, nulliparous and multiparous, with single pregnancy were enrolled. The selected patients were divided into two groups: PGDM (42 with DM1, 14 with DM2, and 2 with MODY); 116 patients with a negative pathological history of diabetes mellitus were the control.ResultsWe reported an incidence of preterm delivery of 55.2% in the PGDM group, of 59.5% in the DM1 group, and 42.9% in the DM2 group VS. 6% in the controls. Foetal growth disorders, such as intrauterine growth retardation, small for gestational age, and foetal macrosomia were found in 19% and 3.6% in the case and in the control group, respectively. A relationship between DM2 and gestational hypertension was found.Conclusionspatients with PGDM are at increased risk of perinatal and neonatal complications in comparison with pregnant women without PGDM.

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Assessing SARS-CoV-2 Vertical Transmission and Neonatal Complications

Journal of Clinical Medicine ◽

10.3390/jcm10225253 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5253

Author(s):

Cosmin Citu ◽

Radu Neamtu ◽

Virgiliu-Bogdan Sorop ◽

Delia Ioana Horhat ◽

Florin Gorun ◽

...

Keyword(s):

Breast Milk ◽

Amniotic Fluid ◽

Pregnant Women ◽

Umbilical Cord ◽

Gestational Hypertension ◽

Close Contact ◽

Outpatient Setting ◽

Serum Samples ◽

Increased Risk ◽

A Prospective Study

We designed and implemented a prospective study to analyze the maternal and neonatal outcomes associated with COVID-19 and determine the likelihood of viral transmission to the fetus and newborn by collecting samples from amniotic fluid, placenta, umbilical cord blood, and breast milk. The study followed a prospective observational design, starting in July 2020 and lasting for one year. A total of 889 pregnant women were routinely tested for SARS-CoV-2 infection in an outpatient setting at our clinic, using nasal swabs for PCR testing. A total of 76 women were diagnosed with COVID-19. The positive patients who accepted study enrollment were systematically analyzed by collecting weekly nasal, urine, fecal, and serum samples, including amniotic fluid, placenta, umbilical cord, and breast milk at hospital admission and postpartum. Mothers with COVID-19 were at a significantly higher risk of developing gestational hypertension and giving birth prematurely by c-section than the general pregnant population. Moreover, their mortality rates were substantially higher. Their newborns did not have negative outcomes, except for prematurity, and an insignificant number of newborns were infected with SARS-CoV-2 (5.4%). No amniotic fluid samples were positive for SARS-CoV-2, and only 1.01% of PCR tests from breast milk were confirmed positive. Based on these results, we support the idea that SARS-CoV-2 positive pregnant women do not expose their infants to an additional risk of infection via breastfeeding, close contact, or in-utero. Consequently, we do not support maternal–newborn separation at delivery since they do not seem to be at an increased risk of SARS-CoV-2 infection.

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JAK2V617F-positive clonal hematopoiesis of indeterminate potential in pregnant women

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347.2019.13.3.204-210 ◽

2019 ◽

Vol 13 (3) ◽

pp. 204-210

Author(s):

I. A. Olkhovskiy ◽

J. G. Garber ◽

A. S. Gorbenko ◽

M. A. Stolyar ◽

O. M. Miller ◽

...

Keyword(s):

Pregnant Women ◽

Gestational Hypertension ◽

Lymphoblastic Leukemia ◽

Venous Blood ◽

First Trimester ◽

Polymerase Chain Reaction Test ◽

Routine Laboratory ◽

Jak2 Mutation ◽

Blood Samples ◽

Increased Risk

Aim: to assess the prevalence of V617F somatic mutation of the JAK2 gene in pregnant women.Materials and methods. This non-interventional study was performed in the framework of routine clinical practice and included 1532 samples of venous blood from pregnant women who applied for medical assistance at Krasnoyarsk Regional Clinical Center for Maternal and Child Welfare. We used blood samples left after all routine laboratory tests had been done. These leftovers were pooled in the way that ensured an equal ratio of nucleated cells. Each pool contained 7 separate blood samples. The unused samples that remained after the pooling were frozen and stored at –20°C until the end of entire testing procedure. The V617F JAK2 mutation was detected by the real-time allele-specific polymerase chain reaction test.Results. Among the examined pregnant women, 6 (0.4 %) were identified as carriers of V617F JAK2 mutation. Three women with this mutation suffered from infertility for 4, 5, and 10 years; two of them had repeated miscarriages in the first trimester of pregnancy. The 6 women – carriers of this mutations had no concomitant genetic polymorphisms typical of thrombophilia (factors FII, FV), and no abnormal coagulation characteristics. Analysis of their medical records showed that in the past, two of these women had gestational hypertension, one developed a clinical picture of preeclampsia, and another one (with the maximum presence of the mutant allele) had a history of acute lymphoblastic leukemia followed by stable remission.Conclusion. The routine laboratory detection of the V617F JAK2 mutation can facilitate timely identification of the increased risk of pregnancy pathology, as well as timely diagnosis of hematological cancer.

