New-onset postpartum preeclampsia: epigenetic mechanism and prediction

Kim, Sun Kwon; Vishweswaraiah, Sangeetha; Macknis, Jacqueline K.; Yılmaz, Ali; Lalwani, Ashna; Mishra, Nitish K.; Guda, Chittibabu; Ogunyemi, Dotun; Radhakrishna, Uppala

doi:10.1080/14767058.2021.1946504

Cited by 3 publications

(3 citation statements)

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“…This suggests that classical monocytes might differentiate to adapt to this altered maternal environment, which is supported by their enhancement in inflammatory pathways when compared to their control counterparts. Although not specific to this cell type, another study did identify overall inflammatory pathways when looking at the placental epigenetic dysregulation in new onset postpartum preeclampsia ( 1 ). We also identified a commonly distinct cluster 3, which had a cytotoxic gene signature resembling previously reported “natural killer dendritic cells”, in addition to co-expressing known classical monocyte genes suggesting a common role in the postpartum period ( 34 – 36 ).…”

Section: Discussionmentioning

confidence: 99%

“…Preeclampsia (PE) is an important cause of maternal morbidities and mortality, with its predominant presentation in the antepartum/intrapartum period being widely studied ( 1 ). However, the postpartum manifestation of PE, also associated with major maternal morbidities, is poorly understood and patients are largely underinformed about its potential development following pregnancy.…”

Section: Introductionmentioning

confidence: 99%

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Predictive biomarkers and initial analysis of maternal immune alterations in postpartum preeclampsia reveal an immune-driven pathology

Couture,

Brien,

Rechtzigel

et al. 2024

Front. Immunol.

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IntroductionPostpartum preeclampsia (PPPE) is an under-diagnosed condition, developing within 48 hours to 6 weeks following an uncomplicated pregnancy. The etiology of PPPE is still unknown, leaving patients vulnerable and making the identification and treatment of patients requiring postpartum care an unmet need. We aimed to understand the immune contribution to PPPE at the time of diagnosis, as well as uncover the predictive potential of perinatal biomarkers for the early postnatal identification of high-risk patients. MethodsPlacentas were collected at delivery from uncomplicated pregnancies (CTL) and PPPE patients for immunohistochemistry analysis. In this initial study, blood samples in PPPE patients were collected at the time of PPPE diagnosis (48h-25 days postpartum; mean 7.4 days) and compared to CTL blood samples taken 24h after delivery. Single-cell transcriptomics, flow cytometry, intracellular cytokine staining, and the circulating levels of inflammatory mediators were evaluated in the blood.ResultsPlacental CD163+ cells and 1st trimester blood pressures can be valuable non-invasive and predictive biomarkers of PPPE with strong clinical application prospects. Furthermore, changes in immune cell populations, as well as cytokine production by CD14+, CD4+, and CD8+ cells, suggested a dampened response with an exhausted phenotype including decreased IL1β, IL12, and IFNγ as well as elevated IL10. DiscussionUnderstanding maternal immune changes at the time of diagnosis and prenatally within the placenta in our sizable cohort will serve as groundwork for pre-clinical and clinical research, as well as guiding clinical practice for example in the development of immune-targeted therapies, and early postnatal identification of patients who would benefit from more thorough follow-ups and risk education in the weeks following an uncomplicated pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictive biomarkers and initial analysis of maternal immune alterations in postpartum preeclampsia reveal an immune-driven pathology

Couture,

Brien,

Rechtzigel

et al. 2024

Front. Immunol.

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“…Interestingly, postpartum preeclampsia has also been associated with epigenetic modifications, with CpG methylation sites as markers for identification of postpartum preeclampsia. 27 , 28 …”

Section: Pathophysiology Of Hypertensive Disorders Of Pregnancymentioning

confidence: 99%

Hypertensive Disorders of Pregnancy

Radparvar,

Vani,

Fiori

et al. 2024

JACC: Advances

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Progression of antenatal preeclampsia in the postpartum period (clinical cases)

Ignatko,

Bogomazova,

Fedyunina

et al. 2023

V.F.Snegirev Archives of Obstetrics and Gynecology

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Background. Preeclampsia is recognized as one of the leading causes of maternal morbidity and mortality. In the majority of observations in the postpartum period, symptoms of preeclampsia appear in patients with antenatal hypertensive complications. These symptoms appear within the first 710 days after delivery and are accompanied by high blood pressure (BP) and neurologic symptoms, commonly presenting as headaches. According to the literature, common risk factors for the progression of preeclampsia in the postpartum period include maternal age over 3540 years, obesity, cesarean section delivery, and non-Hispanic black race. Patients with progression of antenatal preeclampsia in the postpartum period often require readmission after discharge from the hospital. Description of clinical cases. The first clinical observation involves a 25-year-old female patient was transferred to the cardiology department of the hospital on the fourth day after her first spontaneous labor due to a significant increase in BP combined with complaints of intense headache, nausea, and itching of the palms. Progression of antenatal preeclampsia complicated by the cholestasis was detected. The implementation of a complex treatment led to the normalization of clinical and laboratory parameters. In the second clinical observation, a 31-year-old first-pregnant patient at the gestational age of 27 weeks underwent emergency cesarean section due to the development of eclampsia. The patient developed thrombocytopenia and massive proteinuria a day after delivery for the first time, along with high BP, which was not present during pregnancy. The application of a personalized approach to treatment helped stabilize the maternity patients condition. Conclusion. The presented clinical observations demonstrate the progression of antenatal preeclampsia in the postpartum period. In both cases, disturbances of laboratory parameters, high arterial hypertension, resistant to previously conducted antihypertensive therapy, were noted. Given that preeclampsia is a risk factor for severe complications, patients should not be discharged after delivery until clinical and laboratory parameters have completely normalized.

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New-onset postpartum preeclampsia: epigenetic mechanism and prediction

Cited by 3 publications

References 42 publications

Predictive biomarkers and initial analysis of maternal immune alterations in postpartum preeclampsia reveal an immune-driven pathology

Predictive biomarkers and initial analysis of maternal immune alterations in postpartum preeclampsia reveal an immune-driven pathology

Hypertensive Disorders of Pregnancy

Progression of antenatal preeclampsia in the postpartum period (clinical cases)

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