Acta Obstetricia Et Gynecologica Scandinavica, Journal Year: 2024, Volume and Issue: 103(9), P. 1686 - 1688
Published: Aug. 12, 2024
Preeclampsia, a placenta-mediated pregnancy complication that globally affects an estimated 2%–5% of women,1 may severely impact both maternal and fetal–neonatal morbidity mortality in the short long term. Potentially lethal complications for woman include eclampsia cerebral hemorrhage as well increased risk future diabetes mellitus cardiovascular disease, alongside preterm birth, fetal growth restriction, stillbirth baby, all further magnified early-onset disease before 34 gestational weeks.1 Prevention preeclampsia high-risk women by means aspirin prophylaxis has proven to be effective.2 In light potentially severe health consequences preeclampsia, identification at is endorsed International Federation Gynecology Obstetrics, first-trimester screening currently established many countries.1 Still, question remains whether available algorithms are valid they can improved? Risk factors inform prediction models sense these usually constructed applying several based on patient characteristics associated with outcome interest. Screening such Fetal Medicine Foundation (FMF) combined algorithm,3 "Racial origin" pregnant woman, categorized "White," "Black," "South Asian," "East "Mixed." Categorization "race" commonly done self-identification, example skin color ("Black" vs "White") so being, "social construct."4, 5 ethnicity refers partly geographical denominations/country birth oneself or one's mother/father, relying assumption implicitly shared cultural background.4 The terms "ethnicity" often being used interchangeably despite their differing definitions.4 Studies association between contradictory. UK, "Black" women, predominantly parents from Caribbean, Nigeria, Ghana, South Asian have been identified at-risk populations developing compared "White" women.6 contrast, Norway, where categorization country applied, lower preeclampsia/eclampsia hypertension foreign-born (including countries people would self-identify Asian") was found.7 if were Somalia own parental origin, contrast above study UK.6, 8 This one illustrating comparisons studies different regions regard apparently same categories "race," cannot necessarily made. Furthermore, recent Swedish Register-based comparing hypertensive diseases (HDP) among first- second-generation immigrant showed overall HDP women.9 Limitations related analysis comparison data regarding lie large variety ethnic groups: firstly, not groups accurately defined secondly, limited number participants some ethnicities leads merging quite diverse into more less randomly generated larger "ethnic collections." As example, thousand exist Africa alone. FMF algorithm tested various settings spanning ethnicities, variations medians placental factor (PlGF) concentration circulation included assessment noted.1, 10, 11 Wright et al. report higher PlGF sFlt-1/PlGF ratio point out fixed cut-offs angiogenic biomarkers lead underestimation women.11 authors express need classified order test external validity finding.11 One proposed hypothesis "racial" differences circulating markers production,12 implying suggestion genetic basis. Maternal "race—not" "placental race ethnicity" informs algorithms. To illustrate: What do fetus placenta when mother North European descent, father East African heritage, "Black"? Depending method, answer will either "Mixed race." A US variation pathway genes revealed allelic variants preeclampsia; however, dysregulated biomarker levels presence within groups.13 recently published guidance Feero abstain use self-identified analytic variables notion individual insufficiently captured existing population descriptors.5 It widely acknowledged social determinants mediators outcomes general, this also applies adverse outcomes. Minopoli than 13 000 singleton attending routine having prevalence composite outcomes, half affected who socioeconomic deprivation.14 concluded deprivation influenced there exists strong interaction those two factors.14 Accordingly, inclusion preeclampsia.14 pointed danger giving supposedly "lower-risk" group evaluation" good care context taken account.14 accordance above, Wändall Swedish-born living middle- high-deprivation areas HDP.9 Arechvo demonstrated adding indices multiple (IMD) history-only competing risks model did improve England.15 confirm incidence acknowledge limitations IMD measure relative deprivation.15 Further disentangling effects respective predictive value should subject studies. Study designs account since distinct category region world might completely another region, argued above. Also, information rather considered marker warranting investigation status access usage services instead assuming biological causality. Socioeconomic differently depending studied systems (US countries). research associations and/or could clarify relevant evaluation placenta-associated case fetuses "mixed" origin. Our foremost societal aim facilitate possible. Therefore, we must take advance discerning factual health—so better see whole picture.
Language: Английский