Association between gamete source,exposure and preeclampsia: A review of literature

Preeclampsia complicates 3%-5% of pregnancies and is one of the major causes of maternal morbidity and mortality. The pathologic mechanisms are well described but despite decades of research, the exact etiology of preeclampsia remains poorly understood. For years it was believed that the etiology of preeclampsia was the result of maternal factors, but recent evidence suggests that preeclampsia may be a couple specific disease where the interplay between both female and male factors plays an important role. Recent studies have suggested a complex etiologic mechanism that includes genetic imprinting, immune maladaptation, placental ischemia and generalized endothelial dysfunction. The immunological hypothesis suggests exaggerated maternal response against fetal antigens. While the role of maternal exposure to new paternal antigens in the development of preeclampsia was the initial focus of research in this area, studies examining pregnancy outcomes in pregnancies from donor oocytes provide intriguingly similar findings. The pregnancies that resulted from male or female donor gametes or donor embryos bring new insight into the role of immune response to new antigens in pathogenesis of preeclampsia. The primary goal of the current review is the role of exposure to new gametes on the development of preeclampsia. The objective was therefore to provide a review of current literature on the role of cohabitation length, semen exposure and gamete source in development of preeclampsia.     

子痫前期的表观遗传学研究进展

子痫前期是一种严重的产科并发症,可导致母体多系统不可逆损伤以及胎儿生长受限。子痫前期在临床上一经诊断,终止妊娠、娩出胎盘是唯一的根治方法。国内外学者关于子痫前期发病机制有很多学说,但是具体病因至今未明。表观遗传学是相对于传统的遗传学而被研究者所认识,重点阐述DNA序列不变的情况下机体所发生的可遗传改变。最近表观遗传学在子痫前期发病中的研究方兴未艾,表观遗传的各种机制在子痫前期发生中的作用主要涉及DNA甲基化、微小RNA（miRNA）以及基因印迹三个方面。     

脂代谢和脂肪酸代谢与子痫前期

子痫前期是母体在多因素、多机制和多通路作用下的综合征表现形式。孕前及孕期的脂代谢和脂肪酸代谢异常在某些子痫前期发生发展中发挥了重要作用。认识脂代谢和脂肪酸代谢相关遗传、环境、营养及基础疾病因素与子痫前期的关系,更利于深入理解子痫前期多因素、多机制、多通路的发病机制。     

Preeclampsia and the Anti-Angiogenic State

Preeclampsia is a major cause of maternal and fetal morbidity and mortality worldwide, however, its etiology remains unclear. Abnormal placental angiogenesis during pregnancy resulting from high levels of anti-angiogenic factors, soluble Flt1 (sFlt1) and soluble endoglin (sEng), has been implicated in preeclampsia pathogenesis. Accumulating evidence also points to a role for these anti-angiogenic proteins as serum biomarkers for the clinical diagnosis and prediction of preeclampsia. Uncovering the mechanisms of altered angiogenic factors in preeclampsia may also provide insights into novel preventive and therapeutic options.     

子痫前期的营养管理

子痫前期病因不明,孕期营养在降低子痫前期发病中的作用备受关注。早期防控有利于控制风险,改善母婴预后,产前施行营养干预和评估,保证其孕期各营养物质合理、足量的摄入,对预防子痫前期的发生具有重要临床意义,有待进一步的研究提供更多的证据。     

Placental Microparticles,DNA, and RNA in Preeclampsia

Preeclampsia is a common disorder of the second half of pregnancy that complicates 2% to 7% of all pregnancies worldwide and remains a major cause of maternal and fetal morbidity and mortality. Although the origin of the disease is still elusive, population-based studies have suggested that it might implicate genetic, immunologic, or physiologic factors. On the other hand, there is no doubt that the placenta plays an important role in its development. In preeclampsia, the shedding of placenta debris, such as syncytiotrophoblast microparticles (STBMs) and DNA and messenger RNA molecules, into the maternal peripheral blood is increased. The analysis of this material may give new insight into placentation and the underlying etiology of this disorder, as well as yield new tracks of research for the understanding of the molecular mechanisms, leading to the generation of the clinical symptoms.     

