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Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are the most common medical complications in pregnancy. Physical exercise is considered to be safe and beneficial during pregnancy. Moreover, pregnancy could be considered as an opportunity for healthcare providers to promote positive lifestyle behavior and optimize the well-being of pregnant women. Since there are few up-to-date reviews evaluating the role of exercise and the risks of developing obstetrical complications, we performed a review to investigate the effects of physical activity and exercise during pregnancy compared to a control group, focusing on the risk of development of HDP and GDM. We searched Medline and Web of Science, including only randomized controlled trials (RCTs) and systematic reviews. This review supports a beneficial effect of exercise and provides evidence that it significantly decreases the risk of HDP and GDM. [ABSTRACT FROM AUTHOR]

The biologically significant phenomenon that the fetus can survive immune attacks from the mother has been demonstrated in mammals. The survival mechanism depends on the fetus and placenta actively defending themselves against attacks by maternal T cells, achieved through the localized depletion of the amino acid L-tryptophan by an enzyme called indoleamine 2,3-dioxygenase. These findings were entirely unexpected and pose important questions regarding diseases related to human pregnancy and their prevention during human pregnancy. Specifically, the role of this mechanism, as discovered in mice, in humans remains unknown, as does the extent to which impaired activation of this process contributes to major clinical diseases in humans. We have, thus, elucidated several key aspects of this enzyme expressed in the human placenta both in normal and abnormal human pregnancy. The questions addressed in this brief review are as follows: (1) localization and characteristics of human placental indoleamine 2,3-dioxygenas; (2) overall tryptophan catabolism in human pregnancy and a comparison of indoleamine 2,3-dioxygenase expression levels between normal and pre-eclamptic pregnancy; (3) controlling trophoblast invasion by indoleamine 2,3-dioxygenase and its relation to the pathogenesis of placenta accrete spectrum. [ABSTRACT FROM AUTHOR]

Background: The notion of focal infection, which gained traction in the late 19th and early 20th centuries, postulated that sepsis "foci" were to blame for the start and development of numerous inflammatory illnesses, including appendicitis, peptic ulcers, and arthritis. Methodology: Group 1 consisted of the healthy controls; Group 2 was periodontitis patients; Group 3 consisted of CHD patients; Group 4 consisted of periodontitis plus CHD individuals. According to the recently established category for periodontal diseases1, patients with periodontitis met the following inclusion requirements: 1) a minimum of 15 teeth; 2) 40% of sites with a clinical attachment level (CAL) of less than 2 mm and a probing depth (PD) of less than 4 mm; 3) at least 40% of sites with bleeding on probing (BOP); 4) At least two sites with radiographically alveolar bone loss (ABL) of =2 mm verified on periapical Rinn X-rays. Results-SuPAR levels in serum and saliva were assessed using univariate and multivariate linear regression analysis for every subject. One continuous variable that was present was age. Controls were used as a point of reference for CHD and periodontitis. The reference for gender was male. Conclusion: Over the past few decades, a variety of methods have been created to identify biomarkers that can be used for the early diagnosis and detection of CVD and periodontitis. The study's findings show that, in comparison to CHD patients and healthy controls, patients with periodontitis and those with periodontitis + CHD had greater plasma and salivary levels of suPAR. Furthermore, the findings demonstrated that high levels of salivary suPAR and plasma were negatively correlated with periodontitis and high hs-CRP, correspondingly. [ABSTRACT FROM AUTHOR]

