The Management of Preeclampsia: A Comprehensive Review of Current Practices and Future Directions

BACKGROUND: Endothelial dysfunction is the leading pathogenetic factor of preeclampsia. The function of the endothelium may be reflected in its ability to form microvesicles, which are generated by cells through the regulated shedding of the plasma membrane. AIM: The aim of this study was to evaluate the endothelial microvesicles count in peripheral blood of women with normal pregnancy and pregnancy complications such as gestational arterial hypertension and severe preeclampsia. MATERIALS AND METHODS: This study included 72 individuals, of whom there were healthy non-pregnant women (n = 21), women with normal pregnancy (n = 20), pregnant women with gestational arterial hypertension (n = 24), and pregnant women with severe preeclampsia (n = 7). To isolate microvesicles from peripheral blood, the differential centrifugation method was used. Microvesicles were treated with antibodies to vascular endothelial growth factor receptors (VEGFR1, VEGFR2), CD41a, CD34, and CD31 conjugated to fluorochromes. The absolute and relative count of microvesicles, as well as the fluorescence intensity, were analyzed using a BD FACSCanto II cytofluorimeter. RESULTS: In normal pregnancy, the count of microvesicles with the VEGFR1+, VEGFR2+, CD31+, and CD34+ phenotype was increased compared to non-pregnant women. In gestational arterial hypertension compared to normal pregnancy, no differences were found in the endothelial microvesicles count and endothelial marker expression. In severe preeclampsia, the total microvesicles count and endothelial cell derived microvesicles count in the peripheral blood plasma decreased in comparison with normal pregnancy and gestational arterial hypertension. While the expression of endothelial markers such as VEGFR1, VEGFR2, and CD34 in microvesicles membranes in severe preeclampsia increased compared to normal pregnancy and gestational arterial hypertension. CONCLUSIONS: An increase in the endothelial microvesicles count in normal pregnancy may be associated with an increase in the vascular bed area due to placenta formation. A decrease in the endothelial microvesicles count in severe preeclampsia is associated with damage to the endothelium and disruption of its function. Increased expression of endothelial cell receptors on microvesicles in severe preeclampsia may reflect compensatory reactions of the endothelium during the above damage.

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Impact of magnesium levels in pregnancy on adverse birth outcomes: a protocol for a systematic review and meta-analysis

Abdul,

Dorsamy,

Bagwandeen

2024

Preprint

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Background: Magnesium, an often-overlooked trace element, may play a pivotal role in maternal and fetal health outcomes during pregnancy. Magnesium deficiency has been observed to contribute to several maternal complications, such as intrauterine growth restriction, pregnancy-induced hypertension and pre-eclampsia. Pre-eclampsia, a hypertensive disorder of pregnancy, presents substantial risks to both maternal and fetal health. Magnesium sulphate is a cornerstone in the management of pre-eclampsia, underscoring the importance of magnesium in pregnancy. Notably, pre-eclampsia is more prevalent in low-to-middle-income countries, where other co-morbidities such as HIV, anaemia and obesity are also common. Understanding the dynamics of magnesium levels in pregnancy and their interactions with co-morbidities could be critical for improving maternal and fetal health outcomes worldwide. Method: This protocol is for a systematic review and meta-analysis that aims to comprehensively map the literature on magnesium levels in pregnancy. Following the Preferred Reporting Items for Systematic Review and Meta-analysis for Protocols guidelines, our study will provide a rigorous synthesis of available evidence. By conducting a thorough search across multiple databases, including PubMed, Scopus, Directory of Open Access Journals, and Google Scholar, we aim to identify studies reporting on magnesium levels during pregnancy. Through screening and data extraction, we will analyze the association between magnesium levels and pregnancy complications, with further exploration of the impact of co-morbidities on magnesium status in pregnancy. Discussion: The findings of this study may have the potential to affect maternal and fetal health outcomes globally. Improved understanding of magnesium's role in pregnancy physiology can guide targeted interventions aimed at reducing the burden of pre-eclampsia and its associated complications, particularly in low-to-middle-income countries where maternal and infant mortality rates remain unacceptably high. Prospero Registration: CRD42024518427

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The Management of Preeclampsia: A Comprehensive Review of Current Practices and Future Directions

Cited by 3 publications

References 49 publications

Evaluation of the Human Placental Microbiota in Early- and Late-Onset Pre-Eclampsia

Evaluation of the Human Placental Microbiota in Early- and Late-Onset Pre-Eclampsia

Endothelial microvesicles in peripheral blood of pregnant women with preeclampsia

Impact of magnesium levels in pregnancy on adverse birth outcomes: a protocol for a systematic review and meta-analysis

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