Evaluation of biomarkers for the prediction of pre-eclampsia in women with type 1 diabetes mellitus: A systematic review

Wotherspoon, Amy; McCance, David R.; Holmes, Valerie

doi:10.1016/j.jdiacomp.2016.02.001

Cited by 12 publications

(23 citation statements)

References 67 publications

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“…The difference in HbA 1C between groups became significant between gestational 323 weeks 12 and 20. These findings are in accordance with results from other studies and highlight the 324 importance of glycemic control 11,32 . In patients with diabetes, hyperglycemia caused abnormalities in blood 325 flow and increased vascular permeability reflecting decreased activity of vasodilators (as nitric oxide), 326 hypoxia and increased activity of vasoconstrictors (as Ang II and endothelin 1) 41 .…”

Section: Accepted Manuscriptsupporting

confidence: 91%

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Urine albumin is a superior predictor of preeclampsia compared to urine plasminogen in type I diabetes patients

Nielsen

Jensen

Fuglsang

et al. 2018

Journal of the American Society of Hypertension

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Section: Accepted Manuscriptsupporting

confidence: 91%

“…Pre-gestational microalbuminuria predicts PE in 62 women with T1DM 4 . A 2016 review concluded that the strongest predictors of PE early in T1DM-63 pregnancies are HbA 1C and increased levels of urinary (u-) albumin/protein 11 . 64…”

mentioning

confidence: 99%

Urine albumin is a superior predictor of preeclampsia compared to urine plasminogen in type I diabetes patients

Nielsen

Jensen

Fuglsang

et al. 2018

Journal of the American Society of Hypertension

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“…The most commonly reported clinical characteristics included body mass index (BMI) or weight (n = 9 reviews) 58,69,90,107,113,117,124,133,139 , maternal age (n = 2) 69,133 , parity (n = 2) 69,133 , blood pressure (n = 5) 47,57,61,69,90 and oocyte donation (n = 3) 42,86,106 , and six reviews reported on multiple clinical characteristics 23,61,69,89,107,133 . Of the biochemical markers, the following were most commonly studied: pregnancy-associated plasma protein-A (PAPP-A) (n = 7) 24,43,61,89,93,109,110 , placental growth factor (PlGF) (n = 7) 21,23,24,43,88,89,93 and β-human chorionic gonadotropin (β-hCG) (n = 7) 43,61,89,93,104,107,110 . Over 30 additional biomarkers were reviewed.…”

Section: Characteristics Of Included Reviewsmentioning

confidence: 99%

“…Predictive ability of maternal characteristics for pre-eclampsiaTable S5GRADE assessment in prognostic research and definitions of GRADE assessment levels Ultrasound Obstet Gynecol 2019; 54:[16][17][18][19][20][21][22][23][24][25][26][27] Published online in Wiley Online Library (wileyonlinelibrary.com). DOI:10.1002/uog.20117 …”

