Tag: preeclampsia

Categories : Obstetrics & GynaecologyTags :

Defective Sperm in IVF Doubles the Risk of Preeclampsia

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Intracytoplasmic Sperm Injection (ICSI) procedure. Credit: Scientific Animations CC4.0

For the first time, researchers have linked specific frequent defects in sperm to risk of pregnancy complications and negative impacts on the health of the baby. The study from Lund University in Sweden shows that a high proportion of father’s spermatozoa possessing DNA strand breaks is associated with a doubled risk of preeclampsia in women who have become pregnant by IVF. It also increases the risk of the baby being born prematurely.

Infertility is a growing problem and the number of in vitro fertilisation procedures is increasing rapidly. It is already known that women who become pregnant by assisted reproduction techniques have an increased risk of preeclampsia, repeated miscarriages and the baby being born prematurely and with a lower birth weight. Yet, the reasons behind this have not been fully understood. 

“Before a planned in vitro fertilisation, the man’s sperm sample is analysed for concentration, motility and morphology. But there are men who, according to this analysis, have normal sperm, but still have reduced fertility,” says Amelie Stenqvist, lecturer at Lund University and first author of the study published in Fertility and Sterility. She received her PhD from Lund and now works as a specialist in gynaecology and obstetrics at Skåne University Hospital in Malmö.

Around 20-30% of babies born through IVF have fathers with damaged DNA in their sperm, as shown by elevated levels of DNA fragmentation. The DNA fragmentation index (DFI) is a measure of the amount of strand breaks in the DNA and is used to provide important new information about male fertility. Sperm with DNA damage may still be fertile, but the chances of fertilisation are lower and if the percentage of DFI exceeds 30%, the chances of natural conception are close to zero.

Although current in vitro techniques mean that men with a high DFI can become fathers, until now very little has been known about the impact of DNA fragmentation on pregnancy and the health of the baby. It has been difficult to research the topic because the DFI value is not included in the standard measurements currently taken by Sweden’s fertility clinics. It also requires a large study population and access to national medical registries.

“Since half of the placenta’s DNA comes from the father and placental development and function play a central role in preeclampsia, we wanted to investigate whether a high percentage of DNA damage in the sperm affected the risk of preeclampsia,” says Aleksander Giwercman.

He is a professor of reproductive medicine at Lund University, a consultant at Skåne University Hospital in Malmö. Aleksander Giwercman also led a research study that included 1660 children conceived through IVF and ICSI at the Reproductive Medicine Centre in Malmö over the period 2007-2018. 

The results showed that in the 841 couples who underwent IVF, a DFI of over 20% doubled the risk of the woman developing preeclampsia (10.5%) and also increased the risk of premature birth. In the IVF group with a DFI below 20%, there was a 4.8% risk of preeclampsia, which is comparable to pregnancies that occur naturally. For couples undergoing ICSI, there was no association with preeclampsia.

“Today, DFI analysis is only performed at some fertility clinics in Sweden, but we think that it should be introduced as standard at all clinics. It can give couples answers as to why they are not getting pregnant and can influence the chosen method of assisted fertilisation. Not only that, our latest results show that a DFI analysis could be used to identify high-risk pregnancies,” says Aleksander Giwercman.

 What makes this finding even more interesting is that high DNA fragmentation in sperm is linked to the overall health of the father and is potentially treatable. Most DNA damage is caused by oxidative stress, which is an imbalance between harmful molecules and the antioxidants that protect cells. Other factors that increase DNA fragmentation include the man’s age, smoking, obesity and infections. 

“The next step is to identify which group of men respond best to methods to prevent and treat sperm DNA damage, and to test these methods to prevent pregnancy complications,” concludes Amelie Stenqvist.

Source: Lund University

Categories : Emergency Medicine Obstetrics & GynaecologyTags :

Sharp Spike Seen in Emergency Visits for Life Threatening Pregnancy Complication

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Findings suggest significant increase in emergency department utilisation for hypertensive disorders of pregnancy over 14 year span

Photo by Camilo Jimenez on Unsplash

Hypertensive disorders of pregnancy, the second leading cause of maternal deaths worldwide, may be sending a significantly higher number of pregnant people to the emergency department. Between 2006 and 2020, researchers found a surge in emergency visits and admissions for the condition that causes serious maternal and neonatal complications and accounts for 6.3% of all pregnancy-related deaths in the United States.

