Preeclampsia biomarkers (sFlt-1/PlGF) dynamics are not disrupted by SARS-CoV-2 infection during pregnancy in a hypertensive disorder SARS-CoV-2 vaccinated cohort

Pregnancy Hypertension, Journal Year: 2025, Volume and Issue: 39, P. 101196 - 101196

Published: Jan. 31, 2025

Language: Английский

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The pregnancy outcomes of women with SARS-CoV-2 infection in the first trimester ---a longitudinal cohort study

BMC Pregnancy and Childbirth, Journal Year: 2025, Volume and Issue: 25(1)

Published: March 26, 2025

In recent years, severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection has been prevalent worldwide. Pregnant women belong to a special group, and it is very important for clinicians pay attention the impact of SARS-CoV-2 on pregnancy outcomes. However, there are limited studies outcomes during first trimester. To investigate effect in trimester Clinical information pregnant whose last menstrual period was between October 1, 2022, April 2023, who were registered Obstetrics Gynecology department Peking University International Hospital, analyzed. Among them, 498 with included study group; while total 654 no control group. Mann Whitney U test, χ2 Fisher's exact probability method, multivariate logistic regression used analyze A 30 cases group experienced loss before 28 weeks gestation, 468 delivered. 41 613 The rates two groups 6.02% 6.27%, respectively, statistically significant difference (P > 0.05). There 0.05) baseline data (delivery age, pre-pregnancy body mass index, gestational parity) groups. neonatal malformation, premature birth, rupture membranes, postpartum hemorrhage, cesarean section, small age infants, low birth weight macrosomia, asphyxia compared, incidence hypertension significantly higher than that = 0.012). this single center study, we found may increase risk hypertension, incidences other adverse such as did not compared without

Language: Английский

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Does COVID‐19 cause pre‐eclampsia?

Ultrasound in Obstetrics and Gynecology, Journal Year: 2021, Volume and Issue: 59(2), P. 146 - 152

