Re-evaluating large for gestational age: differential effects on perinatal outcomes in term and premature births

Frontiers in Medicine, Journal Year: 2025, Volume and Issue: 11

Published: Jan. 15, 2025

Pregnancies with large-for-gestational-age (LGA) fetuses are associated increased risks of various adverse perinatal outcomes. While existing research primarily focuses on term neonates, less is known about preterm neonates. This study aims to explore the maternal and neonatal outcomes LGA in neonates different degrees prematurity, compared appropriate-for-gestational-age (AGA) Using Birth Reporting Databases (2007-2018) linked Taiwan's National Health Insurance Research Database, we conducted a retrospective nationwide cohort singleton delivered between 24 42 weeks gestation. Based gestational age at delivery, enrolled were classified into (37-42 gestation), late (34-36 moderate (32-33 very (28-31 extremely (24-27 gestation). was defined by 2013 World Organization (WHO) growth standard Taiwan standard. Perinatal AGA across groups. Among 1,602,638 44,359 as WHO Compared groups exhibited higher primary cesarean section, prolonged labor, hypoglycemia, birth trauma, hypoxic ischemic encephalopathy, jaundice needing phototherapy, respiratory distress, intensive care unit (NICU) admission, newborn sepsis, fetal death. However, most these not moderate, very, Conversely, being lower section (very group), phototherapy (moderate groups), distress NICU admission sepsis retinopathy prematurity (late, bronchopulmonary dysplasia group). These findings remained consistent when applied. Being complications but earlier underscore importance tailoring management strategies for consider prematurity.

Language: Английский

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The new era of risk assessment for hypertension in pregnancy: From clinical to biochemical markers in a comprehensive predictive model

Taiwanese Journal of Obstetrics and Gynecology, Journal Year: 2025, Volume and Issue: 64(2), P. 253 - 264

Published: March 1, 2025

This study aims to develop and validate a model based on the weighted random forest (WRF) algorithm predict early-onset preeclampsia (PE) assess importance of various clinical biochemical markers in early risk identification. was conducted at Jiangxi Maternal Child Health Hospital involved 12,699 pregnant women from January 2019 June 2022. Extensive were collected through prenatal care data, which used construct predictive for PE. The developed using WRF Logistic regression methods, multivariable analysis employed identify significantly associated with relative evaluated (RF) sample 1200 patients diagnosed Blood pressure pre-pregnancy body mass index (BMI) identified as most critical variables affecting accuracy PE prediction model. demonstrated higher (AUC = 0.9614) than 0.9138), highlighting its superiority identification WRF-based this effectively predicts PE, blood BMI vital factors. These findings underscore employing comprehensive assessment pregnancy, facilitating intervention improving health outcomes their newborns.

Language: Английский

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Evaluation of Conventional and Combined Doppler Parameters in Preeclampsia: Diagnostic and Prognostic Insights

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(2), P. 647 - 647

Published: Jan. 20, 2025

Background: The aim of this study was to examine the relationship between conventional and novel Doppler parameters, including cerebroplacental ratio (CPR), cerebral–placental–uterine (CPUR), umbilical-to-cerebral (UCR), amniotic-to-umbilical-cerebral (AUCR), with diagnosis preeclampsia (PE) adverse neonatal outcomes in PE cases. Methods: This prospective case-control conducted at Ankara Etlik City Hospital Perinatology Clinic November 2023 May 2024. population divided into two groups: Group 1, consisting 74 patients diagnosed preeclampsia, 2, 80 healthy control patients. Composite perinatal (CANOs) include presence least one outcome: 5th-minute APGAR score < 7, transient tachypnea newborn (TTN), respiratory distress syndrome (RDS), need for continuous positive airway pressure (CPAP), mechanical ventilation, intensive care unit (NICU) admission, hypoglycemia, phototherapy, intraventricular hemorrhage (IVH), sepsis. Results: CPR, CPUR, AUCR were significantly lower group compared group, while UCR notably higher group. Among combined ratios, CPUR exhibited highest diagnostic performance both prediction CANOs. Additionally, UCR, significant diagnosis, only demonstrated a association Conclusions: Combined especially AUCR, offer valuable insights diagnosing predicting accuracy, underscoring its potential utility clinical settings.

