Second-trimester levels of maternal serum human chorionic gonadotropin and inhibin a as predictors of preeclampsia in the third trimester of pregnancy

OBJECTIVE: To determine whether second-trimester maternal serum levels of inhibin A, human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and alpha-fetoprotein (AFP) are predictive of the later onset of preeclampsia in pregnancy. METHODS: Retrospective evaluation of serum analyte levels in 60 women with preeclampsia compared with 300 controls. Levels of each analyte were compared in women with preeclampsia and controls using matched rank analysis. Analytes that were significantly different between groups were examined with univariate and bivariate Gaussian distribution analysis. RESULTS: Second-trimester inhibin A (1.36 multiples of the median [MoM]) and hCG (1.40 MoM) levels were significantly but modestly elevated in women who later developed preeclampsia. A combination test of maternal age plus inhibin A and hCG predicted 23% of cases of preeclampsia with 95% specificity. There was a statistically significant trend for inhibin A, but not hCG, levels to be higher when the onset of preeclampsia occurred within a shorter (<17 weeks) interval after collection of the second-trimester screening sample. CONCLUSIONS: Second-trimester serum levels of inhibin A and hCG are modest predictors of the later onset of preeclampsia. Inhibin A may be a better predictor of early-onset preeclampsia, which is associated with a higher maternal and perinatal morbidity and mortality, than preeclampsia at or near term.     

Bioactivity of serum hCG in preeclampsia

OBJECTIVE: To compare hCG levels, obtained by biologic and immunologic means, in women with normal pregnancies and women with preeclampsia. METHODS: Peripheral blood samples from women in the third trimester with preeclampsia (n = 30) or normal pregnancies (n = 30) were assayed for immunoactive and bioactive hCG (mouse Leydig cell testosterone production assay). RESULTS: Serum bioactive hCG levels tended to be lower than normal, and immunoactive hCG levels tended to be higher in women with preeclampsia, but the differences were not statistically significant. However, the ratio of bioactive to immunoactive hCG was significantly lower than normal for preeclamptic women (0.70 +/- 0.28 vs. 1.15 +/- 0.35 for normotensive pregnant women [mean +/- standard deviation], P <.001). CONCLUSION: The ratio of bioactive to immunoreactive serum hCG is lower among preeclamptic than among normotensive pregnant women.     

Prevention of cardiovascular risk in women who had hypertension during pregnancy after 36 weeks gestation

Objective. The aim of our study was to investigate a possible correlation between the expression of the placenta-secreted hormones, β-subunit of human chorionic gonadotrophin (βhCG) and pregnancy-associated plasma protein A (PAPP-A), during the first trimester screening and the development of preeclampsia. Methods. A total of 155 patients between 11 + 0 and 13 + 6 weeks of gestation were enrolled in this study. PAPP-A and βhCG levels were measured using the KRYPTOR® system. Results. The serum levels of βhCG were significantly higher in pregnancies which subsequently developed preeclampsia. The PAPP-A concentration did not differ significantly in pregnancies complicated by preeclampsia than in uncomplicated pregnancies. Conclusion. These results might contribute to developing new tests in the prediction of preeclampsia.     

Prediction of preeclampsia or intrauterine growth restriction by second trimester serum screening and uterine Doppler velocimetry

OBJECTIVE: To assess the performance of screening for preeclampsia and intrauterine growth restriction by combining second trimester maternal serum screening and uterine Doppler ultrasound. METHODS: A cohort of 2,615 women underwent both maternal serum screening (using human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP)), and second trimester uterine artery Doppler. The sensitivity, specificity and predictive value of different combinations of both tests were compared. RESULTS: The mean values for hCG and AFP were significantly higher in women with subsequent preeclampsia (p < 0.0003 and p < 0.03, respectively). Taking into account obstetrical history, hCG and AFP levels, notching on uterine artery Doppler and parity, the adjusted odds ratios were significantly higher for a high level of hCG for preeclampsia, intrauterine growth restriction (IUGR) and pregnancy-induced hypertension. AFP level >1.5 MoM (multiples of the median) was significantly correlated with subsequent IUGR. The presence of a uterine notch was associated with a significantly higher risk of both preeclampsia and IUGR. The combination of an elevated serum level and the presence of a uterine notch had a positive predictive value (PPV) for preeclampsia of 25 and 21% for hCG and AFP, respectively. The combination of a bilateral notch with a low level of hCG or a high level of AFP had a PPV for IUGR of 50 and 43%, respectively. The sensitivity of the different tests ranged from 2 to 40%. CONCLUSION: The combination of serum markers and abnormal uterine Doppler ultrasound improves the identification of women at risk for subsequent pregnancy complications. These results should encourage care providers to perform a uterine Doppler ultrasound when serum markers are abnormal. However, the sensitivity of these tests is too low to provide an efficient generalized screening.     

