Chronic Hepatitis B Infection is Associated with Decreased Risk of Preeclampsia: A Meta-Analysis of Observational Studies

Huang, Quan; Chen, Jianhong; Zhong, Ming; Hang, Lifeng; Wei, Shanshan; Yu, Yinhua

doi:10.1159/000445548

Cited by 31 publications

(32 citation statements)

References 45 publications

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“…Of these studies, only one reported calibration statistics for the described model 90 and one found that, of the 14 primary model development studies assessed, only six reported model calibration 78 . The remaining prediction-modeling papers 133 1/1 Low Blood pressure 57, 61 2/2 High Maternal infection (any) 62, 123 2/2 Low Hepatitis B 81 1/1 (neg) Moderate HIV 50,51,62,123 0/4 Very low Periodontal disease 62,82,85,128,142 5/5 Low Mental stress 37 1/1 Low Intrauterine device use 99 1/1 (neg) Low Physical activity levels 122 1/1 (neg) Low Polycystic ovary syndrome 33,119 2/2 Low Blood group A or AB 73, 100 2/2 Moderate Celiac disease 135 0/1 Low Cigarette smoker 141 1/1 (neg) Moderate Dietary factors 127 1/1 Very low Flow-mediated dilatation 143 1/1 Low Interpregnancy interval 64,87 0/2 Moderate Sleep-disordered breathing 29,66 2/2 Moderate Antiphospholipid syndrome 69,133 2/2 Moderate Chronic hypertension 133 1/1 Moderate Pre-existing diabetes 69,133 2/2 Moderate Previous FGR 133 0/1 Low Systemic lupus erythematosus 133 1/1 Low Chronic kidney disease 133 1/1 Low Previous abruption 133 1/1 Low Previous pre-eclampsia 69 61,…”

Section: Multivariable Prediction Modelsmentioning

confidence: 99%

Prediction of pre‐eclampsia: review of reviews

Townsend

Khalil

Premakumar

et al. 2019

Ultrasound in Obstet & Gyne

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Objective Primary studies and systematic reviews provide estimates of varying accuracy for different factors in the prediction of pre‐eclampsia. The aim of this study was to review published systematic reviews to collate evidence on the ability of available tests to predict pre‐eclampsia, to identify high‐value avenues for future research and to minimize future research waste in this field. Methods MEDLINE, EMBASE and The Cochrane Library including DARE (Database of Abstracts of Reviews of Effects) databases, from database inception to March 2017, and bibliographies of relevant articles were searched, without language restrictions, for systematic reviews and meta‐analyses on the prediction of pre‐eclampsia. The quality of the included reviews was assessed using the AMSTAR tool and a modified version of the QUIPS tool. We evaluated the comprehensiveness of search, sample size, tests and outcomes evaluated, data synthesis methods, predictive ability estimates, risk of bias related to the population studied, measurement of predictors and outcomes, study attrition and adjustment for confounding. Results From 2444 citations identified, 126 reviews were included, reporting on over 90 predictors and 52 prediction models for pre‐eclampsia. Around a third (n = 37 (29.4%)) of all reviews investigated solely biochemical markers for predicting pre‐eclampsia, 31 (24.6%) investigated genetic associations with pre‐eclampsia, 46 (36.5%) reported on clinical characteristics, four (3.2%) evaluated only ultrasound markers and six (4.8%) studied a combination of tests; two (1.6%) additional reviews evaluated primary studies investigating any screening test for pre‐eclampsia. Reviews included between two and 265 primary studies, including up to 25 356 688 women in the largest review. Only approximately half (n = 67 (53.2%)) of the reviews assessed the quality of the included studies. There was a high risk of bias in many of the included reviews, particularly in relation to population representativeness and study attrition. Over 80% (n = 106 (84.1%)) summarized the findings using meta‐analysis. Thirty‐two (25.4%) studies lacked a formal statement on funding. The predictors with the best test performance were body mass index (BMI) > 35 kg/m2, with a specificity of 92% (95% CI, 89–95%) and a sensitivity of 21% (95% CI, 12–31%); BMI > 25 kg/m2, with a specificity of 73% (95% CI, 64–83%) and a sensitivity of 47% (95% CI, 33–61%); first‐trimester uterine artery pulsatility index or resistance index > 90th centile (specificity 93% (95% CI, 90–96%) and sensitivity 26% (95% CI, 23–31%)); placental growth factor (specificity 89% (95% CI, 89–89%) and sensitivity 65% (95% CI, 63–67%)); and placental protein 13 (specificity 88% (95% CI, 87–89%) and sensitivity 37% (95% CI, 33–41%)). No single marker had a test performance suitable for routine clinical use. Models combining markers showed promise, but none had undergone external validation. Conclusions This review of reviews calls into question the need for further aggregate meta‐analy...