Purpose: To explore the contribution of maternal and fetal parameters in predicting the time interval between diagnosis and development of adverse events leading to delivery in singleton pregnancies complicated with fetal microsomia. Methods: Prospective study on singleton pregnancies referred to a tertiary center because of suspicion of fetal smallness in the third trimester. The study cohort included cases with fetal abdominal circumference (AC) ≤ 10th centile or estimated fetal weight ≤ 10th centile or umbilical artery pulsatitlity index ≥ 90th centile. Development of pre-eclampsia, fetal demise, and fetal deterioration diagnosed by fetal Doppler studies or fetal heart rate monitoring and leading to delivery were considered as adverse events. Maternal demographics, obstetric history, blood pressure, serum PLGF, and fetal Doppler studies were explored as predictors of the time interval between the first visit to the clinic and the diagnosis of complications. Results: In 59 women, the median incubation period from presentation to the clinic to an adverse event was 6, 2 weeks, whereas half of the pregnancies (52.5%) did not develop any adverse event. PLGF was the strongest predictor of adverse events. Both PLGF in raw values and PLGF MOM had equally good predictive ability (AUC 0.82 and 0.78 respectively). Optimal cut-off points were 177.7 pg/ml for PLGF raw values (sensitivity 83% and specificity 66.7%) and 0.277 MoM (sensitivity 76% and specificity 86.7%). On multiple Cox regression analysis, maternal systolic blood pressure, PLGF, fetal increased umbilical artery PI, and reduced CP ratio were independently associated with adverse events. Half of the pregnancies with low PLGF and only one in ten with high PLGF were delivered within two weeks after the initial visit. Conclusion: Half of the pregnancies carrying a small fetus in the third trimester will not develop maternal or fetal complications. PLGF is a strong predictor of adverse events that can be used to customize antenatal care. [ABSTRACT FROM AUTHOR]

Numerous studies have demonstrated the pivotal roles of intestinal microbiota in many physiopathological processes through complex interactions with the host. As a unique period in a woman's lifespan, pregnancy is characterized by changes in hormones, immunity, and metabolism. The gut microbiota also changes during this period and plays a crucial role in maintaining a healthy pregnancy. Consequently, anomalies in the composition and function of the gut microbiota, namely, gut microbiota dysbiosis, can predispose individuals to various pregnancy complications, posing substantial risks to both maternal and neonatal health. However, there are still many controversies in this field, such as "sterile womb" versus "in utero colonization." Therefore, a thorough understanding of the roles and mechanisms of gut microbiota in pregnancy and its complications is essential to safeguard the health of both mother and child. This review provides a comprehensive overview of the changes in gut microbiota during pregnancy, its abnormalities in common pregnancy complications, and potential etiological implications. It also explores the potential of gut microbiota in diagnosing and treating pregnancy complications and examines the possibility of gut‐derived bacteria residing in the uterus/placenta. Our aim is to expand knowledge in maternal and infant health from the gut microbiota perspective, aiding in developing new preventive and therapeutic strategies for pregnancy complications based on intestinal microecology. Highlights: Pregnancy complications critically affect maternal and child health, necessitating urgent research and therapeutic strategies to reduce health and socioeconomic impacts.Gut microbiota dysbiosis in patients with various pregnancy complications acts as both a causal factor and a contributor to these conditions.Gut microbiota‐derived metabolites are involved in various pathophysiological pathways closely related to the pathogenesis of pregnancy complications, including intestinal barrier permeability, inflammatory responses, and glucose and lipid metabolism.Emerging therapeutic strategies based on gut microbes show potential in treating pregnancy complications, yet there is a lack of evidence from randomized controlled trials (RCTs) to substantiate this approach. [ABSTRACT FROM AUTHOR]

This study evaluates the protective effect of Hesperidin (HES), flavanoglycone, during pre-eclampsia developed pregnancy. The pregnant rats were randomly divided into five groups as Control, L-NAME (25 mg/kg), HES (100 mg/kg), L-NAME-HES and L-NAME P-HES. After the 13th day of pregnancy, the chemicals were administrated until the 20th day. 20 days after the offspring's birth, they were separated from their mothers and all rats were sacrificed after 6 weeks' time. Serum samples were analyzed for levels of Glutathione (GSH), lipid peroxidation (LPO), and neuron-specific enolase (NSE) activity. Urine samples were analyzed for the proteinuria. While Proteinuria and LPO level increasing, GSH levels decreased in the L-NAME group when compared to the Control. As we compared L-NAME group with the L-NAMEHES and L-NAME P-HES groups, the GSH levels increased significantly while LPO levels in the HES, L-NAME-HES, L-NAME P-HES groups were decreasing. The NSE activity significantly increased in the L-NAME group compared to the Control. In contrast to the L-NAME group, its activity decreased in HES, L-NAME-HES and L-NAME P-HES groups significantly. Briefly, it can be said that HES has a significant effect on both the LPO levels and the NSE activity in the case of pre-eclampsia. [ABSTRACT FROM AUTHOR]

