Understanding and Preventing Placenta-Mediated Pregnancy Complications

Skeith, Leslie; Blondon, Marc; Áinle, Fionnuala Ní

doi:10.1055/a-1184-8388

“…High levels of β-hCG in the second trimester predict a high incidence of complications during pregnancy and poor pregnancy outcomes [9]. The possible underlying mechanism is that β-hCG produced by placental trophoblasts can directly reflect placental function, and placental function is directly related to the occurrence of various diseases during pregnancy and adverse pregnancy outcomes [29]. At present, it is believed that GDM, PIH, IUGR, PD, miscarriage, fetal respiratory distress, and stillbirth are all caused by pla-cental pathophysiological changes [29,30].…”

Section: Discussionmentioning

confidence: 99%

“…The possible underlying mechanism is that β-hCG produced by placental trophoblasts can directly reflect placental function, and placental function is directly related to the occurrence of various diseases during pregnancy and adverse pregnancy outcomes [29]. At present, it is believed that GDM, PIH, IUGR, PD, miscarriage, fetal respiratory distress, and stillbirth are all caused by pla-cental pathophysiological changes [29,30]. Taken all together, the use of β-hCG to predict the occurrence of gestational hypertension has its pathophysiological basis.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Serum β-Human Chorionic Gonadotropin on Pregnancy Complications and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis

Huang¹,

Liu

²

,

Yang

³

et al. 2022

Computational and Mathematical Methods in Medicine

3

0

1

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Background. The relationship among elevated serum β-human chorionic gonadotropin (β-hCG), the incidence of pregnancy complications, and adverse pregnancy outcomes has been controversial. Differences in study design, subject bias due to demographic characteristics, and differences in local medical levels could contribute to inconsistent results. Methods. Literature searches were performed in PubMed, EMBASE, Medline, Central, China National Knowledge Infrastructure (CNKI), Wanfang, and China Science Digital Library (CSDL) databases. Inclusion criteria were as follows: (1) research subjects were singleton pregnant women; (2) the study is identified as cohort study; (3) the subjects were assigned to the high β-hCG group and control group according to whether the exposure factors increased β-hCG in the second trimester; (4) the observed outcomes include at least pregnancy-induced hypertension (PIH), diabetes (gestational diabetes mellitus, GMD), preterm delivery (PD), and intrauterine growth restriction (IUGR); and (5) the odds ratio (OR) and 95% confidence interval (CI) of exposure factors are calculated based on literature dataset. To determine the risk bias of selected literatures, Newcastle-Ottawa scale was applied. The chi-square test was further used for heterogeneity analysis. If heterogeneity was identified, subgroup analyses were then performed for source investigation. Results. A total of 13 literatures were included and analyzed, including 67,355 pregnant women and 5980 pregnant women assigned to the high β-HCG group and 61,375 pregnant women to the control group. The incidence of PIH in the high β-HCG group was higher than that in the control group ( OR = 2.11 , 95% CI [1.90, 2.35], Z = 13.85 , P < 0.00001 ). There was no heterogeneity among literatures ( χ 2 = 8.53 , P = 0.38 , I 2 = 6 % ), and thus there is no identified publication bias ( P > 0.05 ). The incidence of preterm birth in the high β-HCG group was higher than that in the control group ( OR = 2.11 , 95% CI [1.90, 2.35], Z = 13.85 , P < 0.00001 ). The analysis suggested no heterogeneity among included literatures ( χ 2 = 11.78 , P = 0.11 , I 2 = 41 % ) and no publication bias ( P > 0.05 ). Higher incidence of abortion was observed in the high β-HCG group compared with the control group ( OR = 2.80 , 95% CI [1.92, 4.09], Z = 5.32 , P < 0.00001 ). There was no heterogeneity among literatures ( χ 2 = 3.43 , P = 0.33 , I 2 = 13 % ) and no publication bias ( P > 0.05 ). The incidence of gestational diabetes was higher in the high β-HCG group than in the control group ( OR = 2.15 , 95% CI [1.05, 4.40], Z = 2.09 , P = 0.04 ). Heterogeneity was identified among literatures ( χ 2 = 47.01 , P < 0.00001 , I 2 = 87 % ). Sensitivity analysis showed that the results were not robust, and there was no publication bias ( P > 0.05 ). Compared with control, the incidence of IGUR was higher in the high β-HCG group ( OR = 2.70 , 95% CI [1.75, 4.19], Z = 4.45 , P < 0.0001 ) with no heterogeneity among literatures ( χ 2 = 3.92 , P = 0.14 , I 2 = 49 % ) and no publication bias ( P > 0.05 ). Conclusion. High levels of β-hCG during pregnancy in singleton women are associated with a high incidence of pregnancy complications and adverse pregnancy outcomes. Pregnant women with high levels of β-hCG should be monitored more closely, followed up, and given timely medical interventions to reduce the incidence of pregnancy complications and adverse outcomes.

