Preeclampsia subtypes: Clinical aspects regarding pathogenesis, signs, and management with special attention to diuretic administration

Tamás, Péter; Kovács, Kálmán; Várnagy, Ákos; Farkas, Bálint; Wami, Girma Alemu; Bódis, József

doi:10.1016/j.ejogrb.2022.05.033

Cited by 11 publications

(11 citation statements)

References 83 publications

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“…Our results add more nuance to the hypothesis, and propose that different manifestations of HDP across the reproductive history may indicate the severity or type of the underlying health condition. Aetiological differences between term and pre‐term HDP are debated, including discussions about underlying chronic disease 23–27 . Pre‐term HDP recurs more often in mothers' next births than term HDP, 10,12 and maybe a stronger indicator of future chronic disease.…”

Section: Discussionmentioning

confidence: 99%

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Heterogeneity in the risk of cardiovascular disease mortality after the hypertensive disorders of pregnancy across mothers' lifetime reproductive history

Wyatt,

Kvalvik,

Singh

et al. 2024

Paediatric Perinatal Epid

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BackgroundPrior studies on maternal cardiovascular disease (CVD) mortality and hypertensive disorders of pregnancy (HDP) have focused only on a woman's first birth and have not accounted for successive affected pregnancies.ObjectivesThe objective of this study is to identify mothers' risk of CVD mortality considering lifetime reproductive history.MethodsWe used data from the Medical Birth Registry of Norway, the Norwegian Cause of Death Registry, and the Norwegian National Population Register to identify all mothers who gave birth from 1967 to 2020. Our outcome was mothers' CVD death before age 70. The primary exposure was the lifetime history of HDP. The secondary exposure was the order of HDP and gestational age at delivery of pregnancies with HDP. We used Cox regression models to estimate hazard ratio (HR) and 95% confidence interval (CI), adjusting for education, mother's age, and year of last birth. These models were stratified by the lifetime number of births.ResultsAmong 987,378 mothers, 86,294 had HDP in at least one birth. The highest CVD mortality, relative to mothers without HDP, was among those with a pre‐term HDP in their first two births, although this represented 1.0% of mothers with HDP (HR 5.12, 95% CI 2.66, 9.86). Multiparous mothers with term HDP in their first birth only had no increased risk of CVD relative to mothers without HDP (36.9% of all mothers with HDP; HR 1.12, 95% CI 0.95, 1.32). All other mothers with HDP had a 1.5‐ to 4‐fold increased risk of CVD mortality.ConclusionsThis study identified heterogeneity in the risk of CVD mortality among mothers with a history of HDP. A third of these mothers are not at higher risk compared to women without HDP, while some less common patterns of HDP history are associated with severe risk of CVD mortality.

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Section: Discussionmentioning

confidence: 99%

“…Aetiological differences between term and pre-term HDP are debated, including discussions about underlying chronic disease. [23][24][25][26][27] Pre-term HDP recurs more often in mothers' next births than term HDP, 10,12 and maybe a stronger indicator of future chronic disease.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity in the risk of cardiovascular disease mortality after the hypertensive disorders of pregnancy across mothers' lifetime reproductive history

Wyatt,

Kvalvik,

Singh

et al. 2024

Paediatric Perinatal Epid

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“…PE that develops prior to 34 weeks of gestation is considered early-onset (EO) PE, PE that develops after 34 weeks of gestation is considered late-onset (LO) PE, and while PE that develops after delivery of the fetal-placental unit is considered postpartum PE (PP-PE) (Raymond and Peterson, 2011;Hauspurg and Jeyabalan, 2022). EOPE is characterized by insufficient invasion of trophoblasts into the endometrium resulting in poor spiral artery remodeling leading to placental ischemia and PE phenotype (Tamas et al, 2022). EOPE is considered the most severe form of PE and causes the highest rates of morbidity and mortality in mother and neonate compared of the PE subsets (Madazli et al, 2014).…”