Objective: To describe the maternal outcomes of a prospective cohort of non‐immune hydrops fetalis (NIHF) pregnancies with negative standard‐of‐care evaluations. Methods: This study was a secondary analysis of a prospective cohort study of NIHF pregnancies with negative work‐ups (infection, alloimmune anemia, fetomaternal hemorrhage, and chromosomal disorders). Outcomes were obstetric complications, including pre‐eclampsia, mirror syndrome, preterm birth, polyhydramnios, postpartum hemorrhage, and maternal mental health. Results: Forty pregnancies were included. Four patients developed pre‐eclampsia (4/40, 10.0%); three occurred postpartum. None was diagnosed with mirror syndrome. Of the 31 continued pregnancies, 16 (51.6%) resulted in early fetal death or stillbirth and 15 (48.4%) resulted in live births. Of the 15 live births, 8 (53.3%) were delivered by primary cesarean delivery; 5 (62.5%) were for hydrops fetalis. Eleven live births (73.3%) were delivered preterm; 9 (81.8%) were indicated, most commonly for fetal indications (7/9, 77.8%). Polyhydramnios occurred in 14/40 (35.0%) cases. Where EBL was recorded (n=37), there were 5 (13.5%) cases of postpartum hemorrhage and an additional 3 (8.1%) had uterine atony without hemorrhage. Eighteen patients (18/40, 45.0%) had new‐onset or exacerbated depression or anxiety symptoms. Conclusion: Our study identified several important adverse outcomes of pregnancies complicated by NIHF with negative standard‐of‐care evaluations, including a high rate of postpartum pre‐eclampsia and worsened mental health. We identified a higher rate of cesarean delivery and preterm birth, both primarily for fetal indications. We also observed the known relationship between polyhydramnios, hemorrhage, and atony, but noted that this risk included pregnancies concluding in dilation and evacuation. Counseling after a diagnosis of NIHF should include these adverse outcomes. Synopsis: NIHF pregnancies have higher rates of postpartum pre‐eclampsia, mental health symptoms, medically‐indicated preterm birth, cesarean delivery for fetal hydrops, and postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the modifying effect of low socioeconomic status (SES) on polycystic ovary syndrome (PCOS) women's pregnancy and neonatal complications. Methods: A retrospective population‐based cohort study including all women with an ICD‐9 diagnosis of PCOS in the US between 2004 and 2014, who delivered in the third trimester or had a maternal death. SES was defined according to the total annual family income quartile for the entire population studied. We compared women in the lowest income quartile (<$39 000 annually) to those in the higher income quartiles combined (≥$39 000 annually). Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Results: Overall, 9 096 788 women delivered between 2004 and 2014, of which 12 322 had a PCOS diagnosis and evidence of SES classification. Of these, 2117 (17.2%) were in the lowest SES group, and 10 205 (82.8%) were in the higher SES group. PCOS patients in the lowest SES group, compared to the higher SES group, were more likely to be younger, obese (body mass index ≥30 kg/m2), to have smoked tobacco during pregnancy, and to have chronic hypertension and pregestational diabetes mellitus (DM) (P < 0.05). In a multivariate logistic regression, women in the lowest SES group, compared to the higher SES group, had increased odds of pregnancy‐induced hypertension (aOR 1.27, 95% CI: 1.12–1.46, P < 0.001), pre‐eclampsia (aOR 1.37, 95% CI: 1.14–1.65, P < 0.001), and cesarean delivery (aOR 1.21, 95% CI: 1.09–1.34, P < 0.001), with other comparable pregnancy, delivery and neonatal outcomes. Conclusion: In PCOS patients, low SES increases the risk for pregnancy‐induced hypertension, pre‐eclampsia and CD, highlighting the importance of diligent pregnancy follow‐up and pre‐eclampsia prevention in these patients. Synopsis: In PCOS patients, low SES increases risks for pregnancy‐induced‐hypertension, pre‐eclampsia and CD, highlighting the importance of diligent pregnancy follow‐up and pre‐eclampsia prevention in these patients. [ABSTRACT FROM AUTHOR]