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Obesity and body weight deficiency as predictors of gestational hypertension and cardiovascular disease

Medical Science And Education Of Ural ◽

10.36361/1814-8999-2020-21-4-122-126 ◽

2020 ◽

Vol 21 (4) ◽

pp. 112-126

Author(s):

A. D. Popov ◽

◽

T. V. Zuevskaya ◽

E. S. Chernaya ◽

E. V. Sadrieva ◽

...

Keyword(s):

Diabetes Mellitus ◽

Body Weight ◽

Cardiovascular Diseases ◽

Pregnant Women ◽

Gestational Hypertension ◽

Clinical State ◽

Control Group ◽

Clinical Group ◽

Second Trimester ◽

Microbiological Methods

Purpose of work. To reveal possible predictors of cardiovascular diseases on the basis of studying mechanisms of gestational adaptation, parameters of homeostasis in women with obesity and body weight deficiency. Material and methods. During pregnancy in 297 patients with changed body weight and 107 women of the comparison group carried out dynamic study of homeostasis parameters and adaptation mechanisms. The clinical state was assessed using morphological, electrophysiological, hormonal, biochemical and microbiological methods. Results. Analysis of anamnestic data revealed that parents of 87% of patients with obesity and weight deficit had arterial hypertension combined with atherosclerosis, obesity, diabetes mellitus, and depression. The upper distribution of subcutaneous tissue and gestational hypertension were found to be prevalent in women of the main clinical group: during the whole period, the average blood pressure was exceeded in obese women and in women with a deficit of body weight in the second trimester. General cholesterol level in the second trimester was increased due to atherogenic fractions in pregnant women of the first group up to 6.21 ± 0.13 mmol/l, in the second group – 5.95 ± 0.20 mmol/l, against the control group 4.96 ± 0.31 mmol/l. Transitor glucosuria (in case of excluded diabetes mellitus) occurred only in pregnant women with changed body weight in the 2nd trimester. Stress reactions prevailed in women with obesity and deficit of body weight on the eve of labor: 77% (1) and 88% (2), exceeding the parameters of the control group; there was also an increase in the level of norepinephrine and dioxyphenylalanine in daily excretion of urine by 4-6 times. Decrease in species landscape of intestinal and vaginal flora with increasing share of pathogenic microorganisms was registered in 91% of pregnant main groups and only in 33% of control group patients. Conclusion. In women with changed body weight, pregnancy is accompanied by excessive activation and disintegration of adaptation systems, the clinical equivalent of which is gestational hypertension, metabolic and microecology disorders. Gestational stress-test allows to estimate phylogenetic features of response systems of young women and probable ontogenetic risks of cardiovascular diseases.

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The Novel Ultrasonographic Marker of Uterocervical Angle for Prediction of Spontaneous Preterm Birth in Singleton and Twin Pregnancies: A Systematic Review and Meta-Analysis

Fetal Diagnosis and Therapy ◽

10.1159/000510648 ◽

2021 ◽

pp. 1-7

Author(s):

Kamran Hessami ◽

Maryam Kasraeian ◽

Álvaro Sepúlveda-Martínez ◽

Mauro Cristian Parra-Cordero ◽

Homeira Vafaei ◽

...

Keyword(s):

Systematic Review ◽

Preterm Birth ◽

Meta Analysis ◽

Predictive Marker ◽

Second Trimester ◽

Spontaneous Preterm Birth ◽

Increased Risk ◽

Study Heterogeneity ◽

Mean Differences ◽

Twin Pregnancies

The alteration of the uterocervical angle (UCA) has been proposed to play an important role in spontaneous preterm birth (sPTB). The aim of this systematic review and meta-analysis was to evaluate the evidence on the UCA predictive role in sPTB. In this study, PubMed, Web of Science, Scopus, and Google scholar were systematically searched from inception up to June 2020. Inter-study heterogeneity was also assessed using Cochrane’s Q test and the I2 statistic. Afterward, the random-effects model was used to pool the weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs). Eleven articles that reported second-trimester UCA of 5,061 pregnancies were included in this study. Our meta-analysis results indicate that a wider UCA significantly increases the risk of sPTB in following cases: all pregnancies (WMD = 15.25, 95% CI: 11.78–18.72, p < 0.001; I2 = 75.9%, p < 0.001), singleton (WMD = 14.43, 95% CI: 8.79–20.06, p < 0.001; I2 = 82.4%, p < 0.001), and twin pregnancies (WMD = 15.14, 95% CI: 13.42–16.87, p < 0.001; I2 = 0.0%, p = 0.464). A wider ultrasound-measured UCA in the second trimester seems to be associated with the increased risk of sPTB in both singleton and twin pregnancies, which reinforces the clinical evidence that UCA has the potential to be used as a predictive marker of sPTB.

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