Section: Figurementioning

confidence: 99%

“…Each of these diseases have adverse effects on the health of pregnancy, but importantly they are all recognized as states of chronic inflammation (Harrison et al, 2021). Moreover, patients with autoimmune disease like Systemic Lupus Erythematosus, Rheumatoid Arthritis, and Type 1 Diabetes are at an increased risk for developing PE (Tamas et al, 2022). There is also an association between infectious diseases in pregnancy and increased incidence of PE, such as seen in those diagnosed with COVID-19 (Nourollahpour Shiadeh et al, 2017;Lokki et al, 2018).…”

Section: Adverse Outcomes Associated With Risk Factors For Preeclamps...mentioning

confidence: 99%

Setting a stage: Inflammation during preeclampsia and postpartum

2023

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Preeclampsia (PE) is a leading cause of maternal and fetal mortality worldwide. The immune system plays a critical role in normal pregnancy progression; however, inappropriate inflammatory responses have been consistently linked with PE pathophysiology. This inflammatory phenotype consists of activation of the innate immune system, adaptive immune system, and increased inflammatory mediators in circulation. Moreover, recent studies have shown that the inflammatory profile seen in PE persists into the postpartum period. This manuscript aims to highlight recent advances in research relating to inflammation in PE as well as the inflammation that persists postpartum in women after a PE pregnancy. With the advent of the COVID-19 pandemic, there has been an increase in obstetric disorders associated with COVID-19 infection during pregnancy. This manuscript also aims to shed light on the relationship between COVID-19 infection during pregnancy and the increased incidence of PE in these women.

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“…Preeclampsia (PE) is a gestational hypertensive syndrome that affects around 3–10% of pregnancies worldwide [ 1 ]. According to current guidelines by the International Society for the Study of Hypertension in Pregnancy (ISSHP), this syndrome is described by new-onset hypertension that can be accompanied by proteinuria and/or other maternal end-organ damage at ≥20 weeks of gestation [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Oxidative and Inflammatory Imbalance in Placenta and Kidney of sFlt1-Induced Early-Onset Preeclampsia Rat Model

et al. 2022

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Preeclampsia (PE) is a pregnancy-specific disorder characterized by the new onset of hypertension plus proteinuria and/or end-organ dysfunction. Here, we investigate the role of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system as a major component of reactive oxygen species generation, in a rodent model of early-onset preeclampsia induced by excess sFlt1 (soluble fms-like tyrosine kinase 1). Placenta and kidney samples were obtained from normal pregnant and PE rats to measure the sFlt1/PlGF (placental growth factor) ratio in addition to oxidative stress-related parameters, including the activities and expressions of NADPH oxidase isoforms (NOX1, NOX2, and NOX4), components of nitric oxide (NO) metabolism, and antioxidant enzymes. Peroxisome proliferator-activated receptors (PPARα, PPARγ) and cytokines IL1β, IL3, IL6, IL10, and IL18 were also measured to evaluate the inflammation status in our experimental setting. Excessive O2●− production was found in rats that were treated with sFlt1; interestingly, this alteration appears to be mediated mainly by NOX2 in the placenta and by NOX4 in the kidney. Altered NO metabolism and antioxidant defense systems, together with mitochondrial dysfunction, were observed in this model of PE. Preeclamptic animals also exhibited overexpression of proinflammatory biomarkers as well as increased collagen deposition. Our results highlight the role of NADPH oxidase in mediating oxidative stress and possibly inflammatory processes in the placenta and kidney of an sFlt1-based model of early-onset preeclampsia.

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Preeclampsia subtypes: Clinical aspects regarding pathogenesis, signs, and management with special attention to diuretic administration

Cited by 11 publications

References 83 publications

Heterogeneity in the risk of cardiovascular disease mortality after the hypertensive disorders of pregnancy across mothers' lifetime reproductive history

Heterogeneity in the risk of cardiovascular disease mortality after the hypertensive disorders of pregnancy across mothers' lifetime reproductive history

Setting a stage: Inflammation during preeclampsia and postpartum

Oxidative and Inflammatory Imbalance in Placenta and Kidney of sFlt1-Induced Early-Onset Preeclampsia Rat Model

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