Mid-trimester placentation assessment in high-risk pregnancies using maternal serum screening and uterine artery Doppler.

OBJECTIVE: To determine the value of uterine artery velocimetry and mid-trimester maternal serum AFP/hCG measurements in predicting pregnancy complications in a high-risk group of pregnant patients. METHODS: Eighty-eight patients with chronic hypertension, previous preeclampsia, and thrombophilia were included. Maternal serum AFP/hCG was examined between 15-16 weeks gestation. Levels > 3 multiple of median (MoM) for hCG and > 2 MoM for AFP were considered abnormal. Color Doppler ultrasound was performed at 23-24 weeks gestation. Diastolic notching and pulsatility index (PI) above the 95th percentile were considered abnormal. RESULTS: Thirty-three patients had abnormal uterine artery waveform: 8 patients had abnormal maternal serum hCG and 5 had abnormal maternal serum AFP. Bilateral abnormal uterine artery waveform was associated with pregnancies complicated by lower gestational age at delivery (p=0.05) and birth weight (p<0.01), higher rates of preeclampsia (p=0.006), SGA (p=0.0001), preterm delivery (p=0.0001), and cesarean section rate (p<0.0001) in comparison to patients with normal uterine artery Doppler. Pregnant women with elevated hCG had higher rates of preeclampsia (p=0.006); preterm delivery (p=0.005) and SGA (P=0.03) and, lower birth weight (p=0.001). No significant differences were noted for clinical outcomes according to AFP data. Conclusions. Abnormal uterine artery waveform is superior to maternal serum hCG for identification of placental pathology leading to preterm delivery, low birth weight, and preeclampsia in high-risk pregnant patients.     

Hyperglycosylated hCG

Hyperglycosylated hCG (hCG-H) is a glycosylation variant of the hormone hCG. Here we review all that is known about this independently functioning molecule. As discussed, it is a very different molecule to the hormone hCG. First, hCG-H is produced by cytotrophoblast cells while regular hCG is made in syncytiotrophoblast cell. Second, it is an autocrine acting directly on the cells which produce it, while regular hCG is an endocrine acting on maternal corpus luteal cells. Third, hCG-H has minimal biological activity in promoting progesterone production compared to regular hCG. Fourth, hCG-H functions unlike regular hCG as an invasion promoter, whether invasion as in choriocarcinoma and testicular germ cell malignancies, or as in implantation of pregnancy. These functions seemingly occur through action on cytotrophoblast cell TGFbeta receptors. Fifth, hCG-H is an essential component for successful human implantation to prevent early pregnancy loss and spontaneous abortion. Sixth, hCG-H is critical for promoting the midtrimester hemochorial implantation, and for preventing preeclampsia. Seventh, measurements of hCG-H have advantages over measurements of regular hCG or total hCG, in detecting pregnancy, pregnancy outcome (failing or term pregnancy), predicting preeclampsia in pregnancy, or as a tumor marker for gestational trophoblastic diseases.     

Down syndrome biochemical markers and screening for preeclampsia at first and second trimester: correlation with the week of onset and the severity