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“…Before 16 weeks of pregnancy, Hct levels should be between 3.9 and 7.3 mmol/L; between 20 and 24 weeks of pregnancy, they should be between 3.5 and 5.3 mmol/L; and after 36 weeks of pregnancy, they should be between 3.3 and 7.5 mmol/L. In pregnancy, HHct refers to anything over this threshold (hyperhomocysteinemia) [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

The Association Between Serum Homocysteine Levels and Placenta-Mediated Complications: A Narrative Review

Memon¹,

Acharya²

2022

Cureus

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The most extremely unfavourable outcome of pregnancy is the death of the mother and newborn. Negative outcomes for mothers or babies can occur as a result of complications or issues during pregnancy, birth or the post-partum period. Early elevated maternal homocysteine (Hct) levels during pregnancy have been linked to altered placental development. There is evidence that suggests an elevated maternal blood Hct level is the new obstetrical risk factor, and the association between hyperhomocysteinemia (HHct) and numerous obstetrical problems was recently recognised.Hct is an essential amino acid, which contains sulphur and is formed from the metabolism of methionine. HHct has several known aetiologies, including genetic anomalies; a deficiency in folic acid, vitamin B6 and vitamin B12; hypothyroidism; old age; and renal illnesses. Vascular problems, coronary artery disease, atherosclerosis and embolic illnesses can all occur as a result of high blood levels of Hct. Hct levels are lower in normal pregnancies than it is in women who are not pregnant. Many pregnancy-related problems, including pre-eclampsia (PE), recurrent pregnancy loss (RPL), placental abruption, premature delivery and foetal growth restriction (FGR) have been connected to HHct in recent research.We looked for pertinent literature using a thorough and systematic search from PubMed, Medline, Embase, Cochrane Library, Google, etc., and articles that were published before August 2022 based on serum Hct levels and various placenta-mediated complications for this review.In this review, we described the synthesis and metabolism of Hct in humans, Hct levels at various phases of normal pregnancy and the association between Hct and placenta-mediated pregnancy complications.The outcomes discovered can help obstetricians increase the likelihood of a successful pregnancy in cases where placenta-mediated issues are present. Lowering Hct levels with a high dose of folic acid tablets during the subsequent pregnancy may be useful for women who experienced these difficulties in prior pregnancies as a result of HHct.

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“…4 Pathogenesis of preeclampsia is characterized by abnormal placental vascular development with impaired invasion of the uterine spiral arteries by trophoblasts, resulting in fetal complications and maternal endothelial dysfunction. 5 Intact antithrombotic properties of the endothelial cells and efficient regulation of thrombin generation and platelet activation at the microenvironment of the uterus are necessary conditions for successful trophoblast invasion and development of feto-maternal circulation during normal pregnancy. 6,7 The data available so far indicate that preeclampsia aggravation is driven by inflammation and hypercoagulability due to exacerbated platelet activation, release of procoagulant extracellular vesicles (EVs), and thrombin generation.…”

Section: Introductionmentioning

confidence: 99%

Endothelial Cell Activation and Thrombin Generation Assessment for the Risk of Severe Early Onset Preeclampsia. the ROADMAP-EOP Study

Dreden

¹

,

Lefkou

²

,

Ka

³

et al. 2022

Clin Appl Thromb Hemost

1

0

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Background The ROADMAP-EOP study aimed to identify clinically relevant biomarkers of hypercoagulability for the identification of pregnant women at risk of early onset preeclampsia worsening. Methods The ROADMAP-EOP observational single center retrospective case–control study was conducted in Greece (Centre for Human Reproduction, Genesis Athens Clinic, Athens, Greece) from July 2020 to July and enrolled pregnant women diagnosed with EOP stratified in mild EOP group (n = 34) and severe EOP group (n = 15) as well as women with uncomplicated pregnancy (control group; n = 35). All women were assessed with thromboelastometry (ROTEM®), Calibrated Automated Thrombogram®, tissue factor activity (TFa), procoagulant phospholipid dependentclotting time (Procoag-PPL®), Proteins S (PS), TFPI, D-dimer, antithrombin (AT), thrombomodulin (TM), fibrinogen, prothrombin time (PT) and activated partial thromboplastin time (aPTT). The primary study end-point was severe earlyonset preeclampsia. Principal component analysis (PCA) was performed. Results The PCA analysis showed that a score composed of the lag-time, ttPeak and Procoag-PPL accurately predicted severe EOP (sensitivity 71.4%, specificity 61.8%, and AUC of the ROC analysis 0.953). Conclusion The pilot ROADMAP-EOP shows that activation of endothelial cells and blood hypercoagulability are driven events in the worsening of EOP. Among a large panel of biomarkers and coagulation assays, thrombingeneration test and procoagulant phospholipid dependent clotting time emerged as clinically relevant for the evaluation of the risk of severe EOP. This methodology for the development of a new clinic-biological risk assessment model for prompt identification of pregnant women at risk of severe EOP must be validated in a large multi-centerprospective study.

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Understanding and Preventing Placenta-Mediated Pregnancy Complications

Cited by 17 publications

References 85 publications

The Effect of Serum β-Human Chorionic Gonadotropin on Pregnancy Complications and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis

The Effect of Serum β-Human Chorionic Gonadotropin on Pregnancy Complications and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis

The Association Between Serum Homocysteine Levels and Placenta-Mediated Complications: A Narrative Review

Endothelial Cell Activation and Thrombin Generation Assessment for the Risk of Severe Early Onset Preeclampsia. the ROADMAP-EOP Study

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