The study, which appears in JAMA Network Open, also suggests greater emergency utilisation for the disease among underrepresented racial and ethnic groups. 

“Hypertensive disorders of pregnancy often develop suddenly, even in healthy women, and symptoms may appear without warning and progress rapidly,” said senior author Erica Marsh, MD, professor of obstetrics and gynaecology at the University of Michigan Medical School and chief of the division of reproductive endocrinology and infertility at U-M Health Von Voigtlander Women’s Hospital, of Michigan Medicine.

“Ideally, this risk would be detected during prenatal care and lead to early intervention. Our study indicates more people turning to the emergency department, which may reflect a higher prevalence of the condition or an increased awareness for prompt assessment and treatment.”

Hypertensive disorders of pregnancy, which could include preeclampsia, gestational hypertension, and eclampsia, are serious complications that involve elevated blood pressure. 

The American College of Obstetricians and Gynecologists recommends management of severe blood pressure in pregnancy within 30 to 60 minutes of diagnosis to prevent complications such as stroke, myocardial ischaemia, seizure, placental abruption, and maternal and neonatal mortality.

Disparities in ED reliance, disease severity

Researchers analysed nationally representative data, finding a 76% increase in emergency encounters related to the condition over the 14-year span, up from 31  623 to 55  893, and nearly 1.5 times as many ED admissions – up from 17 338 to 43 563.

Concerns about costs, time constraints, misconceptions about the necessity of early care or barriers to accessing prenatal care may be possible factors for the increase, authors say.

“The disparities in reliance on emergency rooms for this disease may imply limited access to timely outpatient care or other health system barriers,” said lead author Courtney Townsel, MD, MSc, who was at Michigan Medicine at the time of the study and is now at the University of Maryland.

Black, Hispanic, and Asian or Pacific Islander groups were also more likely to both utilise emergency care and be admitted to the hospital for hypertensive disorders of pregnancy.

“The disproportionate rate of admissions among certain racial and ethnic groups suggests worse disease severity by the time people seek care,” Townsel said.

“Racial differences in emergency care utilisation for hypertensive disorders of pregnancy underscore the ongoing racial disparities in US maternal morbidity and mortality and highlight a critical need for accessible, culturally competent community-level interventions for all.”

Original written by Beata Mostafavi. Republished under a Creative Commons Licence.

Source: Michigan Medicine – University of Michigan

 

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Vegan Diet in Pregnancy may Increase Preeclampsia and Low Birth Weight Risks

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Women who follow vegan diets during pregnancy may face higher risks of developing preeclampsia and of giving birth to newborns with lower birth weight, suggests a recent study published in Acta Obstetricia et Gynecologica Scandinavica.

For the study, 65 872 women identified themselves as omnivorous, 666 as fish/poultry vegetarians, 183 as lacto/ovo vegetarians, and 18 as vegans. Based on a questionnaire completed mid-pregnancy, investigators found that protein intake was lower among lacto/ovo vegetarians (13.3%) and vegans (10.4%) compared with omnivorous participants (15.4%). Micronutrient intake was also much lower among vegans, but when dietary supplements were considered, no major differences were observed.

Compared with omnivorous mothers, vegan mothers had a higher prevalence of preeclampsia (a pregnancy complication characterised by high blood pressure), and their newborns weighed an average of 240 g less.

“Further research is needed regarding possible causality between plant-based diets and pregnancy and birth outcomes, to strengthen the basis for dietary recommendations,” the authors wrote.

Source: Wiley

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

Ground-breaking Progress in Identifying the Root Cause of Preeclampsia

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Researchers report in Nature Communications that they have made ground-breaking progress towards identifying the root cause and potential therapy for preeclampsia. They identified a toxic protein, cis P-tau, in the blood and placenta of preeclampsia patients. This protein is also linked to the development of memory loss after brain injury or Alzheimer’s.

The pregnancy complication affects up to 8% of pregnancies globally and is the leading cause of maternal and foetal mortality due to premature delivery, complications with the placenta and lack of oxygen. It also disproportionately affects women of certain races.

According to the study, led by Drs Kun Ping Lu and Xiao Zhen Zhou at the University of Western Ontario, and Drs Surendra Sharma and Sukanta Jash at Brown University, cis P-tau is a central circulating driver of preeclampsia.