Published: Nov. 12, 2021

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the provision of maternal healthcare and fetal outcomes around world1-4. An increase in morbidity mortality been identified attributed to number causes5. These include difficulties faced by systems adapting rapidly changing circumstances during inequity service globally according income status country6. In general, women are at increased risk infection pregnancy. Alterations immune function physiological demand metabolism can lead more complicated recovery worse outcome7. particular, pregnant severe respiratory illness, for example, influenza8, 9. During COVID-19 pandemic, relationship between acute syndrome 2 (SARS-CoV-2) health explored large-scale cohort studies meta-analyses current literature. have highlighted an apparent link pre-eclampsia10-12, but it is not currently known whether this association causal. 1965, English statistician Sir Austin Bradford Hill proposed set nine criteria assess causality presumed cause observed effect13. While some advocate against exclusive use these judge causality, arguing, that scientific deduction powerful, they still widely accepted applied. are: (1) strength (effect size), i.e. larger association, greater likelihood causal; (2) consistency (reproducibility), consistent findings different persons places with samples strengthens effect being (3) specificity, causation likely if there very specific population site no other explanation; (4) temporal sequence; (5) biological gradient (dose–response relationship), exposure should generally incidence effect; (6) plausibility; (7) coherence (between epidemiological laboratory findings); (8) experimental evidence; (9) analogous evidence. Some authors also reversibility, removed, disappear. Based published literature, we assessed SARS-CoV-2 pregnancy development pre-eclampsia using criteria. A national study 342 090 was conducted England 29 May 2020 31 July 2021, as part National Maternity Perinatal Audit14. found testing positive time birth higher rates death, preterm delivery, or eclampsia delivery emergency Cesarean section, compared without test SARS-CoV-2. rate 3.9% 2.5% those (adjusted odds ratio (aOR), 1.55; 95% CI, 1.29–1.85; P < 0.001). INTERCOVID study10, multinational outcome 43 institutions across 18 countries, total 706 diagnosed 1424 COVID-19. This were pre-eclampsia, hemolysis, elevated liver enzymes low platelet count (HELLP) (8.4% vs 4.4%; relative (RR), 1.76; 1.27–2.43). Women either asymptomatic symptomatic who factors such body mass index (BMI), diabetes, pre-existing hypertension chronic comorbidities, 4 times developing did infection. (RR, 1.59; 1.30–1.94). majority (83%) births medically indicated; leading indication pre-eclampsia/eclampsia/HELLP (24.7%). Moreover, when calculated, infection, several complications, including pregnancy-induced hypertension, eclampsia, HELLP death10. Conde-Agudelo Romero recently performed systematic review 28 included 790 954 globe, whom 15 524 infection12. meta-analysis aORs demonstrated associated (pooled aOR, 1.58; 1.39–1.80; 0.0001; I2 = 0%; 11 studies). There 1.18–2.63; 58%; seven studies), 1.97; 1.01–3.84; three studies) 2.10; 1.48–2.97; one study) large important COVID-19, UK, USA Mexican populations15, 16, designed specifically hypertensive disorders pregnancy, so able add data address question. Of Romero12, 14 North America, six Europe, five Asia two Latin America. remaining countries. heterogeneity among visually inspecting forest plots estimating I2. Significant predefined value ≥ 30%. prespecified subgroups analyzed explore potential sources defined severity (asymptomatic symptomatic), design (retrospective prospective cross-sectional), assessment primary secondary aim, confounding controlled (yes no), geographic location (North America Europe multiregion), sample size (< 200 200–999 1000–5000 > 5000), used diagnosing (reverse-transcription polymerase chain reaction (RT-PCR) RT-PCR antigens antibodies serum mixed/unclear) timing diagnosis (at any admission delivery). bias results examined performing sensitivity analysis only bias. direction magnitude most subgroup analyses. However, smaller women), retrospective adjust from Asia, reported slightly ORs than larger, cross-sectional factors. It be recognized dominated studies, UK14 USA17, which collectively contributed 748 526 (94.6%) meta-analysis, could potentially temper conclusions drawn regarding reproducibility countries ethnicities. UK study14, white (76.3%), Asian (12.2%) black (4.6%) women, persisted even after multiple regression adjusting age, ethnicity, parity, diabetes mellitus, socioeconomic deprivation measured 2019. summary, good evidence further needed. Pre-eclampsia well-documented previous renal disease, mellitus autoimmune nulliparity, age 40 years, BMI 35 kg/m2, family history interpregnancy interval 10 years conception in-vitro fertilization18-20. Low-dose aspirin, started before weeks' gestation, reduces high-risk women21. clear contracting similar non-pregnant individuals, namely black, minority overweight/obese having comorbidity (in asthma hypertension)22, 23. overlap highlights conditions. study24 overweight first antenatal visit subsequently highest pre-eclampsia/eclampsia 2.62; 1.57–4.36), suggests modifies exposure. Romero12 varied significantly analyses adjusted, adjusted BMI, comorbidities race/ethnicity. Fourteen confounders perform matching variables. Four evaluate pre-eclampsia10, 25-27. these, one25 factors, one26 race one27 race, low-dose aspirin one10 cigarette smoking, overweight/obese, cardiac adverse outcome. unadjusted OR (95% CI) four were, respectively, 1.94 (1.09–3.46), 1.33 (0.64–2.75), 1.76 (1.01–3.05) 1.93 (1.34–2.78). comparable pooled 1.62 1.45–1.82) all meta-analysis12. adjustment incomplete best, suggest subsequent maintained point pregnancy; 13 delivery. latter USA17 94.6% meta-analysis. is, therefore, unlikely meaningful information studies. Few focused preceded did28, 1223 SARS-CoV-2-positive 51 cases 21 same gestational 23 When develop trend towards moderate (unadjusted RR, 2.28 0.92–5.61) (P 0.07); RR (aRR), 1.96 0.8–4.84) 0.14)). study28, SARS-CoV-2, median 16 (interquartile range (IQR), 7–61) days. Only study26 pre-eclampsia. study, 3.79 (IQR, 0.43–13.0) weeks. hazard 2.88 1.20–6.93) 32 weeks 2.74 0.98–7.71) gestation. absence evaluating under-reporting go made third trimester; given pathophysiology thought originate early second trimesters, might expected causal would readily established earlier ages. conclusion, suggested confirmed. both stronger patients (OR, 2.11; 1.59–2.81) 1.21–2.10). 1219 giving 33 hospitals Institutes Health (NIH) classifying asymptomatic, mild, moderate, critical29. On analysis, severe-to-critical (40.4% 18.8%; aRR, 1.61; 1.18–2.20). mild-to-moderate perinatal outcome, longer duration syndrome10. observational pre-eclampsia28. Patients classified into groups based NIH criteria: severe. model prior characteristics medical history, competing-risks model. excluded analysis. Compared background (expected) 1%, 1.9%, 2.2%, 5.7%, 11.1%, respectively. monotonic statistically (chi-square 0.0017). After differences determined model, almost 5-fold (aRR, 4.9; 1.56–15.38). Moderate mild 3.3; 1.48–7.38). argued their finding supports hypothesis relationship. Several mechanisms systemic high blood pressure, injury thrombocytopenia, well typical COVID-1930. One theory proposes involvement angiotensin-converting enzyme (ACE2) receptor. Activation renin–angiotensin–aldosterone system ultimately leads cleavage angiotensin I (ACE), converting II. Angiotensin II, via (potent arteriolar vasoconstriction, tubular sodium reabsorption, aldosterone secretion antidiuretic hormone secretion) pressure31. ACE2 counterbalances actions ACE cleaving hydrolyzing (1–7), vasodilator. enters cells lungs organs receptor32. spike S1 protein binds enzymatic domain receptor cell surface, resulting translocation virus cell33. binding causes downregulation enzyme, reduced conversion II allowing act relatively unopposed. expressed syncytiotrophoblast cytotrophoblast34, placenta, where plays role trophoblast proliferation, angiogenesis arterial pressure regulation Downregulation placenta may placental oxidative stress release antiangiogenic soluble fms-like tyrosine kinase-1 (sFlt-1)36, reduction proangiogenic characteristic features syndrome37-43 (Figure 1). study44 assessing differentially genes clinical datasets. upregulate sFlt-1 endoglin (both vasoconstriction), nitric oxide modulators prothrombotic-related molecules. are, plausible abovementioned demonstrates production prothrombotic molecules result data. histopathological lesions COVID-1945, 46. Many viruses changes morphology, seen zika cytomegalovirus infection47, 48. reports that, controls, placentae showed poor vascular perfusion49. decidual arteriopathy, peripheral central villous infarction agglutination. unknown what placenta. Another microvasculopathy common women50, suggesting differ relation progression, stage viral clearance already achieved. patient prominent lymphohistiocytic villitis malperfusion changes. indicate occur phase disease50, 51. Prospective provide valuable nature compare measurements hematological, biochemical immunological examination. Clearly, randomized trial neither feasible nor ethical. coronavirus-spectrum (including syndrome, Middle East COVID-19) general population11. If then vaccination antiviral therapies mitigation measures reduce vaccinated unvaccinated COVID-1952, protect (1.4% 11.3%; 0.13; 0.03–0.50; 0.003) non-significant decrease (0.7% 1.2%; 0.58; 0.08–4.25; 0.59). Ongoing placebo-controlled trials will establish outcomes, pre-eclampsia53. Even though available support limitations research needed questions assertion made. 1.5 (as to, 200-fold cancer chimney sweepers, cited Hill) considered too small proven conceivably underlying contributors (i.e. confounding). questioned following advancements genetics, science statistics 21st century54, improved our analytical capabilities exploring cause-and-effect relationships ability appreciate complexity onset progression disease. understanding origin led researchers question considering multifactorial causality49. growing causal, particularly plausibility. however, bolster criteria, sequence, perhaps criterion epidemiologists universally agree essential inference54. possible mediated through cardiovascular pathology, required understand mechanisms. Since publication, determining associations, seismic advances fields (for molecular genomics, toxicology genotoxicology) technology computers, software, methods). disciplines 'peer box' time) disease54. means cause–effect often degree certainty, argue instances, reliance becomes less relevant. Others, application enhanced integrating new techniques each making about robust54. acknowledged case just beginning shine light onto particular 'black Healthcare professionals aware remain factor They cognisant additive combination conditions Pregnant benefit close monitoring order allow syndrome55. Performing swab presenting non-classical markers useful settings SAR-CoV-2 universal55.