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confidence: 99%

Prediction of pre‐eclampsia: review of reviews

Townsend

Khalil

Premakumar

et al. 2019

Ultrasound in Obstet & Gyne

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Objective Primary studies and systematic reviews provide estimates of varying accuracy for different factors in the prediction of pre‐eclampsia. The aim of this study was to review published systematic reviews to collate evidence on the ability of available tests to predict pre‐eclampsia, to identify high‐value avenues for future research and to minimize future research waste in this field. Methods MEDLINE, EMBASE and The Cochrane Library including DARE (Database of Abstracts of Reviews of Effects) databases, from database inception to March 2017, and bibliographies of relevant articles were searched, without language restrictions, for systematic reviews and meta‐analyses on the prediction of pre‐eclampsia. The quality of the included reviews was assessed using the AMSTAR tool and a modified version of the QUIPS tool. We evaluated the comprehensiveness of search, sample size, tests and outcomes evaluated, data synthesis methods, predictive ability estimates, risk of bias related to the population studied, measurement of predictors and outcomes, study attrition and adjustment for confounding. Results From 2444 citations identified, 126 reviews were included, reporting on over 90 predictors and 52 prediction models for pre‐eclampsia. Around a third (n = 37 (29.4%)) of all reviews investigated solely biochemical markers for predicting pre‐eclampsia, 31 (24.6%) investigated genetic associations with pre‐eclampsia, 46 (36.5%) reported on clinical characteristics, four (3.2%) evaluated only ultrasound markers and six (4.8%) studied a combination of tests; two (1.6%) additional reviews evaluated primary studies investigating any screening test for pre‐eclampsia. Reviews included between two and 265 primary studies, including up to 25 356 688 women in the largest review. Only approximately half (n = 67 (53.2%)) of the reviews assessed the quality of the included studies. There was a high risk of bias in many of the included reviews, particularly in relation to population representativeness and study attrition. Over 80% (n = 106 (84.1%)) summarized the findings using meta‐analysis. Thirty‐two (25.4%) studies lacked a formal statement on funding. The predictors with the best test performance were body mass index (BMI) > 35 kg/m2, with a specificity of 92% (95% CI, 89–95%) and a sensitivity of 21% (95% CI, 12–31%); BMI > 25 kg/m2, with a specificity of 73% (95% CI, 64–83%) and a sensitivity of 47% (95% CI, 33–61%); first‐trimester uterine artery pulsatility index or resistance index > 90th centile (specificity 93% (95% CI, 90–96%) and sensitivity 26% (95% CI, 23–31%)); placental growth factor (specificity 89% (95% CI, 89–89%) and sensitivity 65% (95% CI, 63–67%)); and placental protein 13 (specificity 88% (95% CI, 87–89%) and sensitivity 37% (95% CI, 33–41%)). No single marker had a test performance suitable for routine clinical use. Models combining markers showed promise, but none had undergone external validation. Conclusions This review of reviews calls into question the need for further aggregate meta‐analy...

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“…In a systematic review, it was concluded that insufficient glycemic control increased risk for PE (95). Whether hyperglycemia and insulin resistance have a synergistic role together with angiogenic imbalance to elicit exaggeration of hypertension during pregnancy is unknown.…”

Section: Do Combined Obesity and Metabolic Abnormalities Of Gdm Promomentioning

confidence: 99%

Metabolic abnormalities and obesity’s impact on the risk for developing preeclampsia

Spradley

2017

American Journal of Physiology-Regulatory, Integrative and Comp

100

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Preeclampsia (PE), a hypertensive disorder of pregnancy, is increasing as a major contributor to perinatal and long-term morbidity of mother and offspring. PE is thought to originate from ischemic insults in the placenta driving the release of prohypertensive anti-angiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1)] and proinflammatory [tumor necrosis factor-α (TNF-α)] factors into the maternal circulation. Whereas the increased incidence of PE is hypothesized to be largely due to the obesity pandemic, the mechanisms whereby obesity increases this risk are unknown. The maternal endothelium is targeted by placental and adipose tissue-derived factors like sFlt-1 and TNF-α that promote hypertension during pregnancy, resulting in vascular dysfunction and hypertension. Interestingly, not all obese pregnant women develop PE. Data suggest that obese pregnant women with the greatest metabolic abnormalities have the highest incidence of PE. Identifying obesity-related mechanisms driving hypertension in some obese pregnant women and pathways that protect normotensive obese pregnant women, may uncover novel protocols to treat PE. Metabolic abnormalities, such as increased circulating leptin, glucose, insulin, and lipids, are likely to increase the risk for PE in obese women. It is not only important to understand whether each of these metabolic factors contribute to the increased risk for PE in obesity, but also their cumulative effects. This is particularly relevant to obese pregnant women with gestational diabetes mellitus (GDM) where all of these factors are increased and the risk for PE is highest. It is speculated that these factors potentiate the anti-angiogenic and proinflammatory mechanisms of placental ischemia-induced vascular dysfunction thereby contributing to the increasing incidence of PE.

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Evaluation of biomarkers for the prediction of pre-eclampsia in women with type 1 diabetes mellitus: A systematic review

Cited by 12 publications

References 67 publications

Urine albumin is a superior predictor of preeclampsia compared to urine plasminogen in type I diabetes patients

Urine albumin is a superior predictor of preeclampsia compared to urine plasminogen in type I diabetes patients

Prediction of pre‐eclampsia: review of reviews

Metabolic abnormalities and obesity’s impact on the risk for developing preeclampsia

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