低分子肝素在重度子痫前期早期干预中的作用

重度子痫前期是危害严重的妊娠期特有疾病,常伴有严重的母婴并发症,导致不良妊娠结局。低分子肝素有抗凝、抗炎、保护血管内皮细胞的作用,能从多方面对抗重度子痫前期的病理生理过程,可用于重度子痫前期早期的干预治疗,对降低母儿并发症及延缓疾病发展具有重要意义。     

既往子痫前期病史者再次妊娠的保健

子痫前期病史是此次妊娠子痫前期发病的独立危险因素,复发性子痫前期有更严重的不良妊娠结局。子痫前期复发受多因素影响,预防尤为重要。全面评估母体风险因素、强化孕期个体化管理、实施早期预防和早期干预、在恰当的时机终止妊娠,是减少或避免子痫前期复发、改善妊娠结局和远期预后的关键。     

Cerebrovascular accidents complicating pregnancy and the puerperium

The decreasing incidence of direct causes of maternal death over the past half century has led to a heightened awareness of nonobstetric factors responsible for maternal mortality. For example, cerebrovascular accidents are an important nonobstetric cause of maternal morbidity and mortality. During the 6.5-year period from 1984 to mid-1990, we encountered 15 women in whom pregnancy or the puerperium was complicated by an acute cerebrovascular accident. Six of these women had hemorrhagic strokes and nine had ischemic strokes. During this same time, approximately 90,000 women were delivered at Parkland Memorial Hospital, and thus the incidence of stroke was about one in 6000 pregnancies. Chronic hypertension or preeclampsia was causative in three cases of hemorrhagic stroke. It is important that 20% of the women died as a result of stroke, and of the 12 survivors, 40% have residual neurologic deficits. An aggressive work-up to define the etiology of stroke is necessary in order to implement cause-specific management, with subsequent reduction in morbidity and mortality.     

The functional role of the renin-angiotensin system in pregnancy and preeclampsia

During normal pregnancy, the renin-angiotensin system (RAS) plays a vitally important role in salt balance and subsequent well-being of mother and fetus. In this balance, one must consider not only the classical renal RAS but also that of the uteroplacental unit, where both maternal and fetal tissues contribute to the signaling cascade. Many studies have shown that in normal pregnancy there is an increase in almost all of the components of the RAS. In derangements of pregnancy this delicate equilibrium can become unbalanced. Preeclampsia is one such case. It is a disorder of pregnancy characterized by hypertension, proteinuria and placental abnormalities associated with shallow trophoblast invasion and impaired spiral artery remodeling. Despite being a leading cause of maternal death and a major contributor to maternal and perinatal morbidity, the mechanisms responsible for the pathogenesis of preeclampsia are poorly understood. Immunological mechanisms and the RAS have been long considered to be involved in the development of preeclampsia. Numerous recent studies demonstrate the presence of the angiotensin II type I receptor agonistic autoantibody (AT(1)-AA). This autoantibody can induce many key features of the disorder and upregulate molecules involved in the pathogenesis of preeclampsia. Here we review the functional role of the RAS during pregnancy and the impact of AT(1)-AA on preeclampsia.     

Screening for preeclampsia in twin pregnancies

Twin pregnancies are an important risk factor for preeclampsia, a hypertensive disorder of pregnancy that is associated with a significant risk of maternal and perinatal morbidity. Given the burden of preeclampsia, the identification of women at high risk in early pregnancy is essential to allow for preventive strategies and close monitoring. In singleton pregnancies, the risk factors for preeclampsia are well established, and a combined first-trimester prediction model has been shown to adequately predict preterm disease. Furthermore, intervention with low-dose aspirin at 150 mg/day in those identified as high-risk reduces the rate of preterm preeclampsia by 62%. In contrast, risk factors for preeclampsia in twin pregnancies are less established, the proposed screening models have shown poor performance with high false-positive rates, and the benefit of aspirin for the prevention of preeclampsia is not clearly demonstrated. In this review, we examine the literature assessing prediction and prevention of preeclampsia in twin pregnancies.     

Role of vitamin D in influencing angiogenesis in preeclampsia

ABSTRACT

Objective: Vitamin D plays a key role during pregnancy and is involved in implantation and maintenance of pregnancy. Its deficiency is associated with pregnancy complications like preeclampsia, characterized by abnormal angiogenesis.Method: The current article summarises studies examining the role of vitamin D in pregnancy, with special emphasis on preeclampsia.Results and conclusion: An imbalance in pro- and anti-angiogenic factors is reported in women with preeclampsia. Cell culture studies have demonstrated that vitamin D can influence the process of angiogenesis. However, the role of maternal vitamin D in influencing placental angiogenesis in preeclampsia is unclear and needs to be explored.     

