Pre-eclampsia

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

Published: Feb. 16, 2023

Language: Английский

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Modelling the impact of decidual senescence on embryo implantation in human endometrial assembloids

eLife, Journal Year: 2021, Volume and Issue: 10

Published: Sept. 6, 2021

Decidual remodelling of midluteal endometrium leads to a short implantation window after which the uterine mucosa either breaks down or is transformed into robust matrix that accommodates placenta throughout pregnancy. To gain insights underlying mechanisms, we established and characterized endometrial assembloids, consisting gland-like organoids primary stromal cells. Single-cell transcriptomics revealed decidualized assembloids closely resemble endometrium, harbouring differentiated senescent subpopulations in both glands stroma. We show acute senescence glandular epithelium drives secretion multiple canonical factors, whereas stroma it calibrates emergence anti-inflammatory decidual cells pro-inflammatory Pharmacological inhibition stress responses pre-decidual accelerated decidualization by eliminating In co-culture experiments, resulted entrapment collapsed human blastocysts robust, static matrix. By contrast, presence created dynamic environment, enabling embryo expansion attachment, although their persistence led gradual disintegration assembloids. Our findings suggest controls fate decisions at highlight how may accelerate discovery new treatments prevent reproductive failure.

Language: Английский

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Progress in the understanding of the pathophysiology of immunologic maladaptation related to early-onset preeclampsia and metabolic syndrome related to late-onset preeclampsia

American Journal of Obstetrics and Gynecology, Journal Year: 2022, Volume and Issue: 226(2), P. S867 - S875

Published: Jan. 5, 2022

Among mammalian species, human reproduction has 2 outstanding features. The hemochorial placentation is characterized by a very deep endovascular trophoblast invasion in the spiral arteries, reaching into myometrium. This requires an agonistic direct cell-cell interaction between maternal immune system and semiallogeneic trophoblast. second feature preeclampsia, heterogeneous syndrome, uniquely condition. female one of few mammals exposed to her partner's semen on multiple occasions before conception. Regulatory T cells, especially paternal antigen-specific regulatory play important role maintenance pregnancy. Sexual intercourse increases number dendritic cells uterus that induction cells. Paternal maintain pregnancy inducing tolerance. In decidua basalis preeclamptic cases, clonal are reduced; these would normally monoclonally expand recognize fetal or antigens. Programmed cell death-1 expressed regulate cytotoxic T-cell activity protect fetus against rejection. expression reduced preeclampsia early-onset making placenta vulnerable attack These phenomena can explain epidemiologic phenomenon more common couples using condom contraception, with shorter cohabitation periods, first pregnancies, pregnancies multiparous women when they change partner, after assisted donated gametes. contrast its importance shallow does not development is, maladaptation seem be involved. Late-onset (>34 weeks' gestation), representing 80% 90% most developed countries "Western lifestyle," strongly associated cardiometabolic variables (metabolic syndrome). Although underlying pathophysiology might quite different, syncytiotrophoblast stress final pathway leading syndrome among subtypes causing imbalance proangiogenic factors (placental growth factor vascular endothelial factor) antiangiogenic (soluble fms-like tyrosine kinase-1 soluble endoglin). Low-dose aspirin, started 16 week's gestation, will prevent up 60% but late-onset preeclampsia. Optimizing prepregnancy weight controlling gestational gain may effective ways

Language: Английский

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Recent Advances in Treatment of Recurrent Spontaneous Abortion

Obstetrical & Gynecological Survey, Journal Year: 2022, Volume and Issue: 77(6), P. 355 - 366

Published: June 1, 2022

Recurrent spontaneous abortion (RSA) is a distressing condition experienced by approximately 1% of women trying to conceive. However, the treatment RSA challenge both for clinicians and patients.The aim this review discuss medical surgical approach management RSA, including those caused anatomical, genetic, male, infectious, endocrine, immune factors.A literature search using MeSH terms each topic was undertaken PubMed, supplemented hand searching additional references. Retrieved articles were reviewed, synthesized, summarized.Available treatments target hypothetical risk factors although effectiveness many options controversial. Intervention should depend on benefit-to-risk ratio proposed treatment.The etiology heterogeneous, patients often lack specific clinical manifestations, which has hindered progress in predicting preventing some extent. Despite intensive workup, at least 50% couples do not have clear underlying pathology. In addition, an evidence-based available most even if abnormal test results are present. Many new directions also still actively exploring; empirical combined multiple main methods.

Language: Английский

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Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(12), P. 4074 - 4074

Published: June 15, 2023

Recurrent pregnancy loss is a complex health challenge with no universally accepted definition. Inconsistency in definitions involves not only the number of spontaneous abortions (two or three) that are for recurrent but types and gestational age at miscarriage. Due to heterogeneity criteria applied by international guidelines loss, true incidence miscarriage, which reported range from 1% 5%, difficult estimate. Moreover, exact etiology remains questionable; thus, it considered polyetiological multifactorial condition many modifiable non-modifiable factors involved. Even after thoroughly evaluating risk factors, up 75% cases remain unexplained. This review aimed summarize critically analyze accumulated knowledge on etiology, relevant diagnostic options, management approach loss. The relevance various their proposed roles pathogenesis matter discussion. largely depend taken into consideration healthcare professional as cause miscarriage particular woman couple. Underestimation social consequences leads compromised reproductive psychological well-being women Studies especially idiopathic, should be continued. existing require updates assist clinical practice.