Objective: To describe maternal and fetal outcomes of pregnancies after 42 years and to compare maternal and fetal morbidities according to the conception mode; comparing pregnancies obtained spontaneously and those resulting from assisted reproductive technology (ART). Methods: This retrospective cohort study was conducted in a level 3 maternity hospital. This study covered all women, aged 42 years or older, who gave birth between January 1, 2014 and December 31, 2019. Univariate and multivariate analyses with logistic regression models were used to compare maternal and perinatal outcomes depending on conception mode: spontaneous or using ART. Results: A sample of 532 women, including 335 spontaneous pregnancies (63%) and 147 pregnancies after ART (27.6%) were studied. Conception mode was missing for 50 (9.4%). We found increased rates not only of maternal complications such as maternal overweight and obesity, pre‐eclampsia, and gestational diabetes, but also of interventions such as hospitalization during pregnancy, cesarean section, postpartum hemorrhage, and perinatal outcome like preterm birth. There were also more maternal and perinatal negative outcomes among the ART group. After multivariate analysis, pre‐eclampsia was predominant in the ART group (odds ratio 0.25, 95% confidence interval 0.07–0.85, P = 0.02). Conclusion: While maternal and fetal risks increase for late pregnancies, there also appears to be a difference depending on the conception mode, with pregnancies resulting from ART having more pregnancy‐related complications than those obtained spontaneously. Synopsis: Women aged 42 years or older have more maternal and fetal morbidities, and especially those from assisted reproductive technology group. [ABSTRACT FROM AUTHOR]

Pregnancy-related complications (PRC) impact maternal and fetal morbidity and mortality and place a huge burden on healthcare systems. Thus, effective diagnostic screening strategies are crucial. Currently, national and international guidelines define patients at low risk of PRC exclusively based on their history, thus excluding the possibility of identifying patients with de novo risk (patients without a history of disease), which represents most women. In this setting, previous studies have underlined the potential contribution of non-coding RNAs (ncRNAs) to detect patients at risk of PRC. However, placenta biopsies or cord blood samples are required, which are not simple procedures. Our review explores the potential of ncRNAs in biofluids (fluids that are excreted, secreted, or developed because of a physiological or pathological process) as biomarkers for identifying patients with low-risk pregnancies. Beyond the regulatory roles of ncRNAs in placental development and vascular remodeling, we investigated their specific expressions in biofluids to determine favorable pregnancy outcomes as well as the most frequent pathologies of pregnant women. We report distinct ncRNA panels associated with PRC based on omics technologies and subsequently define patients at low risk. We present a comprehensive analysis of ncRNA expression in biofluids, including those using next-generation sequencing, shedding light on their predictive value in clinical practice. In conclusion, this paper underscores the emerging significance of ncRNAs in biofluids as promising biomarkers for risk stratification in PRC. The investigation of ncRNA expression patterns and their potential clinical applications is of diagnostic, prognostic, and theragnostic value and paves the way for innovative approaches to improve prenatal care and maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Mesenchymal stem cells (MSCs) are involved in the pathogenesis of pre-eclampsia (PE). Heme oxygenase (HMOX) protects against placental cytotoxic injuries associated with PE. Here, we aimed to clarify the roles of HMOX1 in MSC proliferation and apoptosis, trophoblast cell migration, and regulation of angiogenesis, and assess its involvement in the pathogenesis of PE. HMOX1 and vascular endothelial growth factor (VEGF) expression levels in decidual tissues and decidua-derived MSCs (dMSCs) of healthy pregnant women and patients with PE were evaluated via quantitative reverse transcription-polymerase chain reaction and western blotting. Moreover, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, flow cytometry, and transwell assays were used to analyze the cell viability, apoptosis, and migration, respectively. The tube formation ability of human umbilical vein endothelial cells (HUVECs) was also evaluated. Compared to the healthy pregnant women, HMOX1 expression was upregulated in the decidual tissue and downregulated in the dMSCs of patients with PE. HMOX1 overexpression significantly increased dMSC proliferation, decreased cell apoptosis, and increased VEGF expression. Moreover, HMOX1-plasmid transfected dMSC culture supernatant promoted the migration of HTR-8/SVneo cells and improved angiogenesis by HUVECs. The opposite effects were observed in HMOX1-small interfering RNA-treated dMSCs cells. However, VEGF-siRNA reversed the effects of HMOX1-plasmid. HMOX1 is involved in the pathogenesis of PE by regulating the proliferation, apoptosis, and angiogenesis modulation potential of MSCs via VEGF, acting as a potential therapeutic target for PE. [ABSTRACT FROM AUTHOR]

