Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum

Bisson, Courtney; Dautel, Sydney E.; Patel, Easha; Suresh, Sunitha C.; Dauer, Patricia; Rana, Sarosh

doi:10.3389/fmed.2023.1144170

Cited by 33 publications

(22 citation statements)

References 86 publications

(125 reference statements)

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“…Pre-eclampsia being a potentially fatal complication, can severely influence maternal and fetal outcomes in pregnancy. 34 Despite being a very common obstetric complication, the condition is diagnosed on onset and currently there lies a need of a predictive biomarker that can aid in foreseeing the risk of pre-eclampsia in pregnant women. Although several markers are being investigated, there is barely any FDA-approved predictive tests for pre-eclampsia.…”

Section: Discussionmentioning

confidence: 99%

Biomarker role of maternal soluble human leukocyte antigen G in pre‐eclampsia: A meta‐analysis

Bhattarai,

Shah,

Dahal

et al. 2024

Immunity Inflam & Disease

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IntroductionHuman leukocyte antigen‐G (HLA‐G) is a non‐classical class I HLA molecule shown to regulate the immunomodulation of maternal immune cells to prevent fetal tissue destruction. Low levels of freely circulating maternal soluble HLA‐G (sHLA‐G) have been observed in pre‐eclampsia, however, no pooled evidence exists. This meta‐analysis aimed to generate pooled findings on the association of sHLA‐G levels with pre‐eclampsia and is the first study to perform a trimester‐wise comparison of the levels of sHLA‐G in preeclamptic cases and normal pregnant controls.MethodsThe databases PubMed, Emba, Web of Science, and Google Scholar through May 31, 2023. Preeclamptic women were defined as cases and normal pregnancies as controls. Data on the level of sHLA‐G in cases and controls was extracted and subjected to a meta‐analysis using a random‐effects model. The pooled effect was expressed in terms of standardized mean difference (SMD). Sensitivity analysis was performed to investigate the effect of the exclusion of each study on the pooled results. Publication bias was assessed statistically.ResultsNine studies with altogether 567 PE cases and 1132 normal pregnancy controls were included in the meta‐analysis. The first and third trimester levels of sHLA‐G in PE cases were significantly lower than that of normal pregnant controls: (SMD: −0.84 [−1.29; −0.38]; p = .003; I2 = 54%) and (SMD: −0.39 [−0.71; −0.06]; p = .02; I2 = 79%) respectively. Sensitivity analysis revealed significant fluctuations in the pooled findings when few studies were excluded, raising questions on the consistency of results among studies.ConclusionAlthough we found that first and third‐trimester sHLA‐G levels in pre‐eclampsia are significantly lower, taking into consideration the inconsistent results from the sensitivity analysis, our findings advocate the demand for more studies with larger sample sizes to generate solid ground pooled evidence on the predictive role of sHLA‐G in pre‐eclampsia.

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Section: Discussionmentioning

confidence: 99%

Biomarker role of maternal soluble human leukocyte antigen G in pre‐eclampsia: A meta‐analysis

Bhattarai,

Shah,

Dahal

et al. 2024

Immunity Inflam & Disease

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“…In a retrospective chart review of pre-eclamptic patients treated at Ayder Comprehensive Specialized Hospital, Ethiopia, headache and blurring were associated with poor maternal outcomes 30. It has been noted that neurological symptoms indicate an impending negative consequence 2…”

Section: Discussionmentioning

confidence: 99%

Maternal outcomes of pre-eclampsia with severe features and its determinants at Abebech Gobena Mothers and Childrens Health and Saint Peter’s Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study