OBJECTIVES: To estimate the combined screening performance of first and early second trimester prenatal serum markers for Down syndrome, in screening for the development of preeclampsia, and analyze the correlation among marker levels, week of onset, and severity of the disease. METHODS: A retrospective cohort study was carried out on 32 women with preeclampsia and 3044 controls. Serum samples from these pregnancies were assayed for pregnancy-associated plasma protein-A (PAPP-A), alpha-fetoprotein (AFP), unconjugated estriol (uE3), human chorionic gonadotrophin (hCG), and inhibin-A. A likelihood ratio and the odds of being affected given a positive result (OAPR) of various combinations of markers were calculated and receiver operating characteristic (ROC) curves analysis was performed. RESULTS: In the pregnancies that subsequently developed preeclampsia, first trimester PAPP-A concentration was significantly lower and concentrations of early second trimester inhibin-A and hCG significantly elevated. Levels of early second trimester uE3 and AFP were not significantly altered. We also found that inhibin-A correlates with both onset of the disease and the severity. CONCLUSION: Down syndrome biochemical markers levels are altered in those patients who subsequently developed preeclampsia and may be a useful screening test for preeclampsia. Inhibin-A is the most predictive marker and correlates with the severity of subsequent preeclampsia and inversely with the week of occurrence of preeclampsia.     

Mid-Trimester Placentation Assessment in High-Risk Pregnancies Using Maternal Serum Screening and Uterine Artery Doppler

Objective. To determine the value of uterine artery velocimetry and mid-trimester maternal serum AFP/hCG measurements in predicting pregnancy complications in a high-risk group of pregnant patients. Methods. Eighty-eight patients with chronic hypertension, previous preeclampsia, and thrombophilia were included. Maternal serum AFP/hCG was examined between 15–16 weeks gestation. Levels > 3 multiple of median (MoM) for hCG and > 2 MoM for AFP were considered abnormal. Color Doppler ultrasound was performed at 23–24 weeks gestation. Diastolic notching and pulsatilty index (PI) above the 95th percentile were considered abnormal. Results. Thirty-three patients had abnormal uterine artery waveform: 8 patients had abnormal maternal serum hCG and 5 had abnormal maternal serum AFP. Bilateral abnormal uterine artery waveform was associated with pregnancies complicated by lower gestational age at delivery (p = 0.05) and birth weight (p < 0.01), higher rates of preeclampsia (p = 0.006), SGA (p = 0.0001), preterm delivery (p = 0.0001), and cesarean section rate (p < 0.0001) in comparison to patients with normal uterine artery Doppler. Pregnant women with elevated hCG had higher rates of preeclampsia (p = 0.006); preterm delivery (p = 0.005) and SGA (P = 0.03) and, lower birth weight (p = 0.001). No significant differences were noted for clinical outcomes according to AFP data. Conclusions. Abnormal uterine artery waveform is superior to maternal serum hCG for identification of placental pathology leading to preterm delivery, low birth weight, and preeclampsia in high-risk pregnant patients.     

Human chorionic gonadotropin and testosterone in normal and preeclamptic pregnancies in relation to fetal sex

OBJECTIVE: The aim of the present study was to evaluate the effects of fetal gender on serum human chorionic gonadotropin (hCG) and testosterone in normotensive and preeclamptic pregnancies. METHODS: The study consisted of 137 women with singleton pregnancies in the third trimester. Seventy-three pregnancies were uncomplicated; among those were 35 male and 38 female fetuses. Sixty-four pregnancies were complicated by preeclampsia; among those were 33 male and 31 female fetuses. Human chorionic gonadotropin and total testosterone were measured in maternal peripheral blood. RESULTS: In male-bearing pregnancies, maternal hCG and testosterone serum levels were significantly higher in preeclamptic than normotensive mothers (P <.001). In female-bearing pregnancies, testosterone levels were significantly higher in preeclamptic than normotensive mothers (P <.001), whereas the hCG levels were not significantly different. Male-bearing preeclamptic women had significantly higher testosterone levels than female-bearing preeclamptic women (P <.02), whereas the hCG levels were not significantly different. In uncomplicated pregnancies the hCG levels were significantly higher in female-bearing than in male-bearing mothers (P <.005), whereas the testosterone levels were not significantly different. CONCLUSION: In preeclamptic pregnancies with male fetuses, the maternal serum hCG levels were significantly higher than in uncomplicated pregnancies. Total testosterone levels were significantly higher in pregnancies with either gender and significantly higher in male-bearing than in female-bearing pregnancies. This may indicate an androgen influence on the pathophysiologic mechanism of preeclampsia.     

