Preeclampsia has two phenotypes which require different treatment strategies

Masini, Giulia; Foo, L.; Tay, J.; Wilkinson, Ian B.; Valensise, H.; Gyselaers, Wilfried; Lees, C.

doi:10.1016/j.ajog.2020.10.052

Cited by 66 publications

(47 citation statements)

References 88 publications

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“…Although we did not identify an overall increased risk of preeclampsia in those homozygous for PAR4 Thr120 genotype, there was a trend toward an association with preterm preeclampsia. Preterm and term preeclampsia are distinct pathophysiological diseases, and there are various subtypes of preeclampsia with different mechanisms of development and progression 10,30‐32 . In fact, an epidemiological study found that early onset preeclampsia appeared to have the greatest genetic component 33 .…”

Section: Results In the Context Of What Is Knownmentioning

confidence: 99%

“…Preterm and term preeclampsia are distinct pathophysiological diseases, and there are various subtypes of preeclampsia with different mechanisms of development and progression. 10,[30][31][32] In fact, an epidemiological study found that early onset preeclampsia appeared to have the greatest genetic component. 33 Our results follow this pattern, although the numbers of preterm preeclampsia (N = 3) were too few to draw conclusions.…”

Section: Platelet Activity and Preeclampsia/preterm Birthmentioning

confidence: 99%

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Platelet protease activated receptor 4 (PAR 4) receptor genotype is associated with an increased risk of preterm birth

Boelig

Cahanap

et al. 2022

Journal of Thrombosis and Haemostasis

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Background: Platelet protease activated receptor-4 (PAR4) Thr120 is a common genetic variant associated with increased platelet activity. Increased platelet activity is implicated in the pathogenesis of preeclampsia and preterm birth.Objective: Compare the rate of preeclampsia and preterm birth in pregnant individuals homozygous for PAR4 Thr120 variant vs not.Study Design: This is a prospective cohort study of patients who delivered November 2020-July 2021. Maternal blood collected on admission for PAR4 genotyping. The primary outcome was the rate of preeclampsia/gestational hypertension in those with Thr/Thr genotype compared with Ala/Thr or Ala/Ala. Secondary outcomes included rates of preterm birth and placental pathology.Results: Three hundred and twenty singletons were included and 52 (16.3%) were PAR4 Thr/Thr. Those PAR4 Thr/Thr were more likely to be Black (67.3% vs 29.5%, p < .001), younger (28 ± 6 vs 31 ± 6, p = .004), and have higher body mass index (35.2 ± 6.8 vs 33.1 ± 7.4, p = .047). There was no difference in preeclampsia/gestational hypertension (19.2% vs 22.8%, p = .705). Those Thr/Thr had a significantly higher rate of preterm birth (15.4% vs 3.7%, adjusted odds ratio [aOR] 4. 04 [1.47-11.10],

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Section: Results In the Context Of What Is Knownmentioning

confidence: 99%

Section: Platelet Activity and Preeclampsia/preterm Birthmentioning

confidence: 99%

Platelet protease activated receptor 4 (PAR 4) receptor genotype is associated with an increased risk of preterm birth

Boelig

Cahanap

et al. 2022

Journal of Thrombosis and Haemostasis

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“…Furthermore, the majority of studies examining CRF during pregnancy measured CRF before HDP diagnosis, limiting our ability to draw conclusions about the effects of HDP on CRF in a current pregnancy. Finally, while preeclampsia is understood as a heterogeneous disorder with different phenotypes during pregnancy (i.e., early-onset vs. late-onset) [ 43 ], the majority of studies included in this review did not report on the timing or severity of HDP. In order to plan tailored postpartum rehabilitation programs, further studies should evaluate CRF according to the timing and severity of HDP.…”

Section: Discussionmentioning

confidence: 99%

Association between Cardiorespiratory Fitness and Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis

Al-Huda

Shapiro

Davenport

et al. 2022

JCM

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Hypertensive disorders of pregnancy (HDP) are associated with future cardiovascular disease (CVD), which may be mediated by diminished cardiorespiratory fitness (CRF). In this systematic review and meta-analysis, we summarize evidence linking CRF with HDP before, during, and after pregnancy. We searched relevant databases to identify observational or randomized studies that measured CRF (VO2 max or peak, VO2 at anaerobic threshold, or work rate at peak VO2) in women with and without HDP. We pooled results using random effects models. Fourteen studies (n = 2406 women) reporting on CRF before, during, and after pregnancy were included. Before pregnancy, women who developed HDP had lower CRF (e.g., VO2max < 37 vs. ≥37 mL O2/min) than those without HDP (two studies, 811 women). VO2max at 14–18 weeks of pregnancy was marginally lower among women who developed preeclampsia vs. normotensive women (three studies, 275 women; mean difference 0.43 mL/kg/min [95% CI 0.97, 0.10]). Postpartum, there was a trend towards lower VO2peak in women with previous preeclampsia (three studies, 208 women; 0.26 mL/kg/min [−0.54, 0.02]). While exploratory, our findings raise the possibility that CRF can identify women at risk for HDP, and furthermore, that HDP confers a hit to a woman’s cardiorespiratory reserve.

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“…An effective examination of maternal CO in PE is seemingly the key method for improved management since it allows a principal segregation of hypo-or hypervolemic types, which obviously need different managements [42,70,71].…”

Section: Management Of Pementioning

confidence: 99%

Preeclampsia subtypes: Clinical aspects regarding pathogenesis, signs, and management with special attention to diuretic administration

Tamás

Kovács

Várnagy

et al. 2022

European Journal of Obstetrics & Gynecology and Reproductiv

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Preeclampsia has two phenotypes which require different treatment strategies

Cited by 66 publications

References 88 publications

Platelet protease activated receptor 4 (PAR 4) receptor genotype is associated with an increased risk of preterm birth

Platelet protease activated receptor 4 (PAR 4) receptor genotype is associated with an increased risk of preterm birth

Association between Cardiorespiratory Fitness and Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis

Preeclampsia subtypes: Clinical aspects regarding pathogenesis, signs, and management with special attention to diuretic administration

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