Risk factors differ between recurrent and incident preeclampsia: a hospital-based cohort study

PurposeTo examine whether risk factors, including prepregnancy body mass index (BMI), differ between recurrent and incident preeclampsia.MethodsData included electronic medical records of nulliparas (n = 26,613) delivering 2 times or more in Utah (2002–2010). Modified Poisson regression models were used to examine (1) adjusted relative risks (RR) of preeclampsia and 95% confidence intervals (CI) associated with prepregnancy BMI; (2) maternal risk factor differences between incident and recurrent preeclampsia among primiparous women.ResultsIn the first pregnancy, compared with normal weight women (BMI: 18.5–24.9), preeclampsia risks for overweight (BMI: 25–29.9), obese class I (BMI: 30–34.9), and obese class II/III (BMI: ≥35) women were 1.82 (95% CI = 1.60–2.06), 2.10 (95% CI = 1.76–2.50), and 2.84 (95% CI = 2.32–3.47), respectively, whereas second pregnancy–incident preeclampsia risks were 1.66 (95% CI = 1.27–2.16), 2.31 (95% CI = 1.67–3.20), and 4.29 (95% CI = 3.16–5.82), respectively. Recurrent preeclampsia risks associated with BMI were highest among obese class I women (RR = 1.60; 95% CI = 1.06–2.42) without increasing in a dose-response manner. Nonwhite women had higher recurrence risk than white women (RR = 1.70; 95% CI = 1.16–2.50), whereas second pregnancy–incident preeclampsia risk did not differ by race.ConclusionPrepregnancy BMI appeared to have stronger associations with risk of incident preeclampsia either in the first or second pregnancy, than with recurrence risk. Nonwhite women had higher recurrence risk.     

两种护理方式在子痫前期治疗中的应用

目的探讨子痫前期治疗中的有效护理方式。方法对该院2012年5月—2013年12月收治的86例子痫前期患者,分别予以循证护理、预见性护理方法,观察疗效、相关并发症、新生儿出生时体重、Apgar评分、患者疾病知识掌握情况、护理依从性、护理人员综合素质水平提高情况。结果经过治疗后,两组在治疗总有效率及新生儿出生存活率均为100%,两组差异无显著意义。在发生相关并发症,新生儿出生时体重及依从性方面,对照组分别为（3.3±0.5）、（8.9±0.2）优于循证组（2.7±0.4、（9.6±0.6）差异有统计学意义（P〈0.05）;而在患者疾病知识掌握情况,Apgar评分、护理人员综合素质水平提高方面,循证组分别为40（93.8）、37（86.2）、42（97.7）优于对照组36（84.5）、42（97.2）、33（76.2）,差异有统计学意义（P〈0.05）。结论两种方法均是子痫前期治疗中的有效护理方式,有效结合效果更佳。     

Reduction of maternal mortality due to preeclampsia in Colombia-an interrupted time-series analysis

Introduction:

Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program.

Methods:

General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions.

Results:

Five years after (2002 - 2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR=0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR=0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042).

Conclusions:

General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations.     

抗磷脂抗体和子痫前期的研究进展

抗磷脂抗体是一类能与磷脂或磷脂结合蛋白结合的自身免疫性抗体,与血栓形成、不良孕产史密切相关。抗磷脂抗体中高滴度阳性的患者易有子痫前期等不良妊娠结局。子痫前期发生于妊娠期,可导致全身多脏器的损伤,严重危及母儿生命和健康。子痫前期的发病机制目前还不是很清楚,研究提示抗磷脂抗体可能通过诱导氧化应激,促进血管内炎症等作用参与子痫前期的发病;对于抗磷脂抗体阳性的患者,早期发现和早期干预对获得良好的妊娠结局至关重要。     

外泌体源性miRNA在子痫前期发病机制中的研究进展

子痫前期作为一种妊娠期特有的高血压综合征,严重威胁母婴安全,但目前尚无准确的生物标志物作为诊断依据且其病因和发病机制尚未完全阐明。外泌体是广泛存在于体液中的细胞外囊泡,携带多种蛋白质、脂质和核酸等生物活性分子,具有多种生物学功能,其所携带的miRNA具有特异性、多元性、抗降解、能被稳定检出的特点。研究发现子痫前期患者胎盘组织分泌的外泌体中有多种差异表达的miRNA,表明其可能参与了子痫前期的发生发展,可能作为子痫前期预测的潜在靶点。本文对外泌体源性miRNA的结构、功能及其与子痫前期发病机制的研究进展进行综述,旨在为子痫前期早期预测及诊治提供新思路。     

Hemodynamic characteristics in preeclampsia women during cesarean delivery after spinal anesthesia with ropivacaine

