Pre-eclampsia

Nature Reviews Disease Primers, Journal Year: 2023, Volume and Issue: 9(1)

Published: Feb. 16, 2023

Language: Английский

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The etiology of preeclampsia

American Journal of Obstetrics and Gynecology, Journal Year: 2022, Volume and Issue: 226(2), P. S844 - S866

Published: Feb. 1, 2022

Language: Английский

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Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

American Journal of Obstetrics & Gynecology MFM, Journal Year: 2021, Volume and Issue: 3(6), P. 100468 - 100468

Published: Aug. 21, 2021

Language: Английский

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SARS-CoV-2 and the subsequent development of preeclampsia and preterm birth: evidence of a dose-response relationship supporting causality

American Journal of Obstetrics and Gynecology, Journal Year: 2021, Volume and Issue: 225(6), P. 689 - 693.e1

Published: Aug. 26, 2021

Pregnant women affected with a severe SARS-CoV-2 infection have worse clinical outcomes than nonpregnant SARS-CoV-2, which can include the greater risks for admission to intensive care unit, use of invasive mechanical ventilation, need extracorporeal membrane oxygenation, and death. In addition, is risk factor fetal death preterm birth. Early during COVID-19 pandemic, preeclampsia-like syndrome was reported in pregnant SARS-CoV-2.1Mendoza M. Garcia-Ruiz I. Maiz N. et al.Pre-eclampsia-like induced by COVID-19: prospective observational study.BJOG. 2020; 127: 1374-1380Google Scholar This association has been confirmed case series,2Metz T.D. Clifton R.G. Hughes B.L. al.Disease severity perinatal patients coronavirus disease 2019 (COVID-19).Obstet Gynecol. 2021; 137: 571-580Google systematic reviews, meta-analyses.3Conde-Agudelo A. Romero R. SARS-COV-2 pregnancy preeclampsia: review meta-analysis.Am J Obstet ([Epub ahead print])Google An important issue whether causes preeclampsia. One Bradford Hill criteria assess causality existence dose-response relationship between an exposure outcome interest, which, this case, likelihood study conducted address question. A retrospective based on data from 14 National Health Service (NHS) maternity hospitals United Kingdom effects pregnancy. The institutions are listed as footnote Supplemental Table. considered exempt Institutional Review Board NHS Research Authority. At each participating site, electronic patient records were reviewed identify cases diagnosis positive polymerase chain reaction test February 1, 2020 May 2021. maternal demographic characteristics, medical history, (ie, live birth or loss, gestational age at delivery, birthweight, hypertensive pregnancy, dates onset) obtained hospital databases. Individual relevant information about classified into 4 groups according modified spectrum used Institutes Health. follows: (1) asymptomatic—this group includes individuals who but no symptoms; (2) mild illness—includes any various signs symptoms (such fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss taste smell) do not shortness breath, dyspnea, abnormal chest imaging; (3) moderate show evidence lower respiratory assessment imaging oxygen saturation (SpO2) ≥94% room air; (4) require high dependency secondary impairment failure multiorgan dysfunction. primary occurrence preeclampsia exposed SARS-CoV-2. other examined delivery. Preeclampsia defined hypertension (blood pressure ≥140 mm Hg/≥90 Hg) developing after 20 weeks gestation previously normotensive woman chronic development new onset proteinuria (≥300 mg per 24 h protein creatinine ratio >30 mg/mmoL >2 + dipstick testing). effect (four factor: asymptomatic, mild, moderate, severe) rate assessed using robust Poisson regression models. Models fit geepack package R statistical language environment (www.r-project.org; Foundation, Vienna, Austria). asymptomatic reference, model included adjustment prior (log thereof), defined, characteristics history competing model.4Wright D. Syngelaki Akolekar Poon L.C. Nicolaides K.H. Competing screening history.Am 2015; 213: 62.e1-62.e10PubMed Google We compared combined against patients. (<37 weeks) evaluated while adjusting age, weight, height, race, method conception, hypertension, smoking, diabetes. selection these variables performed backward elimination. chi-square trend (n=1223) presented Of these, 51 (4.2%) had preeclampsia, 16 (1.3%) miscarriage, 215 (17.6%) birth; there 10 (0.81%) deaths. Women tended be older higher body mass index (P<.05 both) (Supplemental Table). 21 diagnosed before infection, 7 same 23 infection. removed further analysis. median interval among days (interquartile range, 7–61 days). Among 30 analysis, 13 17 term cohort comparable factors those population approximately 1% (Figure, A). observed excluding expected: 1.9% patients, 2.2% COVID-19, 5.7% disease, 11.1% monotonic statistically significant (chi-square trend; P=.0017). then (reference group) differences determined model. Severe associated (adjusted [RR], 4.9; 1.56–15.38). There RR, 3.3; 1.48–7.38). Because others proposed that predisposes we hypothesis within our dataset. analysis all developed SARS-Cov2 did develop found toward increased (unadjusted 2.28; 0.92–5.61) (P=.07), 1.96; 0.8–4.84) (P=.14). Moreover, excluded (n=1162) set. 11.7% 12.8% 29.9% 69.4% B). Similarly, function trend, P<.0001). Compared (moderate: adjusted 2.47, 1.61–3.78; severe: 5.64, 4.09–7.79). delivery C). mean significantly earlier (asymptomatic: 38.7, 37.5, 33 weeks, P<.001 both comparisons). (32 <37 weeks), very (28 <32 extreme (<28 P<.0001 each) D). principal finding here subsequent conclusion large number tested calculation individualized obstetrical history. Patients 5-fold relative 3.3-fold Notably, estimate 1.96 when testing reverse authors.5Papageorghiou A.T. Deruelle P. Gunier R.B. al.Preeclampsia results INTERCOVID longitudinal study.Am 225: 289.e1-289.e17PubMed Our findings consistent Metz al2Metz 1219 meta-analysis, symptomatic illness (odds [OR], 2.11; 95% confidence [CI], 1.59–2.81) more likely (OR, 1.59; CI, 1.21–2.10).3Conde-Agudelo