Gene expression of the constant region of the heavy chain of immunoglobulin G (IgG CRHC) is down-regulated in human decidua in association with preeclampsia

An aberrant interaction at the maternal/fetal interface between the genetically distinct fetal trophoblast cells and cells of the maternal decidua has been proposed as an initiating factor in one of the major complications of human pregnancy, preeclampsia. Biochemical and epidemiological studies suggest that the immune system plays an important role in preeclampsia. Thus, the aim of this study was to determine the decidual gene expression status in preeclampsia of one of the key components of the adaptive immune system. Total RNA was extracted from decidua collected from women with normal pregnancies and those complicated by preeclampsia. Reverse Northern analysis was performed on 72 cDNAs from human decidua and differentially expressed genes identified were analysed further using semi-quantitative RT-PCR and Northern blot analysis. Expression of the gene encoding the constant region of the heavy chain of immunoglobulin G (IgG CRHC) was shown to be down-regulated in association with preeclampsia. These data support the hypothesis that immune maladaptation may play an important role in the pathogenesis of preeclampsia.     

Preeclampsia Due to Fetal Non-immune Hydrops: Mirror Syndrome and Review of Literature

Objective.?Mirror syndrome (Ballantyne's syndrome) refers to the association of fetal hydrops and maternal preeclampsia. The aim of this study was to determine the relation and incidence between fetal hydrops and preeclampsia in our clinic.?Methods.?A retrospective review of patients associated with fetal hydrops and findings with preeclampsia was used. Seventy-five cases with single pregnancy and diagnoses with nonimmune hydrops fetalis were found. According to the data 4 cases were found related with preeclampsia.?Results.?Mirror syndrome is rarely encountered and underdiagnosed. We found a frequency of 5.3% (4 cases in 75 affected pregnancies) for single non-immune hydrops cases in which maternal hypertension occurred. Fetal outcome is depending on etiology and prognosis is mainly very low. Maternal symptoms and laboratory findings are resolving after intrauterine fetal death or delivery. Conclusion. Hydrops fetalis must be considered as a potential risk factor for preeclampsia. It is important that this clinical condition has a potential of about 5% for proceeding preeclampsia.     

Preeclampsia: a review of the role of prostaglandins

The etiology of preeclampsia remains unknown. Because of their widespread and varied effects in the human body, prostaglandins--specifically PGI2, thromboxane A2, PGE, and PGF2 alpha--have come under much investigation as possible etiologic factors. The vasodilating, platelet-disaggregating prostaglandins (PGI2 and PGE) are increased during normal pregnancy and may account for many of the observed hemodynamic changes, which begin as early as the first trimester. In contrast, a relative increase in the vasoconstricting, platelet-aggregating prostaglandins (thromboxane A2 and PGF2 alpha) is seen in preeclampsia. The disruption in the delicate balance between these two opposing pairs of prostaglandins may play an important role in the causation of preeclampsia. The growing body of literature that deals with the relationship between prostaglandins and preeclampsia is discussed.     

子痫前期孕妇血清中氧化应激产物H_2O_2对sHLA-G表达的影响

目的:探讨子痫前期患者血清中氧化应激产物H2O2对可溶性人类白细胞抗原G(sHLA-G)表达的影响,分析早发型及晚发型子痫前期的病因。方法:选择早发型和晚发型子痫前期孕妇各15例为研究组,以同期正常孕妇15例为对照组。采用比色法及ELISA法分别检测3组研究对象血清中H2O2含量和sHLA-G表达,并进行相关性分析。结果:(1)早发型及晚发型子痫前期组孕妇血清中H2O2呈高水平表达[(58.43±3.56)μmol/L,(29.84±7.67μmol/L)],与正常妊娠组相比[(21.61±4.25)μmol/L],差异均有统计学意义(P均<0.05);早发型子痫前期组孕妇血清中H2O2含量显著高于晚发型子痫前期组(P<0.05)。(2)早发型及晚发型子痫前期组孕妇血清中sHLA-G呈低水平表达[(28.65±9.16)U/ml,(51.84±8.67)U/ml],与正常妊娠组[(98.13±13.26)U/ml]相比,差异有统计学意义(P均<0.05);早发型子痫前期组孕妇血清中sHLA-G表达量显著低于晚发型子痫前期组(P<0.05)。(3)正常妊娠、子痫前期孕妇血清中的H2O2水平与sHLA-G表达呈负相关(r=-0.835,P<0.05)。结论:早发型子痫前期发病早,受氧化应激损伤更严重,血清中sHLA-G表达量更低;氧化应激产物H2O2可能潜在下调sHLA-G表达,与子痫前期发病及病情轻重程度相关。     