Language: Английский

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The impact of gestational weeks of Coronavirus disease 2019 (COVID-19) infection on perinatal outcomes

Reproductive Health, Journal Year: 2024, Volume and Issue: 21(1)

Published: March 4, 2024

Abstract Background To evaluate the relationship between coronavirus disease 2019 (COVID-19) infection at different time points during pregnancy and perinatal outcomes. Methods This retrospective study included 611 women who hospitalized for delivery December 7 April 30, 2023. Based on weeks infected with COVID-19, participants were divided into four groups: Group 1 (14–27 +6 gestation), 2 (28–36 3 (37–39 4 (≥ 40 gestation). Data including maternal demographic characteristics, clinical profiles, outcomes analyzed. Results There no significant differences in characteristics among groups ( P > 0.05). Compared to Groups 4, a higher rate of fever was noted < The frequency preeclampsia gestational diabetes mellitus showed decreasing trend as progressing Preterm neonatal intensive care unit admission more frequently observed than Multivariate logistic regression analysis demonstrated that timing gestation which COVID-19 not associated preterm 0.05), whereas age negatively occurrence Conclusions Gestational is simple parameter predicts adverse aid clinicians determining provide early enhanced prenatal increased monitoring reduce complications.

Language: Английский

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Implication of viruses in the etiology of preeclampsia

American Journal of Reproductive Immunology, Journal Year: 2024, Volume and Issue: 91(4)

Published: April 1, 2024

Abstract Preeclampsia is one of the most common disorders that poses threat to both mothers and neonates a major contributor perinatal morbidity mortality worldwide. Viral infection during pregnancy not typically considered cause preeclampsia; however, syndromic nature preeclampsia etiology immunomodulatory effects viral infections suggest microbes could trigger subset preeclampsia. Notably, SARS‐CoV‐2 associated with an increased risk Herein, we review potential role in this great obstetrical syndrome. According vitro vivo experimental studies, can by introducing poor placentation, syncytiotrophoblast stress, and/or maternal systemic inflammation, which are all known play critical development Moreover, clinical investigations have suggested link between several viruses onset via multiple pathways. However, results research always consistent. Therefore, future studies should investigate causal elucidate mechanism behind relationship itself.

Language: Английский

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