Language: Английский

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Molecular subtyping of hypertensive disorders of pregnancy

Nature Communications, Journal Year: 2025, Volume and Issue: 16(1)

Published: April 8, 2025

Language: Английский

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Placenta at single-cell resolution in early and late preeclampsia: insights and clinical implications

American Journal of Obstetrics and Gynecology, Journal Year: 2025, Volume and Issue: 232(4), P. S176 - S189

Published: April 1, 2025

Preeclampsia, one of the great obstetrical syndromes, manifests through diverse maternal and fetal complications remains a leading contributor to adverse perinatal outcomes. In this review, we describe our work on single-cell single-nuclei RNA sequencing elucidate molecular mechanisms that underlie early- late-onset preeclampsia. Analysis 46 cell types, encompassing approximately 90,000 cells from placental tissues collected after delivery, demonstrated cellular dysregulation in early-onset preeclampsia, whereas preeclampsia showed comparatively subtle changes. These findings were observed all lines, including types trophoblast, lymphoid, myeloid, stromal, endothelial cells. Key included disrupted syncytiotrophoblast extravillous trophoblast angiogenic signaling, characterized by an up-regulation FLT1 down-regulation PGF, consistent with imbalance. The stromal vascular compartments exhibited stress-induced transcriptomic shifts. Both pericytes evidence stress, heat shock proteins markers apoptosis. addition, inflammation- stress-responsive states more abundant than matched controls. Inflammatory pathways markedly up-regulated both immune cells; for example, marked increase pro-inflammatory cytokines, secreted phosphoprotein 1 C-X-C motif chemokine ligand 2 3. Conversely, retained adaptive features localized extracellular matrix remodeling markers, underscoring its possible cardiovascular etiology. Single-cell investigations support proposed classification into dysfunction type, primarily presenting early pregnancy, maladaptation later each distinct biomarkers, risk factors, therapeutic targets. advocate interventions target pathways, such as RNA-based therapies specific placenta, modulate soluble fms-like tyrosine kinase-1 levels. contrast, management may benefit optimization, individualized antihypertensive metabolic treatments. results underscore heterogeneity emphasizing need diagnostic strategies. This atlas advances understanding complex interplay among elements maternal-placental-fetal array, thereby bridging clinical phenotypes mechanisms. Future research should focus integrating these insights longitudinal studies develop precision medicine approaches enhance outcomes mothers neonates.

Language: Английский

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Correlation between Fetal-Placental Doppler Indices and Maternal Cardiac Function in Pregnant Women with Late-Onset Preeclampsia or Fetal Growth Restriction

Research Square (Research Square), Journal Year: 2025, Volume and Issue: unknown

Published: May 6, 2025

Introduction To investigate the correlation between fetal-placental Doppler indices and maternal cardiac function in pregnant women with late-onset preeclampsia (PE) or fetal growth restriction (FGR). Methods A total of 90 at 35–39⁺⁶ weeks gestation were enrolled divided into three groups: normal pregnancy (n=30), FGR PE (n=30). ultrasonography was used to measure uterine artery (UtA-PI), umbilical (UA-PI), middle cerebral (MCA-PI) pulsatility indices, alongside hemodynamic parameters, including output (CO), peripheral vascular resistance (PVR), left ventricular mass (LVM), atrial anteroposterior diameter (LAAPD). Spearman analysis Ramsey’s RESET test applied model associations hemodynamics placental-fetal indices. Results The group exhibited significantly higher BMI compared groups (p<0.05), while neonates had lowest birth weights. Hemodynamically, LAAPD, LVM, CO elevated versus (p<0.05) but comparable controls. Conversely, metrics reduced pregnancies (p<0.05). PVR, UtA-PI, UA-PI lower showed values controls MCA-PI no intergroup differences. Correlation analyses revealed that UtA-PI inversely correlated (r=−0.39), LVM (r=−0.28), LAAPD (r=−0.44), positively PVR (r=0.37). Discussion Late-onset exhibit distinct maternal-placental profiles. These pathophysiological divergences underscore need for condition-specific management strategies optimize outcomes complex disorders.