“The root cause of preeclampsia has (so far) remained unknown, and without a known cause there has been no cure. Preterm delivery is the only life-saving measure,” said Lu, professor of biochemistry and oncology at Schulich School of Medicine & Dentistry.

“Our study identifies cis P-tau as a crucial culprit and biomarker for preeclampsia. It can be used for early diagnosis of the complication and is a crucial therapeutic target,” said Sharma.

In 2016, Sharma, a leading preeclampsia researcher, and his team had identified that preeclampsia and diseases like Alzheimer’s had similar root causes related to protein issues. This research builds on that finding.

Until now, cis P-tau was mainly associated with neurological disorders like Alzheimer’s disease, traumatic brain injuries (TBI) and stroke. This association was discovered by Lu and Zhou in 2015 as a result of their decades of research on the role of tau protein in cancer and Alzheimer’s.

An antibody developed by Zhou in 2012 to target only the toxic protein while leaving its healthy counterpart unscathed is currently undergoing clinical trials in human patients suffering from TBI and Alzheimer’s Disease. The antibody has shown promising results in animal models and human cell cultures in treating the brain conditions.

The researchers were curious whether the same antibody could work as a potential treatment for preeclampsia. Upon testing the antibody in mouse models they found astonishing results.

“In this study, we found the cis P-tau antibody efficiently depleted the toxic protein in the blood and placenta, and corrected all features associated with preeclampsia in mice. Clinical features of preeclampsia, like elevated blood pressure, excessive protein in urine and foetal growth restriction, among others, were eliminated and pregnancy was normal,” said Sharma.

Sharma and his team at Brown have been working on developing an assay for early detection of preeclampsia and therapies to treat the condition. He believes the findings of this study have brought them closer to their goal.

Preeclampsia, genetics and the brain

Recent research has also thrown light on preeclampsia’s long-term impacts and possible links to brain health.

“Research has shown that women of certain races have genes that could possibly lead to higher than average blood pressure levels, eventually creating conditions for preeclampsia during pregnancy. However, it’s also true that in many low socio-economic countries there’s no registry to record PE cases. So, its link to other environmental factors is still unclear,” said Sharma.

“Preeclampsia presents immediate dangers to both the mother and foetus, but its long-term effects are less understood and still unfolding,” said Sharma. “Research has suggested a heightened risk of dementia later in life for both mothers who have experienced preeclampsia and their children.” However, the causal link between preeclampsia and dementia is not known.

The researchers say this new study has pinpointed a potential underlying cause of the complex relationship between preeclampsia and brain health.

“Our study adds another layer to this complexity. For the first time, we’ve identified significant levels of cis P-tau outside the brain in the placenta and blood of preeclampsia patients. This suggests a deeper connection between preeclampsia and brain-related issues,” said Jash, the lead author of the study.

As researchers delve deeper, how our bodies respond to stress is also emerging as a potential factor in the onset of preeclampsia.

“Although genetics play a role, factors like stress could be an important piece of the puzzle. Understanding how stress and other environmental factors intersect with biological markers like cis P-tau may offer a more complete picture,” said Jash, assistant professor of molecular biology, cell biology and biochemistry (research) and paediatrics (research) at Brown.

A stress-response enzyme called Pin1

In 1996 and 1997, Lu and Zhou made the ground-breaking discovery of Pin1, which turns out to be a stress-response enzyme. This is a specific protein in the cells that becomes active or changes its behaviour in response to stressors, such as environmental challenges, toxins or physiological changes.

“Pin1 plays a pivotal role in keeping proteins, including the tau protein, in the functional shape during stress. When Pin1 becomes inactivated, it leads to the formation of a toxic, misshapen, variant of tau — cis P-tau,” said Zhou, associate professor, pathology and laboratory medicine at Schulich Medicine & Dentistry.

Interestingly, Pin1 is a key player in cancer signalling networks, turning on numerous cancer-causing proteins and turning off many cancer-suppressing ones. Found in high levels in most human cancers, it’s particularly active in cancer stem cells, which are thought to be central to starting and spreading tumours and are hard to target with existing treatments.

“Essentially, when Pin1 is activated, it can lead to cancer. On the other hand, when there’s a decrease or deactivation in Pin1, it results in the formation of the toxic protein cis P-tau, which leads to memory loss in Alzheimer’s and after TBI or stroke. Now, we’ve uncovered its connection to preeclampsia as well,” said Zhou.