Language: Английский

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Efficacy of Corticosteroids in Patients With Recurrent Pregnancy Loss: A Systematic Review and Meta‐Analysis

American Journal of Reproductive Immunology, Journal Year: 2025, Volume and Issue: 93(1)

Published: Jan. 1, 2025

ABSTRACT Recurrent pregnancy loss (RPL) represents a complication of occurring in 1%–3% all couples trying to conceive. About 50%–60% RPL cases remain idiopathic, therefore therapeutic strategies seem empirical and based on unproven evidence. We investigated the efficacy corticosteroids women with RPL. conducted systematic review meta‐analysis, up August 2024, PubMed, Scopus, Web Science databases, including studies idiopathic comparing versus control treatment. Primary outcome was ongoing rate beyond 12 weeks gestation; secondary outcomes were live birth (LBR), stillbirth, weight, incidence preeclampsia and/or gestational diabetes, age at delivery, fetal abnormalities. Four comprising 417 randomly assigned steroid or treatment included. found that oral significantly increase gestation compared group (log OR [odds ratio] = 1.49 [0.32, 2.67], p 0.01), high heterogeneity ( I 2 75%), improve LBR 0.9 [0.11, 1.69], 0.03), low 0.05%). However, limited number limits strength findings. Also, benefit/risk assessment use early for is still unclear.

Language: Английский

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Vitamin D and miscarriage: a systematic review and meta-analysis

Fertility and Sterility, Journal Year: 2022, Volume and Issue: 118(1), P. 111 - 122

Published: May 28, 2022

To investigate whether a significant association between vitamin D status and the risk of miscarriage or recurrent (RM) exists.Systematic review meta-analysis.Not applicable.Women with RM.We searched Ovid MEDLINE, Embase, Cumulative Index to Nursing Allied Health Literature, Cochrane Central Register Controlled Trials from database inception May 2021. Randomized observational studies investigating maternal and/or treatment were included.The primary outcome was RM, used as predictor risk. Whether reduces RM also assessed.Of 902 identified, 10 (n = 7,663 women) included: 4 randomized controlled trials 666 6 6,997 women). Women diagnosed deficiency (<50 nmol/L) had an increased compared women who replete (>75 (odds ratio, 1.94; 95% confidence interval, 1.25-3.02; studies; n 3,674; I2 18%). Combined analysis, including insufficient (50-75 deficient nmol/L), found 1.60; 1.11-2.30; 6,338; 35%). Although assessed effect on miscarriage, study heterogeneity, data quality, reporting bias precluded direct comparison meta-analysis. The overall quality "low" "very low" using Grading Recommendations, Assessment, Development Evaluations approach.Vitamin insufficiency are associated miscarriage. preconception protects against pregnancy loss in at remains unknown.CRD42021259899.

Language: Английский

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Maternal selection of human embryos in early gestation: Insights from recurrent miscarriage

Seminars in Cell and Developmental Biology, Journal Year: 2022, Volume and Issue: 131, P. 14 - 24

Published: Jan. 31, 2022

Compared to most mammals, human pregnancy is unusual in that it involves chromosomally diverse embryos, cyclical breakdown and regeneration of the uterine mucosa, intimate integration fetal maternal cells at uteroplacental interface. Not surprisingly, often falters early gestation. Whether these losses result clinical miscarriages depends on origins impacts chromosomal errors development ability decidualizing endometrium engage embryo biosensing selection. Aneuploidy originating oocytes during meiosis drives age-related risk miscarriage. By contrast, frequency endometrial cycles with an impaired decidual response may account for stepwise increase miscarriage rates each loss independently age. Additional physiological mechanisms operate gestation ensure failing pregnancies are lost before vascular maternal-fetal connections established by end first trimester. Here, we summarise how investigations into cause led new insights processes govern selection embryos

Language: Английский

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Exposure to multiple trace elements and miscarriage during early pregnancy: A mixtures approach

Environment International, Journal Year: 2022, Volume and Issue: 162, P. 107161 - 107161

Published: Feb. 24, 2022

Exposure to some conventional trace elements has been found be associated with miscarriage; however, evidence for combined exposure is inconclusive. Therefore, it important explore the joint associations between toxic and essential miscarriage.This cross-sectional study measured a wide range of element levels in whole blood pregnant women by using inductively coupled plasma mass spectrometry. The individual miscarriage were appraised logistic regression model. Multi-exposure models, including Bayesian kernel machine (BKMR) weighted quantile sum (WQS), used mixed elements. Furthermore, grouped (GWQS) considered multiple different magnitudes directions associations.In regression, odds ratios (ORs) 95% confidence interval (CI) highest quartiles 5.45 (2.00, 15.91) barium, 0.28 (0.09, 0.76) copper, 0.32 (0.12, 0.83) rubidium. These exposure-outcome confirmed supplemented BKMR, which indicated positive association barium negative copper In WQS, was (OR: 1.71; CI: 1.07, 2.78), (75.7%) element. results GWQS showed that group dominated significantly increased ORs 2.71; 1.74, 4.38). Additionally, observed 0.32; 0.18, 0.54), rubidium contributing most result.As element, positively both evaluations, while elements, particularly exhibited associations. Our findings provide significant exploring effects on miscarriage.

Language: Английский

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Pregnancy loss: Consequences for mental health

Frontiers in Global Women s Health, Journal Year: 2023, Volume and Issue: 3

Published: Jan. 23, 2023

Pregnancy loss, in all its forms (miscarriage, abortion, and fetal death), is one of the most common adverse pregnancy outcomes, but psychological impact such loss often underestimated. The individual response to this outcome may vary between women—and could be influenced by age, race, culture, or religious beliefs—but experience anxiety, stress, symptoms depression. Because not uncommon, health providers are used dealing with diagnosis, however correct management process information-gathering, treatment can greatly ameliorate mental consequences for these women. aim review examine different types consider how each influence women affected their partners—in both short- long-term; risk factors identifying who at consequential problems; provide some advice help better cope loss. Finally, we points follow order aid a particularly spontaneous, induced, recurrent miscarriage, stillbirth.

Language: Английский

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