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Section: Multivariable Prediction Modelsmentioning

confidence: 99%

Prediction of pre‐eclampsia: review of reviews

Townsend

Khalil

Premakumar

et al. 2019

Ultrasound in Obstet & Gyne

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“…Although the clinical symptoms of patients with PE present after 20 weeks of gestation, the molecular events leading to its onset have been suggested to occur early in pregnancy. As many studies on the mechanism of PE are focused on polymorphisms or chronic hepatitis B infection, RNAs (circRNAs) are rapidly gaining prominence recently [4-7]. …”

Section: Introductionmentioning

confidence: 99%

CircRNA-0004904, CircRNA-0001855, and PAPP-A: Potential Novel Biomarkers for the Prediction of Preeclampsia

Jiang

Lash

Zhao

et al. 2018

Cell Physiol Biochem

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Background/Aims: Circular RNAs (circRNAs) are transcribed prevalently in the genome; however, their potential roles in multiple cardiovascular diseases, particularly preeclampsia (PE), are not yet well understood. This study investigated the expression profiles of circRNAs and explored circRNA-mediated pregnancy-associated plasma protein A (PAPP-A) expression as a potential biomarker for PE before 20 weeks of pregnancy. Methods: A nested case-control two-phase screening/validation study was performed in pregnant women before 20 weeks of gestation (before clinical diagnosis) at Guangzhou Women and Children’s Medical Center from 2012 to 2015. In the screening phase, circRNA expression profiles of blood cells were assessed using a human circRNA microarray, which was designed to detect simultaneously 5396 circRNAs, in 5 patients with PE and 5 age- and gestational week-matched controls. In the validation phase, 18 circRNAs in blood cells predicted by bioinformatics tools were validated by quantitative reverse transcription PCR in a cohort of 60 patients (PE and age-, gestational week-, and sample storage time-matched controls). Then, we examined the involvement of circRNAs in PE-related pathways via interactions with miRNAs by multiple bioinformatics approaches. Bioinformatics analysis predicted that hsa_circ_0004904 and hsa_circ_0001855 miRNA sponges directly target PAPP-A. PAPP-A was verified in the serum of the same cohort of patients using an enzyme-linked immunosorbent assay. Finally, we combined PAPP-A with circRNAs to create a novel preclinical diagnostic model for PE with logistic regression and evaluated the efficiency of this model with receiver operating curve analysis. Results: Volcano plot analysis using various parameters showed that circRNAs were differentially expressed among both groups (P < 0.01, fold change > 2). In the screening phase, we found that 2178 circRNAs were differentially expressed between the control and PE groups, in which 884 circRNAs were downregulated and 1294 circRNAs were upregulated in the PE group compared with the control group. In the validation phase, two circRNAs, hsa_circ_0004904 and hsa_circ_0001855, were significantly upregulated in PE patients compared with healthy pregnant women (P < 0.05). PAPP-A expression levels, related to the two circRNAs based on bioinformatics prediction, were increased in the PE group compared with the control group. The area under the curve of the combined model was 0.94 in the predicted PE subjects. Conclusions: This is the first study to report circRNA profiling in patients with PE prior to the onset of symptoms. Our data suggested that hsa_circ_0004904 and hsa_circ_0001855 combined with PAPP-A might be promising biomarkers for the detection of PE. Moreover, circRNAs may provide new insights into the potential mechanisms underlying the pathophysiology of PE.

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“…The hepatitis B carrier status is negatively associated with pre-eclampsia 27 . In a meta-analysis of 11 566 Asian patients, chronic hepatitis B infection is associated with 23% decreased risk of pre-eclampsia and increased risks of gestational diabetes 28 . This is compatible with our finding of hepatitis B carrier status being a protective factor for FGR as pre-eclampsia is a risk factor for FGR.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and pregnancy outcomes of term fetal growth restriction

2019

Hong Kong J Gynaecol Obstet Midwifery

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To evaluate the maternal risk factors associated with term fetal growth restriction (FGR) and immediate perinatal outcomes in these pregnancies. Methods: This was a retrospective cohort study conducted at a regional obstetric unit in Hong Kong over a 6-year period. All singleton livebirths delivered at term (≥37 weeks of gestation) were analysed. Those with major congenital abnormalities were excluded. Maternal epidemiological and anthropometric characteristics, presence of antenatal complications (gestational diabetes and medical disorders), and pregnancy outcomes (need for labour induction, mode of delivery, Apgar scores, occurrence of shoulder dystocia, and birth trauma) were compared between those with FGR (defined as birthweight ≤10th percentile for gestation) and those with birthweight appropriate for gestational age. Logistic regression analysis was conducted to identify risk factors associated with FGR. Results: From 2012 to 2017, 24 010 singleton term livebirths were stratified into FGR (n=2425, 10%), appropriate for gestational age (n=19 162, 80%), and large for gestational age. Those classified as FGR were compared with those appropriate for gestational age pregnancies. A logistic regression model confirmed that the key risk factors for FGR included maternal underweight (adjusted odds ratio [OR]=1.88), hypertensive disorders of pregnancy (adjusted OR=1.78), smoking (adjusted OR=2.02), and antenatal anaemia (adjusted OR=1.20), whereas multiparity, gestational diabetes, and hepatitis B antigen carrier status were apparently protective. Pregnancies with FGR were more likely to undergo induction of labour, but were less likely to have shoulder dystocia, Caesarean section, or postpartum haemorrhage. Conclusion: Despite the inherent risks associated with FGR at term, the immediate perinatal outcomes of these pregnancies appeared to be comparable to those appropriate for gestational age.

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Chronic Hepatitis B Infection is Associated with Decreased Risk of Preeclampsia: A Meta-Analysis of Observational Studies

Cited by 31 publications

References 45 publications

Prediction of pre‐eclampsia: review of reviews

Prediction of pre‐eclampsia: review of reviews

CircRNA-0004904, CircRNA-0001855, and PAPP-A: Potential Novel Biomarkers for the Prediction of Preeclampsia

Risk factors and pregnancy outcomes of term fetal growth restriction

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