“The results have far-reaching implications. This could revolutionise how we understand and treat a range of conditions, from pregnancy-related issues to brain disorders,” said Lu.

Source: University of Western Ontario

Categories : Lab Tests and Imaging Obstetrics & GynaecologyTags : 1 Comment

Researchers Discover a Lipid Biomarker that can Identify Preeclampsia Risk

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University of Virginia School of Medicine researchers have discovered a lipid biomarker to identify pregnant women at risk of preeclampsia, complications from which are the second-leading cause of maternal death around the world. Their findings are published in the Journal of Lipid Research.

The UVA scientists, led by Charles E. Chalfant, PhD, say that their finding opens the door to simple blood tests to screen patients. Further, the approach worked regardless of whether the women were on aspirin therapy, which is commonly prescribed to women thought to be at risk.

“Clinicians have been seeking simple tests to predict risk of preeclampsia before symptoms appear. Although alterations in some blood lipid levels have been known to occur in preeclampsia, they have not been endorsed as useful biomarkers. Our study presents the first comprehensive analysis of lipid species, yielding a distinctive profile associated with the development of preeclampsia,” said Chalfant. “The lipid ‘signature’ we described could significantly improve the ability to identify patients needing preventative treatment, like aspirin, or more careful monitoring for early signs of disease so that treatment could be initiated in a timely fashion.”

Preeclampsia affects up to 7% of all pregnancies. Symptoms typically appear after 20 weeks and include high blood pressure, kidney problems and abnormalties in blood clotting. The condition is associated with dangerous complications such as kidney and liver dysfunction and seizures, as well as a lifelong increased risk of heart disease for the mothers. An estimated 70 000 women around the world die from preeclampsia and its complications each year.

Doctors commonly recommend low-dose aspirin for at-risk women, but it works for only about half of patients, and it needs to be started within the first 16 weeks of pregnancy – well before symptoms appear. That makes it all the more important to identify women at risk early on, and to better understand preeclampsia in general.

Chalfant and his team wanted to find ‘biomarkers’ in the blood of pregnant women that could reveal their risk of developing preeclampsia. They examined blood plasma samples collected from 57 women in their first 24 weeks of pregnancy, then looked at whether the women went on to develop preeclampsia. The researchers found significant differences in ‘bioactive’ lipids in the blood of women who developed preeclampsia and those who did not.

This, the researchers say, should allow doctors to stratify women’s risk of developing preeclampsia by measuring lipid changes in their blood. The changes represent an important ‘lipid fingerprint’, the scientists say, that could be a useful tool for identifying, preventing and better treating preeclampsia.

“The application of our comprehensive lipid profiling method to routine obstetrical care could significantly reduce maternal and neonatal morbidity and mortality,” Chalfant said. “It represents an example of how personalised medicine could address a significant public health challenge.”

Source: University of Virginia Health System

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

Preeclampsia Leads to 4x Higher Risk of MI in Decade after Delivery

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Women with preeclampsia have a higher likelihood of heart attack and stroke than their peers within just seven years of delivery, with risks remaining elevated more than 20 years later. The study in more than one million pregnant women is published today in the European Journal of Preventive Cardiology, a journal of the ESC.

“The high risk of cardiovascular disease after preeclampsia manifests at young ages and early after delivery,” said study author Dr Sara Hallum of the University of Copenhagen. “This indicates that interventions to prevent heart attacks and strokes in affected women cannot wait until middle age when they become eligible for conventional cardiovascular screening programmes.”

Preeclampsia affects up to 8% of pregnancies worldwide, and signs include hypertension and albuminuria, which develop after 20 weeks of pregnancy or soon after delivery. Symptoms include severe headache, stomach pain and nausea. “Women may mistake these for ‘normal’ pregnancy symptoms and thus not seek medical help until the condition becomes severe,” said Dr Hallum. “Most cases are mild, but preeclampsia may lead to serious complications for the mother and baby if not treated in time.”

It is well established that preeclampsia predisposes women to an elevated likelihood of cardiovascular disease later in life. This was the first study to examine how soon after pregnancy these heart attacks and strokes manifest, and the magnitude of risk in different age groups.