Implantationsst?rungen, Pr?eklampsie und intrauterine Wachstumsrestriktion

Preeclampsia and intrauterine growth restriction (IUGR) are major pregnancy pathologies and the leading causes of maternal and perinatal mortality and morbidity. Interestingly the etiologies of both syndromes are still unclear which is why a large number of hypotheses have been developed. The joint occurrence of both syndromes in a single pregnancy has deleterious effects on both mother and child. Studies dealing with such severe cases of preeclampsia with associated IUGR have led to the development of hypotheses attempting to explain all clinical and morphological alterations in a single hypothesis. This in turn has resulted in the general misconception that a failure in invasion of the placental trophoblast is directly linked with the etiology of preeclampsia. However, recent progress in the identification of new biomarkers to predict preeclampsia has changed views on the etiology of preeclampsia. It has become clear that a failure in trophoblast invasion is directly linked to IUGR while a defect of the villous trophoblast precedes preeclampsia.     

Post Magpie: how should we be managing severe preeclampsia?

PURPOSE OF REVIEW: Preeclampsia is a common complication of pregnancy and a significant cause of fetal and maternal morbidity and mortality. The purpose of this review is to highlight and discuss aspects of some of the more recent clinical management papers published in the field of preeclampsia and eclampsia. The title explains the clinical nature of this paper and a detailed review of the basic science literature is beyond the scope of this article. RECENT FINDINGS: Several controversial areas still exist in the current management of severe preeclampsia/eclampsia. We present a number of interesting papers dealing with practical management questions and discuss the optimum treatment regimen for preventing eclampsia. The findings of the MAGPIE study are discussed. Opinions are expressed as to the current management of preterm severe preeclampsia, and we outline a new hypothesis on the etiology of eclampsia. SUMMARY: Preeclampsia/eclampsia remains a disease without a clear etiology. Despite this, clinical management issues are being addressed and maternal morbidity and mortality continue to fall.     

Genes and the preeclampsia syndrome

Preeclampsia is specific to pregnancy and is still a leading cause of maternal and perinatal mortality and morbidity, affecting about 3% of women, but the underlying pathogenetic mechanisms still remain unclear. Immune maladaptation, placental ischemia and increased oxidative stress represent the main components discussed to be of etiologic importance, and they all may have genetic implications. Since the familial nature of preeclampsia is known for many years, extensive research on the genetic contribution to the pathogenesis of this severe pregnancy disorder has been performed. In this review, we will overview the linkage and candidate gene studies carried out so far as well as summarize important historical notes on the genetic hypotheses generated in preeclampsia research. Moreover, the influence of maternal and fetal genes and their interaction as well as the role of genomic imprinting in preeclampsia will be discussed.     

子痫前期复发危险因素分析

Objective?The purpose of this study was to investigate the related risk factors of recurrent preeclampsia. Methods?Medical documents of 115 women who had second singleton pregnancy with the previous pregnancy complicated with preeclampsia were retrospectively analyzed from January 2010 to December 2020. These women were divided into two groups, 71 with preeclampsia and 44 without preeclampsia in the subsequent pregnancy. Data was analyzed using univariate analysis and multivariate logistic regression. Results?① Univariate analysis showed that the pre-pregnancy blood pressure, body mass index(BMI), delivered gestational weeks, NICU, birth weight, maternal serum ALB/CR/LDH have an effect on the recurrence of preeclampsia(P<0.05). ② The diagnostic gestational age and pre-existing chronic hypertension of previous pregnancy may have an effect on the recurrence of preeclampsia(P<0.05).③ After adjusting for confounding factors, the recurrence of preeclampsia was found to be influenced by the level of systolic blood pressure before the subsequent pregnancy (OR=1.135, 95%CI 1.067~1.205, P=0.000). Conclusion?The level of systolic blood pressure before the subsequent pregnancy is an independent risk factor for the recurrence of preeclampsia.