Background: Hesperidin, a flavanone commonly found in citrus fruits and herbal formulations, has emerged as a potential new therapeutic agent for modulating several diseases. Since pre‐eclampsia is a growing public health threat, it may negatively impact the economy and increase the disease burden of South Africa. Phytocompounds are easily accessible, demonstrate minimal side effects, and may confer novel medicinal options as a treatment and preventive preference. Objective: To investigate the physiological, biochemical, and hematological outcomes of hesperidin in an arginine vasopressin (AVP)‐induced rodent model of pre‐eclampsia. Methods: Female Sprague–Dawley rats were surgically implanted with mini‐osmotic pumps to deliver AVP (200 ng/h) subcutaneously. Animals were treated with hesperidin at 200 mg/kg.b.w via oral gavage for 14 days. Systolic and diastolic blood pressures were measured on GD 7, 14, and 18 using a non‐invasive tail‐cuff method and were euthanized on GD 21. Results: The findings showed that hesperidin administration significantly decreased blood pressure (P < 0.05) and urinary protein levels in pregnant rats (P < 0.001). Placental and individual pup weight also increased significantly in the pregnant hesperidin‐treated groups compared to AVP untreated groups (P < 0.001). Biochemical and hematological markers such as white blood cell count and lymphocyte levels differed significantly (P < 0.05) in AVP groups treated with and without hesperidin. Conclusion: Our results suggest that hesperidin is an antihypertensive agent with modes of action associated with its diuretic and blood pressure lowering effects and reduction of proteinuria in AVP‐induced pre‐eclamptic rats. [ABSTRACT FROM AUTHOR]

Introduction: Human leukocyte antigen‐G (HLA‐G) is a non‐classical class I HLA molecule shown to regulate the immunomodulation of maternal immune cells to prevent fetal tissue destruction. Low levels of freely circulating maternal soluble HLA‐G (sHLA‐G) have been observed in pre‐eclampsia, however, no pooled evidence exists. This meta‐analysis aimed to generate pooled findings on the association of sHLA‐G levels with pre‐eclampsia and is the first study to perform a trimester‐wise comparison of the levels of sHLA‐G in preeclamptic cases and normal pregnant controls. Methods: The databases PubMed, Emba, Web of Science, and Google Scholar through May 31, 2023. Preeclamptic women were defined as cases and normal pregnancies as controls. Data on the level of sHLA‐G in cases and controls was extracted and subjected to a meta‐analysis using a random‐effects model. The pooled effect was expressed in terms of standardized mean difference (SMD). Sensitivity analysis was performed to investigate the effect of the exclusion of each study on the pooled results. Publication bias was assessed statistically. Results: Nine studies with altogether 567 PE cases and 1132 normal pregnancy controls were included in the meta‐analysis. The first and third trimester levels of sHLA‐G in PE cases were significantly lower than that of normal pregnant controls: (SMD: −0.84 [−1.29; −0.38]; p =.003; I2 = 54%) and (SMD: −0.39 [−0.71; −0.06]; p =.02; I2 = 79%) respectively. Sensitivity analysis revealed significant fluctuations in the pooled findings when few studies were excluded, raising questions on the consistency of results among studies. Conclusion: Although we found that first and third‐trimester sHLA‐G levels in pre‐eclampsia are significantly lower, taking into consideration the inconsistent results from the sensitivity analysis, our findings advocate the demand for more studies with larger sample sizes to generate solid ground pooled evidence on the predictive role of sHLA‐G in pre‐eclampsia. [ABSTRACT FROM AUTHOR]