National registers were used to identify all pregnant women in Denmark between 1978 and 2017. Women were grouped into those with one or more pregnancies complicated by preeclampsia and those with no preeclampsia. Participants were free of cardiovascular disease before pregnancy and with follow-up for heart attack and stroke up to 39 years later. Dr Hallum said: “This allowed us to evaluate exactly when cardiovascular disease occurs in women with and without pre-eclampsia, and to estimate risk in different age groups and at various durations of follow-up.”

Up to 2% of those with pre-eclampsia in their first pregnancy had a heart attack or stroke within 20 years of delivery, compared with up to 1.2% of unaffected women. Differences in risk became apparent seven years after delivery. “A 2% incidence of acute myocardial infarction and ischaemic stroke should not be accepted as the cost of a pregnancy complicated by preeclampsia, particularly considering the young age of these women when they fall ill (below 50 years of age),” states the paper.

Overall, women with pre-eclampsia were four times more likely to have a heart attack and three times more likely to have a stroke within 10 years of delivery than those without pre-eclampsia. The risk of heart attack or stroke was still twice as high in the preeclampsia group more than 20 years after giving birth compared to unaffected women.

When the researchers examined the risk of cardiovascular disease according to age, they found that women aged 30 to 39 years with a history of preeclampsia had five- and three-fold higher rates of heart attack and stroke, respectively, than those of similar age with no history of pre-eclampsia. The raised likelihood of cardiovascular disease in those with a history of pre-eclampsia persisted throughout adulthood, with women over 50 years of age still at doubled risk compared to their peers with no history of the pregnancy complication.

Dr Hallum said: “Women are often in contact with the healthcare system during and immediately after pregnancy, providing a window of opportunity to identify those at increased risk of cardiovascular disease. The number of women with previous pre-eclampsia is large, and routine follow-up could last years or even decades. Our study suggests that the women most likely to benefit from screening are those who had pre-eclampsia after age 35 and those who had it more than once. Prevention should start within a decade of delivery, for example by treating high blood pressure and informing women about risk factors for heart disease such as smoking and inactivity.”

Source: European Society of Cardiology

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

Study Demonstrates Safer Preeclampsia Treatment with Nifedipine

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Image by Hush Naidoo from Unsplash
Image by Hush Naidoo from Unsplash

Women with severe preeclampsia may be treated with extended-release nifedipine, a blood pressure-lowering medicine, daily during the labour and delivery process, according to new research published today in Hypertension. Women receiving the drug had a lower risk of dangerously high blood pressure that would require treatment with fast-acting medicines including intravenous (IV) medications.

The study examined whether treatment with nifedipine, an extended-release blood pressure-lowering medication, leading up to labour and delivery may prevent severe blood pressure levels from developing, and, as a result, avoid the need to administer fast-acting IV medications.

According to the American Heart Association, preeclampsia is typically diagnosed after 20 weeks of pregnancy and indicates high blood pressure measures with symptoms such as headaches, vision changes and swelling of the hands, feet, face or eyes. It affects up to 8% of pregnancies. A diagnosis of preeclampsia with severe features typically includes systolic BP of ≥ 160mmHg and/or diastolic BP ≥ 110mmHg, and proteinuria. It increases the risk of stroke, liver or kidney damage and pre-term delivery. Delivery of the baby is the only way to start to cure preeclampsia, and symptoms usually go away within days of delivery. However, some women require BP medication for six weeks after delivery or longer.

“We know that bringing down very high blood pressure to a safer range will help prevent maternal and foetal complications. However, besides rapid-acting, IV medicines for severe hypertension during pregnancy, optimal management for hypertension during the labour and delivery process, has not been studied,” said lead study author Erin M. Cleary, MD.

Sever hypertension also raises the risk for complications such as placental abruption, leading to serious complications for mother and/or the baby.

“Some of these complications may include emergency delivery, blood loss for the mother and may be life threatening for both the mother and baby,” Dr Cleary said. “About 10% of patients treated with a rapid-IV treatment for very high blood pressure may quickly have very low blood pressures. When blood pressure gets too low, too fast, that can lead to other serious complications.”

The study was conducted from June 2020 to April 2022 at The Ohio State University Wexner Medical Center and included 110 women who were at least 22 weeks pregnant, diagnosed with severe preeclampsia and who underwent induction of labour. Half were randomised to take a 30mg oral pill nifedipine extended-release once a day until delivery, the other half took a placebo pill daily until delivery. Participants were followed through hospital discharge, and chart review was performed through six weeks postpartum to monitor for any postpartum readmissions along with reasons for readmission.

