Effect of aspirin response signature gene expression on preterm birth and preeclampsia among women with lupus: a pilot study.
Eudy A M,Voora D,Myers R A,Clowse M E B
BACKGROUND:Women with lupus have an increased risk of preeclampsia and preterm birth, and aspirin 81 mg/day is recommended as a preventative measure for preeclampsia. This pilot study quantified the association between a 60-gene aspirin response signature (ARS) gene expression with preterm birth and preeclampsia risk among women with lupus taking aspirin. METHODS:The analysis included 48 RNA samples from 23 pregnancies in the Duke Autoimmunity Pregnancy Registry. RNA was isolated from peripheral blood, and quantitative polymerase chain reaction was performed for ARS genes. The primary outcome was poor pregnancy outcome (preeclampsia or preterm birth). Gene expression was modeled as a response to presence or absence of a poor pregnancy outcome using linear regression models, stratified by trimester. RESULTS:Of the 23 pregnancies, nine delivered preterm and four had preeclampsia. Expression of and was higher in the second trimester among patients who experienced a poor pregnancy outcome compared to those who did not. However, in a global test of all ARS genes, we identified no association between expression of ARS genes and poor pregnancy outcomes. CONCLUSION:Our pilot study identified two candidate genes that are reflective of the platelet function response to aspirin. Further work is needed to determine the role of these genes in identifying women with lupus at high risk for preeclampsia and preterm delivery despite aspirin therapy.
Association of MicroRNA-210 and MicroRNA-155 with severity of preeclampsia.
Youssef Hanan Mohamed Gabr,Marei Elham Sayed
BACKGROUNDS AND OBJECTIVES:Preeclampsia (PE) is one of the leading causes of maternal and neonatal morbidity and mortality. Preeclampsia is associated with aberrant expression of several MicroRNAs which function as gene regulators. The present study aims to determine the expression of MicroRNA-210 and MicroRNA-155 in Preeclampsia, and to detect the association of MicroRNA-210 and MicroRNA-155 levels with the severity of Preeclampsia. METHODS:The study was carried out on thirty PE pregnant women as the Preeclampsia group compared to twenty healthy pregnant women who served as the control group. The patients were chosen at labor wards from Ain Shams Maternity Hospital during the period from June to December 2016. Preeclampsia group was then subdivided into mild Preeclampsia and severe Preeclampsia subgroups according to the levels of arterial blood pressure with the presence of thrombocytopenia, impairment in liver function, progressive renal insufficiency, pulmonary edema and cerebral or visual disturbance. MicroRNA-210 and MicroRNA-155 were estimated by a quantitative real time polymerase chain reaction (qRT-PCR). Results of this study showed that the levels of MicroRNA-210 and MicroRNA-155 detected in the Preeclampsia group are significantly higher than in the control group. Although MicroRNA-210 levels showed high significant increase in severe PE compared to mild PE cases, there were no significant differences in MicroRNA-155 levels between the two PE subgroups detected. CONCLUSIONS:MicroRNA-210 may be the noncoding RNA at the molecular level in which the increase in its level accompanies the progression of PE; and is closely associated with the severity of Preeclampsia.
Maternal and perinatal outcome of preeclampsia without severe feature among pregnant women managed at a tertiary referral hospital in urban Ethiopia.
Belay Tolu Lemi,Yigezu Endale,Urgie Tadesse,Feyissa Garumma Tolu
BACKGROUND:Preeclampsia refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. Pregnant women with preeclampsia are at an increased risk of adverse maternal, fetal and neonatal complications. The objective of the study is, therefore, to determine the maternal and perinatal outcome of preeclampsia without severity feature among women managed at a tertiary referral hospital in urban Ethiopia. METHODS:A hospital-based prospective observational study was conducted to evaluate the maternal and perinatal outcome of pregnant women who were on expectant management with the diagnosis of preeclampsia without severe feature at a referral hospital in urban Ethiopia from August 2018 to January 2019. RESULTS:There were a total of 5400 deliveries during the study period, among which 164 (3%) women were diagnosed with preeclampsia without severe features. Fifty-one (31.1%) patients with preeclampsia without severe features presented at a gestational age between 28 to 33 weeks plus six days, while 113 (68.9%) presented at a gestational age between 34 weeks to 36 weeks. Fifty-two (31.7%) women had maternal complication of which, 32 (19.5%) progressed to preeclampsia with severe feature Those patients with early onset of preeclampsia without severe feature were 5.22 and 25.9 times more likely to develop maternal and perinatal complication respectively compared to late-onset after 34 weeks with P-value of <0.0001, (95% CI 2.01-13.6) and <0.0001(95% CI 5.75-115.6) respectively. CONCLUSION:In a setting where home-based self-care is poor expectant outpatient management of preeclampsia without severe features with a once per week visit is not adequate. It's associated with an increased risk of maternal and perinatal morbidity and mortality. Our findings call for special consideration and close surveillance of those women with early-onset diseases.