First trimester hyperglycosylated human chorionic gonadotrophin in serum – A marker of early-onset preeclampsia

Introduction

Recent studies indicate that treatment with low-dose aspirin may reduce the risk of preeclampsia. Thus, early prediction of preeclampsia is needed. Low serum concentrations of hyperglycosylated human chorionic gonadotrophin (hCG-h) are associated with early pregnancy loss. We therefore studied whether it may serve as an early marker of preeclampsia.

Methods

A nested case-control study included 158 women with subsequent preeclampsia, 41 with gestational hypertension, 81 normotensive women giving birth to small-for-gestational-age (SGA) infants and 427 controls participating in first trimester screening for Down's syndrome between 8 and 13 weeks of gestation. Gestational-age-adjusted multiples of medians (MoMs) were calculated for serum concentrations of hCG-h, the free beta subunit of hCG (hCGβ) and pregnancy-associated plasma placental protein A (PAPP-A) and the proportion of hCG-h to hCG (%hCG-h). Clinical risk factors including mean arterial pressure (MAP) and parity were also included in the risk calculation.

Results

In women with subsequent preeclampsia %hCG-h was lower than in controls (median MoM 0.92, P < 0.001), especially in 29 cases with early-onset preeclampsia (0.86, P < 0.001), in which PAPP-A also was reduced (0.95, P = 0.001). At 90% specificity for prediction of early-onset preeclampsia, sensitivity was 56% (95% confidence interval, 52–61%) for %hCG-h, 33% (28–37%) for PAPP-A, and 69% (51–83%) for the combination of these with first trimester MAP and parity. The area under the receiver-operating characteristic (ROC) curve for the combination of all these was 0.863 (0.791–0.935).

Conclusions

hCG-h is a promising first trimester marker for early-onset preeclampsia. Addition of PAPP-A and maternal risk factors may improve the results.     

Detrimental effects of high levels of antioxidant vitamins C and E on placental function: considerations for the vitamins in preeclampsia (VIP) trial

Aim:  Supplementation with antioxidant vitamins has been proposed to reduce the risk of preeclampsia and perinatal complications. In a recent study, it has been shown that this supplementation to above physiological doses does not reduce the risk of preeclampsia, but increases the rate of low birthweight babies, suggesting a detrimental effect on placental function, given the lower birthweight. The aim of the present study was to investigate the effects of high levels of antioxidants vitamins C and E on placental cells in vitro .
Methods:  Isolated fresh human cytotrophoblasts were exposed to high concentrations of vitamins C and E for 48 h. Then the secretion of human chorionic gonadotropin (hCG) and the production of tumor necrosis factor-alpha (TNF-α) were assessed.
Results:  High levels of vitamins C and E, separately or combined, decrease the secretion of hCG by cytotrophoblasts and increase their production of TNF-α.
Conclusion:  Exposure of cytotrophoblasts to high levels of antioxidant vitamins C and E may affect placental function, as reflected by decreased secretion of hCG; and placental immunity, as reflected by increased production of TNF-α. Such alterations are known to lead to endothelial dysfunction and adverse pregnancy outcomes, such as fetal growth restriction (FGR).     

Impaired fetal thymic growth precedes clinical preeclampsia: a case-control study

In preeclampsia the maternal adaptive immune system undergoes specific changes, which are different from the physiological processes associated with healthy pregnancy. Whether preeclampsia also affects the fetal immune system is difficult to investigate, due to limited access to the fetus. We hypothesized that if preeclampsia affects the fetal adaptive immune system this might be associated with early changes in thymic growth. In this case-control study, 53 preeclamptic and 120 healthy control pregnancies were matched for maternal age, gestational age and smoking. Fetal thymus diameter was measured as the greatest width perpendicular to a line connecting sternum and spine based on ultrasound images taken at 17-21 weeks gestation. Independent of fetal and maternal anthropometric measures, thymuses were found to be smaller in preeclamptic pregnancies than healthy controls (16.2 mm versus 18.3 mm, respectively, mean difference=2.1 mm, 95% CI: 0.8-3.3, p<0.001), and the odds of developing preeclampsia was estimated to be 0.72 (95% CI: 0.60-0.86, p<0.001) lower for each 1 mm increase in thymus diameter. There was no correlation between the onset of preeclampsia and fetal thymus size. This is the first study to suggest that fetal thymus growth is reduced before the clinical onset of preeclampsia and precedes any described fetal anomalies or maternal immunological changes associated with preeclampsia. We propose that the fetal adaptive immune system is either passively affected by maternal processes preceding clinical preeclampsia or is actively involved in initiating preeclampsia in later pregnancy.     