The researchers also examined the impact of nifedipine treatment on delivery, if and how long the baby may have needed care in the neonatal intensive care unit (NICU) and other adverse outcomes for the mother and/or baby.

The study found:

  • 34% of women in the nifedipine group needed acute hypertension therapy compared to 55.1% of those in the placebo group.
  • There were fewer Caesarean deliveries among the women treated with nifedipine: 20.8% of women in the nifedipine treatment group had a Caesarean section, compared to 34.7% of women in the placebo group.
  • The rate of NICU admission for the newborns was lower if the mother was treated with nifedipine (29.1%) compared to the placebo group (47.1%).
  • Poor outcomes for the infant – such as lower Apgar score, low blood sugar levels, high bilirubin or needing extra oxygen – did not differ significantly between the two treatment groups.

It’s important to note, however, that the number of participants in this study was too small to determine whether the differences in the NICU and Caesarean rates may hold true or if they may be due to chance or other factors. The researchers plan to conduct larger studies with more participants to better understand if these differences are valid.

Source: American Heart Association

Categories : Obstetrics & GynaecologyTags :

Scientists Test A Potential New Therapy for Preeclampsia

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Researchers have proposed a new therapy for preeclampsia that corrects the defects identified in placental cells, and restores placental and foetal weight, which they report in the journal Redox Biology. The treatment, tested in two rodent models, successfully lowers blood pressure in the mother and resolves the characteristic preeclampsia symptoms of proteinuria and cardiovascular abnormalities.

Preeclampsia is a placental dysfunction that affects approximately 2 to 8% of pregnant women worldwide. It can have potentially complications for mother and child, and longer-term consequences for the mother. Preeclampsia symptoms are primarily arterial hypertension, proteinuria, abnormal coagulation in the placenta, cardiovascular abnormalities in the mother and foetal growth restriction. Treatments for preeclampsia are limited and mostly involve aspirin as a preventative measure, reducing the procoagulant state in the placenta and partly relieving pressure on the vascular network.

Preeclampsia is characterised by a defective placenta caused by trophoblast dysfunction. Trophoblasts are placental cells that help organise and manage the vascular network which provides the essential resources for foetal growth. At the molecular level, preeclampsia is characterised by an uncontrolled increase in oxidative stress, with excessive production of various reactive species including reactive oxygen and nitrogen species. There is a genetic component: the first gene to be identified as being implicated in the genetic forms of preeclampsia was the STOX1 transcription factor, which controls the expression of thousands of genes, especially those involved in the production of nitric oxide (NO).

In a transgenic mouse model, high accumulation of STOX1 in the placenta induced a preeclampsia-like syndrome. In preeclampsia, NO, a powerful vasodilator that promotes blood flow to the placenta, is mobilised to produce potentially toxic molecules (nitrosative stress) and its levels become insufficient in the placental vascular network, affecting trophoblast function and the vascular network and destabilising other reactive species. This creates a vicious circle and causes uncontrollable oxidative/nitrosative stress with multiple complications, also affecting maternal blood vessel cells, with potentially fatal consequences.

NO is produced by a family of enzymes known as nitric oxide synthases (NOSs). Finding a way of restoring NO production in the placenta via NOSs could represent an effective new therapy to treat preeclampsia. A years-long collaboration gave rise to a potential solution. The scientists’ research was based on trophoblasts overexpressing STOX1 and on two rodent models of preeclampsia, one mimicking early-onset forms via placental overexpression of STOX1 and the other mimicking late-onset forms by partial occlusion of the lower abdominal aorta.

The research revealed a cascade of events that ultimately led the scientists to propose a new therapy. Treating trophoblasts with BH4 (tetrahydrobiopterin, a cofactor that stabilises the NOS enzyme producing NO) corrected the defects identified in these cells, restoring production of NO rather than potentially toxic molecules. More importantly, administering BH4 to the two preclinical rodent models restored placental and foetal weight. Finally, in the early-onset STOX1 preclinical model with significant arterial hypertension and proteinuria, the BH4 treatment corrected blood pressure, excess protein in urine, and cardiovascular abnormalities in the mother. The results even suggest that the treatment may be effective in addressing the long-term effects of preeclampsia on mothers (vascular abnormalities in the brain, kidneys, heart and liver).