Language: Английский

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Prevalence of placental bed spiral artery pathology in preeclampsia and fetal growth restriction: a prospective cohort study.

Placenta, Journal Year: 2024, Volume and Issue: 156, P. 1 - 9

Published: Aug. 20, 2024

Preeclampsia and fetal growth restriction (PE/FGR) are pregnancy complications known to be associated with poor utero-placental function due abnormal "physiological" remodeling of spiral arteries unfavorable maternal cardiovascular health. However, the prevalence degree impaired artery has not been clearly established.

Language: Английский

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Maternal Microvascular Dysfunction During and After Preeclamptic Pregnancy

Comprehensive physiology, Journal Year: 2024, Volume and Issue: unknown, P. 5703 - 5727

Published: Oct. 9, 2024

Abstract Preeclampsia, a pregnancy disorder characterized by de novo hypertension and maternal multisystem organ dysfunction, is the leading cause of mortality worldwide associated with fourfold greater risk cardiovascular disease throughout lifespan. Current understanding etiology preeclampsia remains unclear, due in part to varying phenotypical presentations disease, which has hindered development effective mechanism‐specific treatment or prevention strategies both during after affected pregnancy. These sequelae are symptoms systemic vascular dysfunction nonreproductive microvascular beds that drives progression adverse outcomes preeclampsia. Despite normalization disturbances delivery, subclinical persists beds, contributing an increased lifetime metabolic diseases all‐cause mortality. Given women history demonstrate despite absence traditional CVD factors, underlying mechanisms essential identify potential therapeutic avenues mitigate reverse overt disease. This article aims provide summary existing literature on pathophysiology preeclampsia, residual current treatments may reduce these high‐risk women. © 2024 American Physiological Society. Compr Physiol 14:5703‐5727, 2024.

Language: Английский

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Prediction and prevention of late-onset pre-eclampsia: a systematic review

Frontiers in Medicine, Journal Year: 2024, Volume and Issue: 11

Published: Nov. 21, 2024

Pre-eclampsia is a major cause of perinatal morbidity and mortality worldwide. Late-onset pre-eclampsia (LOP), which results in delivery ≥34 weeks gestation, the most common type. However, there lack knowledge its prediction prevention. Improving our understanding this area will allow us to have better surveillance high-risk patients thus improve clinical outcomes.

Language: Английский

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Immunoexpression of placental growth factor (PlGF) and soluble FMS-like tyrosine kinase 1 (sFlt-1) in the placental bed of preeclamptic women of African ancestry living with HIV infection

Histochemistry and Cell Biology, Journal Year: 2024, Volume and Issue: 163(1)

Published: Nov. 23, 2024

Abstract Preeclampsia, a severe pregnancy complication linked to defective placentation, poses significant maternal risks and is characterized by dysregulated angiogenic factors, including placental growth factor (PlGF) soluble fms-like tyrosine kinase-1 (sFlt-1). Women with HIV/AIDS receiving ART may face an increased susceptibility preeclampsia development due immunological imbalance. This study investigates the immunoexpression of these factors in context HIV-associated preeclampsia, utilizing morphometric image analysis. The cohort comprised 180 women, 60 normotensive 120 preeclamptic participants, further stratified HIV status gestational age (early-onset PE [EOPE] < 34 weeks late-onset [LOPE] ≥ weeks). Placental bed tissues were immunostained mouse anti-human sFlt-1 PlGF antibodies, results analyzed using Zeiss Axio-Vision GraphPad Prism software. levels showed no overall difference between women ( p = 0.8661), though slightly myometrium, independent status. However, significantly higher EOPE compared both LOPE groups. immunostaining also 0.7387) but was notably lower pregnancies LOPE. did not impact or levels, although HIV-negative while marginally HIV-positive women. These findings highlight complex role pathophysiology suggest that antiretroviral therapies (ARTs) contribute dysregulation heightened immune milieu.

Language: Английский

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