Language: Английский

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COVID-19 and Pregnancy

Infectious Disease Clinics of North America, Journal Year: 2022, Volume and Issue: 36(2), P. 423 - 433

Published: Jan. 31, 2022

Language: Английский

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Vaccine hesitancy in pregnant Women: A narrative review

Vaccine, Journal Year: 2023, Volume and Issue: 41(29), P. 4220 - 4227

Published: June 1, 2023

Pregnant women are often at higher risk for morbidity and mortality due to contracting vaccine-preventable diseases that result in adverse pregnancy outcomes such as spontaneous abortion, preterm births, congenital fetal defects. For example, health care provider recommendation is correlated with maternal acceptance of influenza vaccination, however, up 33 % pregnant remain unvaccinated irrespective recommendation. Vaccine hesitancy a multifactorial problem both the medical public systems need address synergistically. education should incorporate balanced perspectives deliver vaccine education. This narrative review addresses four questions: 1) what primary concerns lead them be hesitant about receiving vaccinations; 2) extent does source (e.g. provider, friend, family) advice information influence person's decision accept vaccine; 3) how delivery method their decision; 4) can categorizing patients into distinct groups based on opinions behavior regarding vaccines used improve provider-patient communication increase acceptance. Results from literature show three most common reasons include: i.) fear side effects or events; ii.) lack confidence safety; iii.) low perception being high infection during and/or not having previously received vaccination when pregnant. We conclude dynamic therefore people do always hold static level hesitancy. People may move between continuum reasons. A framework, characterized by levels before pregnancy, was constructed help providers find balance promoting individual while providing

Language: Английский

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Effects of Vertical Transmission of Respiratory Viruses to the Offspring