This research is the first step towards the development of a therapy for preeclampsia. Genetic analyses of placentas treated with BH4 showed that it corrects the expression of several genes disrupted by excess STOX1 differently than the deregulation induced by aspirin in the placenta. The scientists therefore propose that a treatment combining BH4 and aspirin could be the ultimate therapeutic solution for many cases of preeclampsia. This hypothesis needs to be validated in clinical trials.

Source: Institut Pasteur

Categories : Obstetrics & GynaecologyTags :

Is Fathers’ Lifestyle a Risk Factor for Partners’ Preeclampsia?

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Although various maternal risk factors have been recognised, it is still unclear what causes preeclampsia, and some evidence suggests paternal risk factors such as obesity and cardiovascular disease. New research published in Acta Obstetricia et Gynecologica Scandinavica suggests that fathers’ characteristics and lifestyle however do not in fact play a significant role in their partners’ susceptibility to preeclampsia.

Preeclampsia (PE) is a complex vascular disorder in pregnancy characterized by new-onset hypertension and proteinuria after 20 weeks of gestation or new-onset PE-associated signs in the absence of proteinuria.

In this study, researchers examined questionnaire data from 586 men who had fathered a preeclamptic pregnancy and 660 control men who had fathered a non-preeclamptic pregnancy. Fathers in the former group more often reported preeclampsia in a previously fathered pregnancy, but there were no differences in the socioeconomic background or health history of the preeclamptic and control fathers or their parents.

“Importance of paternal genetic factors has been demonstrated in their partners’ susceptibility to preeclampsia, but the role of paternal phenotype and lifestyle is still not well understood. Both paternal genotype and phenotype need to be addressed in future studies,” said co-author Noora Jaatinen, MD, a University of Turku PhD student.

Source: Wiley

Categories : Obstetrics & GynaecologyTags :

Taking Action Before and Between Pregnancies Reduces Risk of Preeclampsia

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In a new study, John Hopkins researchers have found that the periods before pregnancy and in between pregnancies are crucial times to address preeclampsia risk factors like obesity, diabetes and hypertension.

Preeclampsia, a common pregnancy complication, is characterised by high blood pressure and signs of damage to the liver, kidneys or other organs. It usually starts after 20 weeks of pregnancy in women whose blood pressure had previously been normal. .

The team, led by S. Michelle Ogunwole, MD, a fellow in the Division of General Internal Medicine, and Wendy Bennett, MD, MPH, associate professor of medicine, both at the Johns Hopkins University School of Medicine, published their findings in the Journal of the American Heart Association.

Dr Ogunwole said: “Preconception health care is really important as it’s a window of opportunity to think about your future health. We encourage patients to work on chronic disease issues before their pregnancies and between their pregnancies.”

A woman who develops preeclampsia during her first pregnancy has a higher risk of the condition recurring in a second or any successive pregnancies, she said.

“As an internist concerned about maternal outcomes, I am interested in what health care providers can do to help women reduce their risk of preeclampsia, including being a big proponent of preconception counseling,” said Dr Ogunwole.

The team compared two sets of women who were participating in the Boston Birth Cohort. Since 1998, the cohort has looked at a broad array of early life factors and their effects on pregnancy, infancy and child health outcomes. The researchers wanted to understand the differences between women who developed preeclampsia and those who did not, and how a first case of the condition affects subsequent pregnancies. Dr Ogunwole’s team studied 618 women to gain “rich maternal health data among racially and ethnically diverse pregnant women.”

“We wanted to make sure that we’re asking questions in a population that looks like the populations we serve,” she says. “I’m interested in the life course of women and pregnancy complications that can shape the trajectory of their future health.”

The researchers found that obesity, diabetes, high blood pressure, gestational diabetes and preterm birth were common factors in women who had preeclampsia during both first and second pregnancies, or who developed the condition during gestation with a second or later child.

“We know that improving weight will improve other conditions, so we advise that women create healthier lifestyles before and between pregnancies,” said Dr Ogunwole. “Whether you have another pregnancy again or not, you can still improve your overall health.”

Future research should hopefully include larger trials to confirm their results. Dr  Ogunwole  also plans to study the structural barriers that may prevent women from engaging in healthy lifestyles and develop strategies to improve long-term health outcomes for women.

Source: John Hopkins Medicine