Hypertensive disorders affect approximately 8–10% of all pregnancies and include pre-eclampsia, gestational hypertension and pre-existing chronic hypertension, which may be primary or secondary. New onset hypertension in pregnancy is defined as a sustained systolic blood pressure (sBP) ≥140 mmHg and/or diastolic blood pressure (dBP) ≥90 mmHg, and severe hypertension diagnosed when sBP ≥160 mmHg and/or dBP ≥110 mmHg. Gestational hypertension and pre-eclampsia are most common, affecting 4.2–7.9% and 1.5–7.7% respectively. Chronic hypertension affects 0.6–2.7% of pregnancies but may be under-reported due to early physiological adaptations in pregnancy lowering blood pressure or unknown preconception blood pressure. New onset hypertension developing at any stage of pregnancy requires a full history, examination, and investigations to delineate an underlying cause, assess for target organ damage and the presence of pre-eclampsia to assign risk. Developing a hypertensive disorder in pregnancy is associated with increased life-long cardiometabolic risk and other cardiovascular risk factors should be minimised to improve a woman's long-term health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increased cardiovascular risk following preeclampsia is well established and there are signs of early cardiovascular aging 6 months postpartum. This study assessed whether blood pressure (BP) and other cardiovascular measures are abnormal 2 years postpartum in the same cohort to determine ongoing risk markers. METHODS: Six months and 2 years postpartum, BP was measured using sphygmomanometry, 24-hour ambulatory BP monitoring, and noninvasive central BP. Anthropometric measures, blood, and urine biochemistry were performed. Cross-sectional comparisons between preeclampsia and normotensive pregnancy (NP) groups and longitudinal comparisons within each group were made at 6 months and 2 years. RESULTS: Two years postpartum, 129 NP, and 52 preeclampsia women were studied who also had 6 months measures. At both time points, preeclampsia group had significantly higher BP (office BP 2 years, 112±12/72±8 versus 104±9/67±7 mm Hg NP; [ P <0.001]; mean ambulatory BP monitoring 116±9/73±8 versus 106±8/67±6 mm Hg NP; [ P <0.001]). No significant BP changes noted 6 months to 2 years within either group. Office BP thresholds of 140 mm Hg systolic and 90 mm Hg diastolic classified 2% preeclampsia and 0% NP at 2 years. American Heart Association 2017 criteria (above normal, >120/80 mm Hg) classified 25% versus 8% (P <0.002), as did our reference range threshold of 122/79 mm Hg. American Heart Association criteria classified 60% post-preeclampsia versus 16% after NP with above-normal ambulatory BP monitoring (P <0.001). Other cardiovascular risk markers more common 2 years post-preeclampsia included higher body mass index (median 26.6 versus 23.1, P =0.003) and insulin resistance. CONCLUSIONS: After preeclampsia, women have significantly higher BP 6 months and 2 years postpartum, and have higher body mass index and insulin-resistance scores, increasing their future cardiovascular risk. Regular cardiovascular risk screening should be implemented for all who have experienced preeclampsia. [ABSTRACT FROM AUTHOR]

Background: PE is a common pregnancy disease that can cause various pathologies in pregnant women. GEO microarray data revealed low expression of FGD5-AS1 in placenta tissues from patients with severe PE. As predicted by ENCORI, FGD5-AS1 sponges miR-16-5p, and IGF2, and promotes cell proliferation, differentiation, and metabolism. Objectives: This study aimed to interrogate the interaction of FGD5-AS1/miR-16-5p/IGF2 axis and the mechanism of FGD5-AS1 in hypoxia-induced trophoblast cell injury. Results: Our findings revealed that FGD5-AS1 and IGF2 were substantially decreased in PE patients than that in normal pregnant females, whereas miR-16-5p was increased in PE patients than that in normal pregnant females. In vitro studies showed that FGD5-AS1 were reduced in trophoblast cells after hypoxia treatment, accompanied by decreased viability and increased apoptosis, also reduced invasion, migration and angiogenesis. However, FGD5-AS1 overexpression substantially reversed these effects. Further mechanistic analysis showed that FGD5-AS1 could target miR-16-5p to regulate IGF2. FGD5-AS1 promoted the expression of IGF2 by sponging miR-16-5p, thereby increasing the viability of trophoblast cells after hypoxia treatment and promoting invasion and migration. Conclusion: Overall, our findings demonstrated that FGD5-AS1 promoted growth and mobility of trophoblast cells by regulating miR-16-5p/IGF2 axis in PE. [ABSTRACT FROM AUTHOR]

