The evolution of the diagnostic criteria of preeclampsia-eclampsia

Tanner, Michael S.; Davey, Mary‐Ann; Mol, Ben W.; Rolnik, Daniel L.

doi:10.1016/j.ajog.2021.11.1371

Cited by 33 publications

(25 citation statements)

References 56 publications

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“…A chemokine can be defined as a class of small cytokines or signaling molecules secreted by cells that have the ability to stimulate chemotaxis in nearby cells. As a member of the CC chemokine subfamily, CCL21 is highly expressed in the T-cell region of high endothelial venules and lymph nodes of secondary lymphoid tissue in humans; there is an expression of its receptor CCR7 in naive T-cells, B cells, DC cells, and numerous tumor cells [ 8 , 9 ]. In spite of their involvement in many functions of the body, HSP90 and CCL21 do not show any signs of expression during PE.…”

Section: Introductionmentioning

confidence: 99%

A Study of Heat Shock Protein 90 and Serum CCL21 Expression in Pregnant Women with Preeclampsia

Yang

Zhang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. The purpose of the study was to determine the significance of heat shock protein 90 (HSP 90) and serum chemokine ligand 21 (CCL-21) in pregnant women with preeclampsia (PE). Methods. From June 2021 to June 2022, the study enrolled 100 women undergoing obstetric examinations and delivering in our hospital; 50 PE patients undergoing routine obstetric examinations and delivering during the same period were enrolled in the research group; according to the severity, they were divided into mild PE and severe PE groups, while 50 healthy pregnant women undergoing obstetric examinations and delivering in our hospital during the same period were enrolled in the control group. In a subsequent analysis, serum levels of CCL-21 and HSP90 were compared between the two groups, and the correlation among CCL-21, HSP 90, and PE severity was analyzed. Results. An overall total of 50 patients with PE were enrolled in the study, which included 32 patients with mild PE and 18 patients with severe PE. Patients with severe PE had lower mean arterial pressure (MAP), HSP 90, and CCL21 index levels than those with mild PE; MAP, HSP 90, and CCL21 in the severe PE group were higher than those in the mild PE group, but the difference was not statistically significant; In the research group, MAP was weakly correlated with HSP90 concentration and CCL21 concentration, with correlation coefficients of 0.33 and 0.30, respectively, and the correlation analysis was significant. Conclusion. Patients with PE showed significantly increased serum concentrations of HSP90 and CCL-21, but a significant difference did not exist between mild and severe PE. In addition, there was a weak relationship between HSP90 and CCL-21 concentrations in PE patients and MAP, suggesting that HSP90 and CCL-21 play an instrumental role in the pathogenesis of PE, although more studies are needed to clarify the exact mechanisms.

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Section: Introductionmentioning

confidence: 99%

A Study of Heat Shock Protein 90 and Serum CCL21 Expression in Pregnant Women with Preeclampsia

Yang

Zhang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…38 However, renal or liver dysfunction can be a diagnostic criteria of preeclampsia. 37 Gynecological conditions, such as fibroids and PCOS, have been shown to be associated with a greater risk for adverse pregnancy outcomes, including preeclampsia. [39][40][41][42] While the gastrointestinal and gynecological systems are physically close, there is a lack of literature on how they interact.…”

Section: C1 Further Discussion Of Interaction Effectsmentioning

confidence: 99%

Racial/ethnic differences in pre-pregnancy conditions and adverse maternal outcomes in the nuMoM2b cohort: a population-based cohort study