Elevated maternal mid-trimester chorionic gonadotropin > or =4 MoM is associated with fetal cerebral blood flow redistribution

BACKGROUND: Elevated mid-trimester human chorionic gonadotropin (hCG) is associated with adverse maternal and perinatal outcome. The aims of the study were to evaluate the association between elevated hCG, fetal pathological arterial waveforms and maternal and perinatal complications. METHODS: Pulsatility indices (PI) of middle cerebral artery (MCA) and umbilical artery (UA) were determined prospectively in 121 consecutive patients with abnormal maternal serum hCG (> 2.5 MoM). Each patient had four US scans during pregnancy. Patients with known structural or chromosomal anomalies were excluded. RESULTS: Of 121 women with hCG > 2.5 MoM, 36/121(29.6%) had hCG between 2.5 and 3.0 MoM, 35/121(28.9%) had hCG between 3.0 and 3.5 MoM, 21/121(17.3%) had hCG of 3.5-4.0 MoM, 17/121(14.1%) had hCG levels between 4.0 and 4.5 MoM, and 12/121(9.9%) had hCG > 4.5 MoM. Middle cerebral artery PI was significantly lower in women with hCG > 4.0 MoM between 28 and 36 weeks' gestation, but not between 18 and 27 weeks' gestation. No differences of MCA PI were found when the cut-off point of hCG was 3.5. Women with hCG levels > 4.0 MoM had a significantly higher rate of preterm deliveries, cesarean sections, higher rate of Apgar scores < 7 and a significantly lower mean birth weight in comparison with women with hCG < 4.0 MoM. The prevalence of PIH and preeclampsia and perinatal death were found to be higher among patients with hCG levels > 4.0 MoM, although not significantly. No differences were found at hCG levels less than 4.0 MoM. CONCLUSIONS: In pregnancies with mid-trimester hCG > 4.0 MoM, redistribution of cerebral blood flow is expressed after 28 weeks' gestation. These pregnancies have higher rates of maternal and neonatal complications as compared to pregnancies with lower hCG levels.     

Inflammatory changes in preeclampsia: current understanding of the maternal innate and adaptive immune response

Preeclampsia is characterized by generalized endothelial dysfunction as a result of an inappropriate maternal immune response against the fetus. It has been postulated that the adaptive immune system plays a key role in the etiology of preeclampsia by generating a pro-inflammatory Th1 type immune reaction. In this review, recent studies on Th1 and Th2 type cytokine mapping in preeclampsia are reviewed, as well as on the sources of pro-inflammatory cytokines and the role of regulatory cytokines and chemokines. In addition, we discuss the possible role of Toll-like receptors of the innate immune system in the pathophysiology of preeclampsia. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to summarize the newer concepts related to the pathogenesis of preeclampsia and explain the role of the maternal immune system and the role of pro-inflammatory and regulatory cytokines and chemokines in the pathophysiology of the disease.     

Elevated serum levels of interleukin-15 and interleukin-16 in preeclampsia

A generalized inflammatory response has been considered to be the main pathology and has an important role in the pathogenesis of preeclampsia. The immune aberrations per se and immunomodulatory milieu present in serum need to be elucidated. The purpose of the current investigation was to characterize changes in serum levels of interleukin (IL)-15 and IL-16 in preeclampsia. Thirty-seven women with preeclampsia were recruited and 36 age- and gestational age-matched women with normal pregnancy served as control. Levels of IL-15 and IL-16 were detected with immune assays in all serum samples. We found that serum levels of IL-15 and IL-16 were significantly higher in preeclampsia than in normal pregnancy (p<0.001 for both). There were significant differences in serum IL-15 and IL-16 between mild and severe preeclampsia (p<0.01 for both). Our data corroborate the hypothesis of an increased inflammatory response in preeclampsia, as illustrated by the elevated serum levels of IL-15 and IL-16, suggesting their possible role in the pathogenesis of preeclampsia. These associations may offer insight into the pathophysiology of preeclampsia.     

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.     

