Racial Disparities in Diagnosis, Management, and Outcomes in Preeclampsia

Suresh, Sunitha C.; Amegashie, Courtney; Patel, Easha; Nieman, Kristin M.; Rana, Sarosh

doi:10.1007/s11906-022-01172-x

Cited by 25 publications

(16 citation statements)

References 41 publications

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“…In early pregnancy, trophoblasts invade the uterine spiral artery, remodel the uterine spiral artery, ensure the placenta engineering, and provide nutrients for the fetus [21]. Preeclampsia pregnant women have insufcient trophoblast invasion in early pregnancy, which leads to the disorder of uterine spiral artery remodeling and abnormal placenta formation, which lays a hidden danger for the occurrence and development of preeclampsia; the placental blood perfusion is insufcient, and placental ischemia and hypoxia will release cells Toxic substances enter the blood, further causing oxidative stress and vascular endothelial injury [22]. When the condition worsens, the uterine spiral artery experiences atherosclerosis, and the placental perfusion is further reduced and induces thrombosis and placental infarction.…”

Section: Discussionmentioning

confidence: 99%

[Retracted] Clinical Value of Serum SIRT1 Combined with Uterine Hemodynamics in Predicting Disease Severity and Fetal Growth Restriction in Preeclampsia

Kong

2023

Evidence-Based Complementary and Alternative Medicine

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Objective. The sirtuin regulator 1-related enzyme (SIRT1) has been shown to play an important role in various pathophysiological processes. Our aim was to investigate the effect and correlation of serum SIRT1 combined with uterine hemodynamic parameters on disease severity and fetal uterine growth restriction in the progression of preeclampsia and to evaluate its clinical value as a potential marker. Methods. A total of 100 patients with preeclampsia who were hospitalized in Qufu Normal University Hospital from June 2017 to June 2021 were selected as the research objects. According to the severity, they were divided into the mild (62 cases) and severe groups (38 cases), and according to whether the fetal growth restriction was combined or not, they were divided into the combined fetal growth restriction group (56 cases) and the uncomplicated fetal growth restriction group (44 cases). Serum SIRT1 expression and uterine artery hemodynamic parameters were detected, and Spearman analysis was used to evaluate the association of serum SIRT1 expression and uterine artery hemodynamic parameters (the peak-to-trough ratio of arterial blood velocity, the pulsatility index, and the resistance index) with disease severity (systolic blood pressure, diastolic blood pressure, and random urinary protein levels) and fetal growth restriction (femoral length, biparietal diameter, head circumference, and neonatal weight); unsupervised principal component analysis (PCA), supervised partial least-squares discrimination analysis (PLS-DA), cluster heat map analysis, the receiver operating characteristic (ROC) curve, and the area under curve (AUC) were used to evaluate the diagnostic value of serum SIRT1 expression combined with uterine artery hemodynamic parameters in the severity of disease and fetal growth restriction in patients with preeclampsia. Results. Compared with patients with mild preeclampsia, serum SIRT1 expression was lower in patients with severe preeclampsia ( p < 0.0001 ), the arterial blood flow velocity peak-to-trough ratio, pulsatility index, and resistance index were higher ( p < 0.001 ; p < 0.0001 ); and serum SIRT1 expression and uterine artery hemodynamic parameters were closely related to disease severity ( p < 0.001 ; p < 0.0001 ). In addition, the expression of serum SIRT1 in patients with preeclampsia combined with fetal growth restriction was lower than patients without preeclampsia ( p < 0.0001 ); the peak-to-trough ratio of arterial blood flow velocity, the pulsatility index, and the resistance index were higher ( p < 0.0001 ); and serum SIRT1 expression and uterine artery hemodynamics were closely related to fetal growth restriction ( p < 0.0001 ). Unsupervised PCA analysis and supervised PLS-DA analysis showed that patients with different severity of disease and patients with or without fetal growth restriction were similar within the groups, and there were significant differences between the groups; cluster heat map analysis showed that the mild and severe groups were stratified clustering, and the combined fetal growth restriction group and the uncombined group were hierarchically clustered; ROC curve showed that the AUC of serum SIRT1 expression combined with uterine artery hemodynamic parameters was 0.776 in identifying the severity of preeclampsia and 0.956 in identifying the preeclampsia complicated by fetal growth restriction. Conclusion. Serum SIRT1 combined with uterine hemodynamic parameters in preeclampsia is closely related to disease severity and fetal growth restriction and is expected to become a potential biomarker for early clinical intervention in patients.

