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Nuclear receptors represent a large family of ligand-activated transcription factors which sense the physiological environment and make long-term adaptations by mediating changes in gene expression. In this review, we will first discuss the fundamental mechanisms by which nuclear receptors mediate their transcriptional responses. We will focus on the PPAR (peroxisome proliferator-activated receptor) family of adopted orphan receptors paying special attention to PPARγ, the isoform with the most compelling evidence as an important regulator of arterial blood pressure. We will review genetic data showing that rare mutations in PPARγ cause severe hypertension and clinical trial data which show that PPARγ activators have beneficial effects on blood pressure. We will detail the tissue- and cell-specific molecular mechanisms by which PPARs in the brain, kidney, vasculature, and immune system modulate blood pressure and related phenotypes, such as endothelial function. Finally, we will discuss the role of placental PPARs in preeclampsia, a life threatening form of hypertension during pregnancy. We will close with a viewpoint on future research directions and implications for developing novel therapies.

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Introduction: Diagnosis and management of fetal thrombosis during pregnancy is rare. Few cases of prenatally diagnosed inferior vena cava thrombi are reported and often occur with renal vein thrombi. Several maternal and fetal risk factors have been identified, including thrombophilias. Case Report: Patient is a 39-year-old G6P2123 with heterozygous Factor V Leiden with a prenatally diagnosed fetal inferior vena cava thrombus at 34 weeks of gestation during antenatal ultrasound. Her peripartum course was uncomplicated. On day 1 of life, neonatal ultrasound and computed tomography confirmed the presence of thrombus. On day 7, the neonate underwent a thrombectomy for definitive management due to risk of embolization. Conclusion: While ultrasound is not routinely used for screening for fetal thromboses, when thrombosis is diagnosed, antenatal management is complex, weighing fetal and maternal risks and benefits. Thrombectomy as definitive thrombus management is an appropriate treatment when risk of embolization exists. Imaging modalities are useful for both diagnosis and management of fetal thrombi.

The Edinburg postpartum depression scale (EPDS) is a valuable tool to screen for perinatal depression. Recognizing depression after diagnosis of fetal anomaly is important to protect mother and baby from adverse outcomes. Our objective is to assess the impact of fetal intervention (FI) on mothers diagnosed with fetal anomaly. STUDY DESIGN: Retrospective review of patients with confirmed fetal anomaly receiving prenatal care at our center from January 2018 to January 2020. FI was offered for open neural tube defects, fetal anemia, congenital diaphragmatic hernia, pleural effusion, bladder obstruction, and twin-twin transfusion syndrome. EPDS surveys were administered during perinatal care. Patients were separated into two groups: Fetal anomaly-intervention (FA-FI) and no intervention (FA-non FI). Women with elevated EPDS scores (! 10) or indication for assessment were referred to psychiatry. Fisher's exact test and logistic regression analyses were performed, with statistical significance defined as p<0.05. RESULTS: 462 patients met criteria, 77 in the FA-FI and 385 in the FA-non FI group. There was no significant difference in mean EPDS scores between FA-FI and FA-non FI, antenatal [5.48 (AE4.60), 5.95 (AE5.53), p ¼ 0.25] or postnatal [6.44 (AE4.56), 6.62 (AE5.93), p ¼ 0.39]. However, women with a diagnosis of cardiac anomaly who underwent FI had greater antenatal EPDS scores [7.75 (AE1.50) vs. 5.49 (AE5.21), p ¼ 0.02]. Positive psychiatric history was a significant predictor of depression (p < 0.0001). Neither intervention (p ¼ 0.24) nor anomaly (p ¼ 0.43) were predictive of depression. The FAnon FI group had a higher EPDS score in the postnatal period in patients followed and treated by psychiatry [8.29 (AE4.60) vs 12.18 (AE5.97), p ¼ 0.007; 6.33 (AE3.33) vs 10.58 (AE4.49), p ¼ 0.01]. CONCLUSION: Type of anomaly or need for intervention were not predictive of depression in the perinatal period. The greatest predictor of depression is a history of a pre-existing psychiatric disorder. For patients with fetal anomaly, not receiving FI, depression presents in the postnatal period during psychiatric treatment.