Tadese,

Damesa,

Solomon

et al. 2024

BMJ Open

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ObjectiveThe main objective of this study was to determine the prevalence and factors associated with unfavourable maternal outcomes among pregnant women with pre-eclampsia with severity features (PEWSF) at Abebech Gobena Maternal and Children’s Health and St. Peter’s Hospital, Addis Ababa, Ethiopia, 2023.DesignA hospital-based cross-sectional study was conducted from 1 January 2023 to July 2023. The data was collected using a structured and pre-tested questionnaire through face-to-face interviews and a review clinical chart. Data was entered using EpiData V.4.6 and analysed using SPSS V.26.0 statistical software. Binary logistic regression analysis was run to identify predictors of maternal outcome.SettingTwo hospitals in Addis Ababa, Ethiopia.Participants348 pregnant women with PEWSF were included.Outcome measuresUnfavourable maternal outcome was defined as mothers with PEWSF that develop at least one complication, that is, eclampsia, abruption placenta, Haemolysis, Elevated Liver Enzymes and Low Platelet Count (HELLP) syndrome, acute renal failure, disseminated intravascular coagulation, cardiac failure, stroke, postpartum haemorrhage, pulmonary oedema and death.ResultsThe overall prevalence of unfavourable maternal outcomes was 33.9% (N=118) (95% CI=28.7 to 38.8). Abruptio placenta (17.2%), HELLP syndrome (15.5%) and postpartum haemorrhage (13.8%) were common complications that occurred among mothers with PEWSF. Age above 35 years (adjusted OR (AOR) (95% CI)=2.70 (1.31 to 5.59)), rural residence (AOR (95% CI)=1.94 (1.07 to 3.53)), unemployment (AOR (95% CI)=0.35 (0.20 to 0.62)), severe blood pressure on admission (AOR (95% CI)=2.32 (1.03 to 5.19)) and complain of severe headache (AOR (95% CI)=1.91 (1.16 to 3.16)) were significant associates of unfavourable maternal outcomes.ConclusionsThe prevalence of unfavourable maternal outcomes was high compared with other studies in Ethiopia. Maternal age, residence, occupation, blood pressure on admission and severe headache have shown a statistically significant association with unfavourable maternal outcomes. Socioeconomic development and early identification of severe signs and symptoms of pre-eclampsia are needed to reduce unfavourable outcomes.

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“…Indeed, different CVD phenotypes may arise as a result of exposure to distinct pathophysiologic processes, influenced by factors experienced both during pregnancy and over an individual's life course. However, whether HDP causes CVD, provides an early warning signal indicative of an individual's pre‐existing CVD risk, or a combination of both, remains unclear 5 …”

Section: Introductionmentioning

confidence: 99%

Assessing cardiovascular disease risk in women with a history of hypertensive disorders of pregnancy: A guidance paper for studies using administrative data

Johnston,

Smith,

Tanuseputro

et al. 2024

Paediatric Perinatal Epid

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BackgroundHypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality, and their association with increased cardiovascular disease (CVD) risk represents a major public health concern. However, assessing CVD risk in women with a history of these conditions presents unique challenges, especially when studies are carried out using routinely collected data.ObjectivesTo summarise and describe key challenges related to the design and conduct of administrative studies assessing CVD risk in women with a history of HDP and provide concrete recommendations for addressing them in future research.MethodsThis is a methodological guidance paper.ResultsSeveral conceptual and methodological factors related to the data‐generating mechanism and study conceptualisation, design/data management and analysis, as well as the interpretation and reporting of study findings should be considered and addressed when designing and carrying out administrative studies on this topic. Researchers should develop an a priori conceptual framework within which the research question is articulated, important study variables are identified and their interrelationships are carefully considered.ConclusionsTo advance our understanding of CVD risk in women with a history of HDP, future studies should carefully consider and address the conceptual and methodological considerations outlined in this guidance paper. In highlighting these challenges, and providing specific recommendations for how to address them, our goal is to improve the quality of research carried out on this topic.

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Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum

Cited by 33 publications

References 86 publications

Biomarker role of maternal soluble human leukocyte antigen G in pre‐eclampsia: A meta‐analysis

Biomarker role of maternal soluble human leukocyte antigen G in pre‐eclampsia: A meta‐analysis

Maternal outcomes of pre-eclampsia with severe features and its determinants at Abebech Gobena Mothers and Childrens Health and Saint Peter’s Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study

Assessing cardiovascular disease risk in women with a history of hypertensive disorders of pregnancy: A guidance paper for studies using administrative data

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