How does preeclampsia affect neonates? Highlights in the disease’s immunity

Abstract

The cytotoxic environment present in PE affects the development of fetal cell lineages. Neutropenia is observed in 50% of neonates and is correlated with mortality, although its treatment is not well-established. The enhancement in erythropoietin and the hypoxic setting present in the disease can also lead to thrombocytopenia. Per partum management includes platelet transfusion in order to avoid severe complications such as intraventricular hemorrhage. Regarding other cell lines, a cytotoxic profile is observed to be reflecting the milieu present in the mothers' bloodstream. This disruption alters the immune system response into a proinflammatory profile and can be correlated to neonatal necrotizing enterocolitis. An antiangiogenic environment is also part of the preeclampsia presentation and can be responsible for the enhancement of bronchopulmonary dysplasia observed in this population. Meanwhile, the reduction in angiogenic factors, such as vascular endothelial growth factor (VEGF), can be a protective mechanism for retinopathy of prematurity. Studies of the long-term effects of these observations are lacking, but lower neurodevelopmental scores and a higher cardiovascular risk are noted. New treatments in research propose a prevention of the disease during gestation in order to reduce the effects more efficiently in the fetus. Phosphodiesterase inhibitors, endothelin 1 receptor antagonists and manipulation of heme oxygenase-1 enzyme pathway are possible therapeutic alternatives. This review summarizes the current understanding of how preeclampsia affects neonates. As a conclusion, further studies are needed to build up a guideline to manage those effects. A research agenda is proposed.

Components of the antepartum, intrapartum, and postpartum exposome impact on distinct short-term adverse neonatal outcomes of premature infants: A prospective cohort study

“…Because most stillbirths were encountered in the PE group, we believe this phenomenon could be linked with the fetus’ inability to mount an inflammatory response. Our assertion is supported by previous studies demonstrating that babies of mothers with PE display disrupted hematopoiesis manifested as neonatal thrombocytopenia and neutropenia [53]. Because transcription of the human Hp gene is induced by IL-6, a fetal hypo-inflammatory response would be also associated with low Hp levels and death, as previously shown [50,54].…”

Blood Cells Profile in Umbilical Cord of Late Preterm and Term Newborns

“…Studies suggest that increased erythropoiesis and reduced white cells are associated with prolonged exposure to hypoxia 20 21 It is suggested that frequent placental infarctions with platelet consumption may lead to thrombocytopenia and polycythemia, and that preeclampsia and chronic hypertension may play a role in the genesis of thrombocytopenia 5 …”

Effect of Maternal Preeclampsia on Hematological Profile of Newborns in Qatar

“…Although the etiology and pathogenesis of preeclampsia is not fully known, a proinflammatory immune state prevails and can disrupt fetal hematopoiesis. Some of the effects on newborns include neonatal thrombocytopenia, neutropenia, a reduction in T regulatory cells, and an increased cytotoxic natural killer cell profile [3,4]. There are no established international guidelines for routine screening of babies delivered to women with preeclampsia.…”