Frontiers in Immunology, Journal Year: 2022, Volume and Issue: 13

Published: March 14, 2022

Overt and subclinical maternal infections in pregnancy can have multiple significant pathological consequences for the developing fetus, leading to acute perinatal complications and/or chronic disease throughout postnatal life. In this context, current concept of as a state systemic immunosuppression seems oversimplified outdated. Undoubtedly, immune system undergoes complex changes establish maintain tolerance fetus while still protecting from pathogens. addition downregulated immunity, hormonal changes, mechanical adaptation (e.g., restricted lung expansion) make pregnant woman more susceptible respiratory pathogens, such influenza virus, syncytial virus (RSV), severe syndrome coronavirus-2 (SARS-CoV-2). Depending on infectious agent timing infection during gestation, fetal pathology range mild severe, even fatal. Influenza is associated with higher risk morbidity mortality women than general population, and, especially third trimester pregnancy, mothers are at increased hospitalization cardiopulmonary illness, their babies show prematurity, neurological congenital anomalies, admission neonatal intensive care. RSV exposure utero selective deficit, remodeling cholinergic innervation tract, abnormal airway smooth muscle contractility, which may predispose inflammation hyperreactivity, well development dysfunction childhood. Although there limited evidence supporting occurrence vertical transmission SARS-CoV-2, high prevalence prematurity among infected by SARS-CoV-2 suggests alter responses maternal-fetal interface, affecting both mother her fetus. This review aims summarizing about short- long-term intrauterine influenza, RSV, terms pediatric outcomes.

Language: Английский

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Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras

International Journal of Surgical Pathology, Journal Year: 2022, Volume and Issue: 31(4), P. 387 - 397

Published: May 29, 2022

Objectives. The goal of this study is to describe placental pathology after infection with SARS-CoV-2 before the predominance variants concern (pre-VOC) and during eras predominant transmission Alpha & Gamma (co-circulating), Delta, Omicron variants. Methods. We used county-level variant data establish population-level proportions, PCR identify cases, IgG serology exclude latent infections from controls histopathologic examination pathology. Results. report findings in 870 placentas pregnancies complicated by including 90 Alpha/Gamma era, 60 Delta era 56 era. Features maternal vascular malperfusion (MVM), decidual arteriopathy, were significantly more frequent infection. risk these varied over time, highest rates Increased COVID-19 severity presence comorbidities strengthened associations. Conclusion. MVM a feature pregnancy. Lesion frequency changed circulating virus should be considered new

Language: Английский

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Differences and similarities in endothelial and angiogenic profiles of preeclampsia and COVID-19 in pregnancy

American Journal of Obstetrics and Gynecology, Journal Year: 2022, Volume and Issue: 227(2), P. 277.e1 - 277.e16

Published: March 26, 2022

COVID-19 presents a spectrum of signs and symptoms in pregnant women that might resemble preeclampsia. Differentiation between severe preeclampsia is difficult some cases.To study biomarkers endothelial damage, coagulation, innate immune response, angiogenesis pregnancy addition to vitro alterations cells exposed sera from with COVID-19.Plasma samples were obtained infection classified into mild (n=10) or (n=9) normotensive pregnancies as controls patients (n=13). A panel plasmatic was assessed, including vascular cell adhesion molecule-1, soluble tumor necrosis factor-receptor I, heparan sulfate, von Willebrand factor antigen (activity multimeric pattern), α2-antiplasmin, C5b9, neutrophil extracellular traps, placental growth factor, fms-like tyrosine kinase-1, angiopoietin 2. In addition, microvascular patients' sera, changes the expression intercellular molecule 1 on membranes release matrix evaluated through immunofluorescence. Changes inflammation signaling pathways also assessed by p38 mitogen-activated protein kinase phosphorylation. Statistical analysis included univariate multivariate methods.Biomarker profiles similar those controls. Both showed significant most circulating distinctive profiles. Whereas exhibited higher concentrations factor-α receptor antigen, reduction compared controls, presented marked increase molecule-1 I (significantly increased COVID-19), striking activity, α2-antiplasmin. As expected, reduced kinase-1 2, very high ratio observed C5b9 traps detected Principal component demonstrated clear separation other groups (first second components explained 42.2% 13.5% variance), mainly differentiated variables related kinase-1. Von revealed absence high-molecular-weight multimers (similar profile disease type 2A), whereas healthy patients, pattern normal. Sera both induced an overexpression culture However, effect less pronounced than COVID-19. Immunoblots lysates Patients statistically different suggesting can activate inflammatory pathways.Although dysfunction, exhibit coagulopathy, angiogenic imbalance could aid differential diagnosis these entities.

Language: Английский

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First- or second-trimester SARS-CoV-2 infection and subsequent pregnancy outcomes

American Journal of Obstetrics and Gynecology, Journal Year: 2022, Volume and Issue: 228(2), P. 226.e1 - 226.e9

Published: Aug. 13, 2022

Language: Английский

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