Meredith

Steimle

Platner

et al. 2022

Preprint

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Background: Adverse maternal outcomes and multimorbidity affect a growing proportion of pregnant individuals in the United States and with racial and ethnic disparities in the rates of multimorbidity. There is limited research on multimorbidity, measured as the co-occurrence of two or more chronic conditions, and how it impacts adverse maternal outcomes. Objectives: We sought to: (1) determine how pre-pregnancy conditions and their combined effects contribute to racial disparities in adverse maternal outcomes; and (2) incorporate conditions and their combined effects into predictive modeling algorithms to improve risk prediction using information available in the first trimester, specifically for racial minority subgroups. Study Design: We used data from the 'Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be' (nuMoM2b) observational cohort study. We defined multimorbidity as the co-occurrence of two or more pre-pregnancy conditions. The primary outcomes of interest were severe preeclampsia, postpartum readmission, and blood transfusion during pregnancy or up to 14 days postpartum. We used weighted Poisson regression with robust variance to estimate adjusted risk ratios and 95% confidence intervals, and we used mediation analysis to evaluate the contribution of the combined effects of pre-pregnancy conditions to racial/ethnic disparities. We also evaluated the performance of our models by racial subgroup using the area under the receiver operating characteristic curve (AUC) metric. Results: In the nuMoM2b cohort (n=8729), 3.6% (n=318) experienced severe preeclampsia, 1.8% (n=157) experienced blood transfusion, and 1.8% (n=154) experienced postpartum readmission. 22.8% of all participants experienced two or more co-occurring pre-pregnancy conditions. Cardiovascular conditions were associated with an increased relative risk for severe preeclampsia (aRR, 1.71; CI, 1.59-1.84), and this risk was additionally exacerbated when hematologic conditions were co-occurring with cardiovascular conditions (aRR, 1.34; CI, 1.12-1.60). The mediation analysis results were not statistically significant; however, cardiovascular conditions explained 36.6% of non-Hispanic Black individuals' association with increased risk for severe preeclampsia (p=0.07). The addition of pre-pregnancy conditions increased AUC for the prediction of blood transfusion and severe preeclampsia, and moreover, the multiracial subgroup experienced the greatest improvement in predictive performance of blood transfusion due to this addition (an increase in AUC 0.51 to 0.69). The best subgroup performance was in predicting severe preeclampsia in multiracial individuals using confounders and condition types, with an AUC of 0.74. Conclusion: Though there is a greater burden of some pre-pregnancy conditions and co-occurring conditions among minority individuals, these conditions alone do not fully explain the higher rates of adverse maternal outcomes. However, some conditions and their combined effects are associated with adverse maternal outcomes. The incorporation of pre-pregnancy multimorbidity improves the performance of some risk prediction models, especially for correctly classifying individuals of minority race.

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“…Preeclampsia (PE), which occurs in 2 to 8% of all pregnancies, is a major cause of maternal and perinatal morbidity and mortality [ 1 , 2 , 3 ]. Although the definition of PE slightly differs between regions and countries, it is a condition of hypertension that develops after 20 weeks of gestation and is complicated by organ and uteroplacental dysfunctions [ 4 , 5 ]. The only fundamental treatment for PE is the termination of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Non-Coding RNAs and Prediction of Preeclampsia in the First Trimester of Pregnancy

Ogoyama

Takahashi

Suzuki

et al. 2022

Cells

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Preeclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality. The only fundamental treatment for PE is the termination of pregnancy. Therefore, not only severe maternal complications but also perinatal complications due to immaturity of the infant associated with early delivery are serious issues. The treatment and prevention of preterm onset preeclampsia (POPE) are challenging. In 2017, the ASPRE trial showed that a low oral dose of aspirin administered to POPE high-risk women in early pregnancy reduced POPE by 62%. A prediction algorithm at 11–13 weeks of gestation identifies POPE with 75% sensitivity when the false positive rate is set at 10%. New biomarkers to increase the accuracy of the prediction model for POPE high-risk women in early pregnancy are needed. In this review, we focused on non-coding RNAs (ncRNAs) as potential biomarkers for the prediction of POPE. Highly expressed ncRNAs in the placenta in early pregnancy may play crucial roles in placentation. Furthermore, placenta-specific ncRNAs have been detected in maternal blood. In this review, we summarized ncRNAs that were highly expressed in the primary human placenta in early pregnancy. We also presented highly expressed ncRNAs in the placenta that were associated with or predictive of the development of PE in an expression analysis of maternal blood during the first trimester of pregnancy. These previous studies showed that the chromosome 19 microRNA (miRNA) -derived miRNAs (e.g., miR-517-5p, miR-518b, and miR-520h), the hypoxia-inducible miRNA (miR-210), and long non-coding RNA H19, were not only highly expressed in the early placenta but were also significantly up-regulated in the blood at early gestation in pregnant women who later developed PE. These maternal circulating ncRNAs in early pregnancy are expected to be possible biomarkers for POPE.

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The evolution of the diagnostic criteria of preeclampsia-eclampsia

Cited by 33 publications

References 56 publications

A Study of Heat Shock Protein 90 and Serum CCL21 Expression in Pregnant Women with Preeclampsia

A Study of Heat Shock Protein 90 and Serum CCL21 Expression in Pregnant Women with Preeclampsia

Racial/ethnic differences in pre-pregnancy conditions and adverse maternal outcomes in the nuMoM2b cohort: a population-based cohort study

Non-Coding RNAs and Prediction of Preeclampsia in the First Trimester of Pregnancy

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