Circulating immune complexes in hypertensive disease of pregnancy

Circulating immune complexes in the blood of patients with hypertensive diseases of pregnancy were investigated. Sixty women with pregnancies between 30 and 40 weeks were studied. Of these patients, 22 were normal, 18 developed preeclampsia, 2 developed eclampsia, 14 had essential hypertension, and four had hypertension of renal origin. Circulating immune complexes were determined by the method of phagocytosis and immunofluorescence. They were found only in patients with preeclampsia or eclampsia, and were constituted of IgG and C3. It is suggested that the detection of circulating immune complexes by this method can be useful in the differential diagnosis of preeclampsia from other hypertensive diseases of pregnancy.     

Androgenetic complete mole coexistent with a twin live fetus.

OBJECTIVE: The aim of this study was to evaluate the clinical course and the management policy of complete mole coexistent with a twin live fetus confirmed with DNA polymorphism in a single hospital. METHODS: From 1981 to 1995, six patients with androgenetic complete hydatidiform mole coexistent with a twin live fetus were diagnosed by DNA polymorphism analysis. The clinical course of these six patients was analyzed. RESULTS: Two patients chose to terminate pregnancies and four patients desired to continue the pregnancy. However, the pregnancy had to be interrupted in two patients because of severe preeclampsia and sudden intrauterine fetal death. In two patients, fetuses were growing unremarkably and normal babies were delivered at term. The development of persistent trophoblastic tumor (PTT) in these rare pregnancies was higher (50.0%: 3/6) than that of single complete mole. In three patients, serum hCG titers during pregnancy were monitored. Although serum hCG levels progressively decreased during pregnancy in one patient without PTT, hCG levels initially decreased, but subsequently increased or showed a plateau with advancing gestational age in two patients with PTT. CONCLUSIONS: In patients with complete mole coexistent with a live fetus, the pregnancy may be allowed to continue when the fetal karyotype and development are normal and serum hCG titers are constantly falling with advancing gestational age.     

Enhancement of humoral immunity to the hCG beta protein antigen by fusing a molecular adjuvant C3d3

The vaccine directed against human chorionic gonadotropin (hCG) has previously undergone clinical test demonstrating the feasibility of the approach in preventing pregnancy in women. Some individuals, however, did not response adequately despite employing highly immunogenic bacterial toxoids as carriers. In this study, we investigated the potential of three copies of C3d as a new molecular adjuvant to enhance the immunogenicity of hCG beta protein antigen. The antibody response to the hCG beta-C3d3 fusion protein immunization was compared with those resulting from immunization with the hCG beta alone and the hCG beta plus CFA/IFA either in BALB/c mice or in C(57)BL/6J mice. Our results showed that the fusion of C3d3 to hCG beta protein antigen resulted in a significant elevation of the serum anti-hCG beta antibody level in the two mouse strains and the antibodies were capable of effectively neutralizing the bioactivity of hCG. The immunization with C3d3 as a molecular adjuvant favored Th2 bias of immune response. The immunity-enhancing effect of the C3d3 was 10-fold (initial) and 20-32-fold (booster) greater than CFA/IFA. These findings indicated that fusion of C3d3 to hCG beta, as a means of harnessing the adjuvant potential of the innate immune system, may improve immunogenicity of the hCG beta contraceptive vaccine, which is useful to produce a cost-effective vaccine and for the less-responsive population.     

蜕膜化缺陷在子痫前期发病机制中的研究进展

子痫前期是一种严重影响孕产妇和胎儿健康的妊娠期高血压疾病。其病因和发病机制至今尚未阐明,如何有效地预测、诊断和治疗子痫前期,一直是妇产科学界关注的焦点。子宫内膜的蜕膜化为胚胎着床和胚胎发育提供必需的营养和免疫豁免基质。而蜕膜细胞的生物学功能（增殖、分化、凋亡、血管发生和能量代谢等）紊乱所致的蜕膜化缺陷,可影响滋养层细胞的侵袭、炎症抵抗、氧化应激及免疫保护,影响胚胎着床和妊娠维持,从而调控子痫前期的发生、发展。充分了解蜕膜细胞的生物学功能异常所致的蜕膜化缺陷在子痫前期发病机制中的作用,将有助于为预测及诊治子痫前期提供更多的理论依据。