Toward personalized management of chronic hypertension in pregnancy

Magee, Laura A.; Khalil, Asma; Kametas, Nikos A.; Dadelszen, Peter von

doi:10.1016/j.ajog.2020.07.026

Cited by 22 publications

(20 citation statements)

References 151 publications

(79 reference statements)

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“…Presently, the diagnostic criteria of PE remain uncertain because no known specific biomarkers are available, thus, women at risk are identified based on epidemiological and clinical risk factors [ 250 ]. Many studies on PE diagnosis, which have analyzed the sFlt-1/sVEGFR-1/PlGF ratio as a predictor for poor pregnancy, have demonstrated its reliability [ 100 , 102 , 103 , 104 ].…”

Section: Discussionmentioning

confidence: 99%

PlGF Immunological Impact during Pregnancy

Albonici

Benvenuto

Focaccetti

et al. 2020

IJMS

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During pregnancy, the mother’s immune system has to tolerate the persistence of paternal alloantigens without affecting the anti-infectious immune response. Consequently, several mechanisms aimed at preventing allograft rejection, occur during a pregnancy. In fact, the early stages of pregnancy are characterized by the correct balance between inflammation and immune tolerance, in which proinflammatory cytokines contribute to both the remodeling of tissues and to neo-angiogenesis, thus, favoring the correct embryo implantation. In addition to the creation of a microenvironment able to support both immunological privilege and angiogenesis, the trophoblast invades normal tissues by sharing the same behavior of invasive tumors. Next, the activation of an immunosuppressive phase, characterized by an increase in the number of regulatory T (Treg) cells prevents excessive inflammation and avoids fetal immuno-mediated rejection. When these changes do not occur or occur incompletely, early pregnancy failure follows. All these events are characterized by an increase in different growth factors and cytokines, among which one of the most important is the angiogenic growth factor, namely placental growth factor (PlGF). PlGF is initially isolated from the human placenta. It is upregulated during both pregnancy and inflammation. In this review, we summarize current knowledge on the immunomodulatory effects of PlGF during pregnancy, warranting that both innate and adaptive immune cells properly support the early events of implantation and placental development. Furthermore, we highlight how an alteration of the immune response, associated with PlGF imbalance, can induce a hypertensive state and lead to the pre-eclampsia (PE).

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Section: Discussionmentioning

confidence: 99%

PlGF Immunological Impact during Pregnancy

Albonici

Benvenuto

Focaccetti

et al. 2020

IJMS

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“…While the prevalence of chronic hypertension increases with age, it can affect all patients of childbearing age, both in its idiopathic and secondary forms, and is estimated to be present in 1–2% of pregnancies [ 16 ]. Apart from the specific susceptibility of women of Afro-American ethnicity, the prevalence of chronic hypertension in pregnancy is rising, as shown by a population-based cross-sectional study of more than 150 million hospital deliveries in the United States, where the increase in chronic hypertension was closely related to increased maternal age and body mass index (BMI) [ 17 ].…”

Section: Definitionsmentioning

confidence: 99%

“…The clinical relevance of chronic hypertension in pregnancy is high, as it is associated with a higher rate of maternal and neonatal complications, including the need for cesarean section (41%), small-for-gestational-age (SGA) newborns (17%), preterm delivery (28%), the need for a neonatal intensive care unit (NICU) (21%), and perinatal death (4%) [ 18 ]. In addition, hypertension is an independent risk factor for “superimposed” PE (relative risk (RR), 5.1; 95% CI, 4.0–6.5) [ 16 , 19 , 20 , 21 ], defined by the development of proteinuria or end-organ damage in hypertensive patients after 20 gestational weeks.…”

Section: Definitionsmentioning

confidence: 99%

The Hypertensive Disorders of Pregnancy: A Focus on Definitions for Clinical Nephrologists

Longhitano

Siligato

Torreggiani

et al. 2022

JCM

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About 5–10% of pregnancies are complicated by one of the hypertensive disorders of pregnancy. The women who experience these disorders have a greater risk of having or developing kidney diseases than women with normotensive pregnancies. While international guidelines do not provide clear indications for a nephrology work-up after pregnancy, this is increasingly being advised by nephrology societies. The definitions of the hypertensive disorders of pregnancy have changed greatly in recent years. The objective of this short review is to gather and comment upon the main definitions of the hypertensive disorders of pregnancy as a support for nephrologists, who are increasingly involved in the short- and long-term management of women with these disorders.

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“…The adhesion of the blastocyst to the endometrium is also promoted by the expression of adhesion molecules, such as cadherins. The presence of endothelial cadherin (E-cadherin) in both the trophoblasts and endometrial epithelium, regulated by progesterone, indicates that it may play an important role in blastocyst adhesion to the endometrium [250]. As trophoblast cells proliferate, differentiate and invade the stroma, they downregulate E-cadherin and increase osteoblast cadherin (OB-cadherin) [251,252].…”

Section: Adhesion Molecules Mediating Blastocyst Adhesionmentioning

confidence: 99%

Embryo Implantation and Placental Development

2022

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Toward personalized management of chronic hypertension in pregnancy

Cited by 22 publications

References 151 publications

PlGF Immunological Impact during Pregnancy

PlGF Immunological Impact during Pregnancy

The Hypertensive Disorders of Pregnancy: A Focus on Definitions for Clinical Nephrologists

Embryo Implantation and Placental Development

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