Could molecular assessment of calcium metabolism be a useful tool to early screen patients at risk for pre-eclampsia complicated pregnancy? Proposal and rationale

Abstract

One of the most frequent causes of maternal and perinatal morbidity is represented by hypertensive disorders during pregnancy. Women at high risk must be subjected to a more intensive antenatal surveillance and prophylactic treatments. Many genetic risk factors, clinical features and biomarkers have been proposed but none of these seems able to prevent pre-eclampsia onset. English literature review of manuscripts focused on calcium intake and hypertensive disorders during pregnancy was performed. We performed a critical analysis of evidences about maternal calcium metabolism pattern in pregnancy analyzing all possible bias affecting studies. Calcium supplementation seems to give beneficial effects on women with low calcium intake. Some evidence reported that calcium supplementation may drastically reduce the percentage of pre-eclampsia onset consequently improving the neonatal outcome. Starting from this evidence, it is intuitive that investigations on maternal calcium metabolism pattern in first trimester of pregnancy could represent a low cost, large scale tool to screen pregnant women and to identify those at increased risk of pre-eclampsia onset. We propose a biochemical screening of maternal calcium metabolism pattern in first trimester of pregnancy to discriminate patients who potentially may benefit from calcium supplementation. In a second step we propose to randomly allocate the sub-cohort of patients with calcium metabolism disorders in a treatment group (calcium supplementation) or in a control group (placebo) to define if calcium supplementation may represent a dietary mean to reduce pre-eclampsia onset and to improve pregnancy outcome.

May Underdiagnosed Nutrition Imbalances Be Responsible for a Portion of So-Called Unexplained Infertility? From Diagnosis to Potential Treatment Options

“…Since clinicians involved in infertility care may benefit from expert support in excluding dietary abnormalities in patients affected by apparent unexplained infertility, it would be considered good medical practice to avoid empirical treatments since while they may be useful (as in the case of calcium supplementation and onset of preeclampsia), 12,32 they may also be damaging (as in aspirin supplementation during ovarian stimulation). 11 Finally our study, although pioneeristic and innovative both for aim and results, is not free of limitations potentially affecting the accuracy of the evidence.…”

An Update on Maternal Hydration Strategies for Amniotic Fluid Improvement in Isolated Oligohydramnios and Normohydramnios: Evidence from a Systematic Review of Literature and Meta-Analysis

“…While debate continues regarding the best method to estimate AFV, it has become evident that there are numerous maternal and fetal risk factors associated with a reduction of this parameter. [ 4 – 8 ] Indeed, an increased fetal and neonatal morbidity and mortality is described when pregnancies are complicated by oligohydramnios. [ 9 , 10 ]…”

Preventive and Therapeutic Role of Dietary Inositol Supplementation in Periconceptional Period and During Pregnancy: A Summary of Evidences and Future Applications

“…In the near future, the efforts of both clinicians and scientists may further clarify inositol mechanisms of action in the periconceptional period and define what patients may truly benefit from inositol supplementation and the ideal timing, dose, and combination of inositol stereoisomers of such a supplementation. As occurred in the introduction of calcium supplementation in prevention of preeclampsia, 54,55 efforts to identify target patients represent an important step in evaluating the actual advantages of inositol supplementation, since an empirical administration (and related adverse effects) in patients without real necessity may represent a bias in estimating the overall advantages of this supplementation. 56…”