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Section: Discussionmentioning

confidence: 99%

[Retracted] Clinical Value of Serum SIRT1 Combined with Uterine Hemodynamics in Predicting Disease Severity and Fetal Growth Restriction in Preeclampsia

Kong

2023

Evidence-Based Complementary and Alternative Medicine

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“…Although reasons for this are unclear, prior studies have shown that individuals with chronic conditions fail to have these conditions well controlled before pregnancy and may miss important subspecialty care. 2,6 Reasons for suboptimal prepregnancy care require more study, particularly given high rates of diabetes and hypertension among this population with a disproportionate representation of racially and/or ethnically minoritized women. For instance, among women at risk for PRESKD, acute kidney injury and other risk factors for PRESKD may be underdiagnosed due to physicians' historical use of biased race-based kidney function estimation equations which could have inappropriately labeled individuals included in this study cohort as having better kidney function.…”

Section: + Related Articlementioning

confidence: 99%

“…This crisis has worsened across the overall US population over the past 2 decades, and it has disproportionately burdened Alaska Native, American Indian, and Black individuals, heightening the need for our collective attention. Studies designed to better understand the causes for this crisis and its associated social inequities are emerging, and the rising prevalence of chronic conditions such as hypertension and diabetes among pregnant women has drawn scrutiny as these are important potential contributing factors for poor pregnancy outcomes and racial and ethnic disparities . Chronic kidney disease has been implicated as an additionally important potential risk factor for poor pregnancy outcomes .…”

mentioning

confidence: 99%

“…Notably, individuals with PRESKD were less likely to receive pre-ESKD nephrology care. Although reasons for this are unclear, prior studies have shown that individuals with chronic conditions fail to have these conditions well controlled before pregnancy and may miss important subspecialty care . Reasons for suboptimal prepregnancy care require more study, particularly given high rates of diabetes and hypertension among this population with a disproportionate representation of racially and/or ethnically minoritized women.…”

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confidence: 99%

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Uncovering the Role of Kidney Disease and Its Care in the US Maternal Health Equity Crisis

Mohottige,

Boulware

2023

JAMA Netw Open

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“…[13][14][15][16] Over the past two decades, similar racial and ethnic disparities have been observed in several pregnancy-related outcomes. 17 For instance, racial and ethnic minority women are more likely to experience preeclampsia 18 and deliver at preterm 19,20 compared to their White counterparts. Considering the disproportionate impact of COVID-19 on minority populations and the longstanding racial/ethnic disparities in several pregnancy outcomes, racial disparities in COVID-19-related adverse perinatal outcomes are likely.…”

mentioning

confidence: 99%

Association between SARS-CoV-2 Infection and Adverse Perinatal Outcomes by Race/Ethnicity in a Large Integrated Health Care System

Mensah,

Fassett,

Lurvey

et al. 2024

Am J Perinatol

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Objective: Recent studies have reported associations between SARS-CoV-2 infection during pregnancy and adverse perinatal outcomes but the extent to which these associations vary by race/ethnicity remains uncertain. Therefore, we examined how the association between prenatal SARS-CoV-2 infection and adverse perinatal outcomes may be modified by race/ethnicity. Study Design: A retrospective cohort study was performed using data on 67,986 pregnant women extracted from the Kaiser Permanente Southern California electronic health records between 04/06/2020-12/31/2021. Upon admission to labor & delivery, all women were routinely tested for COVID-19 using RT-PCR test. Adjusted odds ratios (aOR) were used to estimate associations. Results: During the study period, COVID-19 was diagnosed in 4,960 (7%) of singleton pregnancies, with the highest rates observed among Hispanics (9.4%) and Non-Hispanic Blacks (6.2%). Compared with Non-Hispanic Whites, Hispanics (aOR:1.12, 95% CI: 1.03-1.21) with SARS-CoV-2 infection had the highest odds of a pregnancy associated with non-reassuring fetal heart rate tracing. Neonates of all races/ethnicities, except for non-Hispanic Blacks, showed significantly increased odds of SARS-CoV-2 infection, with the highest risk observed among Asians/Pacific Islanders (aOR:10.88, 95% CI: 1.33-89.04). Non-Hispanic White mothers who tested positive were admitted to ICU at a higher rate at delivery and within 7 days of delivery (aOR:34.77, 95% CI: 11.3-107.04; aOR:26.48, 95% CI: 9.55-73.46, respectively), Hispanics were also at a significantly higher odds of admission to ICU (aOR:4.62, 95% CI: 2.69-7.94; aOR:4.42, 95% CI: 2.58-7.56, respectively). Non-Hispanic Black, Hispanic and Asian mothers who tested positive for SARS-CoV-2 prenatally, were at increased risk for preeclampsia/eclampsia, and preterm birth as compared to Non-Hispanic White mothers. Conclusion: The findings highlight racial/ethnic disparities in the association between SARS-CoV-2 infection and adverse perinatal outcomes. The risk of neonatal SARS-CoV-2 infection was highest for Asian/Pacific Islanders. We also observed a remarkably high risk of ICU admission for non-Hispanic White mothers infected with SARS-CoV-2.

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Racial Disparities in Diagnosis, Management, and Outcomes in Preeclampsia

Cited by 25 publications

References 41 publications

[Retracted] Clinical Value of Serum SIRT1 Combined with Uterine Hemodynamics in Predicting Disease Severity and Fetal Growth Restriction in Preeclampsia

[Retracted] Clinical Value of Serum SIRT1 Combined with Uterine Hemodynamics in Predicting Disease Severity and Fetal Growth Restriction in Preeclampsia

Uncovering the Role of Kidney Disease and Its Care in the US Maternal Health Equity Crisis

Association between SARS-CoV-2 Infection and Adverse Perinatal Outcomes by Race/Ethnicity in a Large Integrated Health Care System

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