BACKGROUND Very few studies have been published on the hemodynamic changes associated with spinal anesthesia induced with ropivacaine during cesarean deliveries in preeclamptic women.AIM To record and analyze hemodynamic data in women with preeclampsia undergoing cesarean delivery after spinal anesthesia induced with ropivacaine.METHODS Ten eligible women with preeclampsia were enrolled in this prospective observational study.Spinal anesthesia was performed with 2.4 mL of 0.5%ropivacaine.Hemodynamic changes were then analyzed at multiple time points.The hemodynamic responses to vasopressor interventions and uterotonic agents,as well as maternal and neonatal outcomes were also recorded.RESULTS Stable hemodynamic trends were observed in this study.Cardiac output(CO)and stroke volume increased mildly during surgery.In contrast,mean arterial pressure and systemic vascular resistance showed a moderate decrease from induction until the end of surgery.Central venous pressure dramatically increased after delivery.Oxytocin administration was associated with the most significant hemodynamic fluctuations during surgery,namely,an increase in CO and heart rate.Phenylephrine intervention was only required in three patients,and caused an increase in mean arterial pressure and systemic vascular resistance along with a decrease in heart rate,stroke volume,and CO.No maternal and neonatal complications were observed during this study,except transient episodes of hypotension.CONCLUSION Spinal anesthesia for caesarian delivery with ropivacaine in women with preeclampsia is linked to modest hemodynamic changes of no clinical significance in this study.Careful cardiovascular monitoring is still recommended,particularly after the delivery of the fetus or the use of oxytocin.     

子痫前期和凝血功能异常

子痫前期孕妇表现为病理性高凝状态,凝血功能的监测对妊娠期高血压疾病及其并发症的预防和治疗具有一定的临床意义.随着对子痫前期凝血机制的深入研究,阿司匹林、低分子肝素等抗凝剂在改善子痫前期母胎预后方面的作用受到了更多关注.     

Genetic polymorphisms in vasoactive genes and preeclampsia: a meta-analysis

There are controversies in reports on the association of polymorphisms in endothelial nitric oxide synthase, angiotensinogen, angiotensin receptor type 1 and angiotensin-converting enzyme genes with an increased risk of developing preeclampsia. We performed a systematic search of published case-control studies through the PubMed database up to January 2006, and report the results of a meta-analysis of polymorphisms investigated in more than five studies: Glu298Asp in eNOS gene (9 analyses involving 1055 patients and 1788 controls), Met235Thr in AGT gene (13 analyses involving 1128 patients and 2278 controls), and intron 16 insertion-deletion polymorphism in ACE gene (10 analyses involving 1121 patients and 1361 controls). Statistically significant associations with preeclampsia were identified for the Met235Thr/AGT polymorphism: OR 1.65 (95% CI 1.19, 2.29) if the polymorphism is considered under the dominant genetic model, and OR 1.54 (95% CI 1.12, 2.11) under the recessive model. For insertion-deletion/ACE polymorphism, statistical significance was demonstrated when the polymorphism was considered under the recessive model: OR 1.51 (95% CI 1.17, 1.94). No single polymorphism was identified as having a major effect.     

Syncytin-A Knockout Induces Placental Developmental Abnormalities Partially through Calpain1-Apoptosis-Inducing Factor-Mediated Trophoblast Apoptosis

Objective::Structural abnormalities and dysfunction of the placenta contribute to pregnancy-related complications, such as preeclampsia. Syncytin-A (synA) has b...     

子痫前期患者血清腺苷活化蛋白激酶水平与可溶性血管内皮生长因子受体-1及氧化应激的相关性

目的 分析子痫前期(PE)患者血清腺苷活化蛋白激酶(AMPK)水平与可溶性血管内皮生长因子受体-1(sFlt-1)及氧化应激的相关性。方法 选取2020年6月至2023年4月在成都医学院第一附属医院治疗的67例PE患者为试验组,选择本院同期住院的正常分娩孕妇50名为对照组。比较两组AMPK、sFlt-1和氧化应激反应水平[丙二醛(MDA)、超氧化物歧化物(SOD)];分析试验组不同严重程度的PE患者AMPK、sFlt-1、MDA、SOD水平差异;利用多变量逻辑回归方法对妊娠女性发病风险因子进行分析;分析试验组患者AMPK、sFlt-1与氧化应激的相关性。结果 试验组患者AMPK、sFlt-1、MDA水平均高于对照组,SOD水平低于对照组(P<0.05);轻度PE组的AMPK、sFlt-1、MDA水平均低于重度PE组,SOD高于重度PE组(P<0.05);两组妊娠期患糖尿病情况和AMPK、sFlt-1、MDA、SOD水平比较,差异有统计学意义(P<0.05);经多元Logistic回归分析显示,妊娠期合并糖尿病和AMPK、sFlt-1、MDA、SOD水平是影响孕妇发生P...