Pregnancy outcomes in correlation with placental histopathology in subsequent pregnancies complicated by preeclampsia.
Levy Michal,Kovo Michal,Schreiber Letizia,Kleiner Ilia,Koren Liron,Barda Giulia,Volpert Eldar,Bar Jacob,Weiner Eran
OBJECTIVE:In attempt to deepen our understanding of the etiopathogenesis of preeclampsia we aimed to study the placental component and pregnancy outcomes in two consecutive pregnancies complicated by preeclampsia in the same patient. STUDY DESIGN:Pregnancy and placental reports of all pregnancies complicated by preeclampsia between 2008 and 2018 were reviewed. Included were only cases with recurrent preeclampsia in two consecutive pregnancies Neonatal outcomes and placental histopathology were compared between the first preeclampsia delivery (first preeclampsia group) and the subsequent preeclampsia delivery (subsequent preeclampsia group), thus each subject served as her own control in two consecutive pregnancies. Placental lesions were classified according to the current "Amsterdam" criteria. Adverse neonatal outcome was defined as ≥1 early neonatal complication. RESULTS:Included in the study a total of 83 cases with recurrent preeclampsia. The first preeclampsia group delivered at an earlier gestational age (35.7 ± 3.7 vs. 36.8 ± 3.1 weeks, p = 0.03) and had higher rates of severe features (44.6% vs. 25.3%, p = 0.03), placental weight <10th percentile (44.5% vs. 26.5%, p = 0.02), maternal vascular malperfusion (MVM) lesions (84.3% vs. 62.6%, p = 0.002), SGA (44.5% vs. 33.7%, p = 0.03), and adverse neonatal outcome (55.4% vs. 34.9%,p = 0.01), compared to the subsequent preeclampsia group. Using multivariate logistic regression analysis, severe features (aOR = 1.36, 95%CI = 1.12-2.36), MVM lesions (aOR = 1.12, 95%CI = 1.04-1.87) and adverse neonatal outcome (aOR = 1.26 95%CI = 1.14-2.23) were found to be independently associated with the first preeclampsia group. CONCLUSION:The first event of preeclampsia is characterized by an earlier, more severe presentation, as well as a higher rate of MVM lesions, SGA, and adverse neonatal outcome, compared to preeclampsia in a subsequent pregnancy.
Levels of sex steroid hormones and their receptors in women with preeclampsia.
Lan Kuo-Chung,Lai Yun-Ju,Cheng Hsin-Hsin,Tsai Ni-Chin,Su Yu-Ting,Tsai Ching-Chang,Hsu Te-Yao
Reproductive biology and endocrinology : RB&E
BACKGROUND:Pregnant women have high serum concentrations of sex steroid hormones, which are major regulators of paracrine and autocrine responses for many maternal and placental functions. The main purpose of this study was to compare patients with preeclampsia and patients with uncomplicated pregnancies in terms of serum steroid hormones (estradiol [E2], progesterone [P4], dehydroepiandrosterone sulfate [DHEAS], and testosterone [T]) throughout pregnancy and the levels of cord blood and placental steroid receptors during the third trimester. METHODS:Quantitative real-time reverse transcription PCR, western blotting, and immunohistochemistry were used to determine the levels of steroid hormones in the serum and cord blood and the placental levels of estrogen receptor-α (ERα), ERβ, androgen receptor (AR), and progesterone receptor (PR). RESULTS:There were 45 women in the uncomplicated pregnancy group and 30 women in the preeclampsia group. Serum levels of T were greater and serum levels of E2 were reduced in the preeclampsia group, but the two groups had similar levels of P4 and DHEAS during the third trimester. Cord blood had a decreased level of DHEAS in the preeclampsia group, but the two groups had similar levels of P4, E2, and T. The two groups had similar placental mRNA levels of ERα, ERβ, AR, and PR, but the preeclampsia group had a higher level of ERβ protein and a lower level of ERα protein. Immunohistochemistry indicated that the preeclampsia group had a greater level of ERβ in the nucleus and cytoplasm of syncytiotrophoblasts and stromal cells. CONCLUSIONS:Women with preeclampsia had lower levels of steroid hormones, estrogen, and ERα but higher levels of T and ERβ. These molecules may have roles in the pathogenesis of preeclampsia.