Liver function abnormalities are noted in a minority of pregnancies with multiple causes for the same. A small proportion of these develop severe liver injury and progress to acute liver failure (ALF). There is a discrete set of etiology for ALF in pregnancy and comprehensive understanding will help in urgent evaluation. Certain diseases such as acute fatty liver of pregnancy, hemolysis, elevated liver enzyme, low platelet (HELLP) syndrome and pre-eclampsia are secondary to pregnant state and can present as ALF. Quick and targeted evaluation with urgent institution of etiology-specific management, especially urgent delivery in patients with pregnancy-associated liver diseases, is the key to avoiding maternal deaths. Pregnancy, as also the fetal life, imparts a further layer of complication in assessment, prognosis and management of these sick patients with ALF. Optimal management often requires a multidisciplinary approach in a well-equipped centre. In this review, we discuss evaluation, assessment and management of pregnant patients with ALF, focussing on approach to pregnancy-associated liver diseases. [ABSTRACT FROM AUTHOR]

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Background: this study aimed to determine the expression of RNA-binding oncofetal proteins IMP3 and LIN28A in extravillous (EVT) and villous trophoblast (VT) cells of placentas from pre-eclamptic (PE) pregnancies to better understand the pathogenesis of PE. Methods: placental tissue of 10 patients with PE with severe features, 10 patients with PE without severe features and 20 age-matched healthy pregnancy controls were analyzed by immunohistochemistry, double immunofluorescence and qPCR. Results: We found a decreased percentage of IMP3-positive EVT cells in PE with and without severe features compared to that of the healthy control (p < 0.001). IMP3 expression was significantly low in VT of PE placentas compared to that of the healthy control (p = 0.002). There was no significant difference in LIN28A expression between groups of PE and the control group. Additionally, we noticed the trend toward downregulation of IMP3 mRNA and LIN28A mRNA in severe PE compared to that of healthy controls. Conclusions: We demonstrated that IMP3 expression is decreased in EVT and VT cells of placentas from pregnancies complicated with both PE with and without severe features. However, additional functional investigations are needed to clarify the role of IMP3 as a potential therapeutic target in the management of PE. [ABSTRACT FROM AUTHOR]

This study aims to assess the level of knowledge and adherence to evidence-based practices among nurses in managing pre-eclampsia in pregnant women. Once preeclampsia is diagnosed, evidence-based interventions may reduce the risk or severity of maternal and infant health outcomes of preeclampsia. A descriptive study design was utilized and conducted at the obstetrical and gynecological department of the General Hospital, Lahore. Convenient sampling was used. Three tools were used for data collection: A self-administered questionnaire, an Observational checklist, and a Modified Likert scale. There were more than one-third of studied nurses(41.7%) had an average level of total knowledge, less than two-thirds of studied nurses (65%) had a satisfactory level, and more than half of studied nurses (53.4) had a high level of knowledge for the management of pre-eclampsia. It is recommended that nurses' awareness regarding preeclampsia be improved by involving them in educational programs to encourage them to participate in patients' daily care. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine maternal serum concentration of β‐human chorionic gonadotropin (β‐hCG) on Day 16 after embryo transfer and risk of miscarriage, pre‐eclampsia, and intrauterine growth restriction (IUGR). Methods: In this study, we evaluated 125 pregnancies following in vitro fertilization (IVF). β‐hCG concentrations were measured on the morning of Day 16 after embryo transfer. Baseline characteristics of the study participants were also recorded. Results: Concentrations of β‐hCG on Day 16 after embryo transfer were inversely associated with the higher risk of miscarriage (p < 0.001), but did not with pre‐eclampsia and IUGR (p > 0.05). Spearman's correlation coefficient showed a reverse and significant association between β‐hCG and higher risk of miscarriage (σ = 0.531 and p < 0.001). There was a significant association between frozen embryo transfer and the risk of IUGR and pre‐eclampsia (p = 0.005 and p = 0.023, respectively). Conclusions: Maternal serum concentrations of β‐hCG on Day 16 after IVF/embryo transfer were associated with the higher risk of miscarriage, but not pre‐eclampsia and IUGR. [ABSTRACT FROM AUTHOR]

Fetal and neonatal exposures to perinatal oxidative stress (OS) are key mediators of bronchopulmonary dysplasia (BPD). To characterize these exposures, adductomics is an exposure science approach that captures electrophilic addition products (adducts) in blood protein. Adducts are bound to the nucleophilic cysteine loci of human serum albumin (HSA), which has a prolonged half-life. We conducted targeted and untargeted adductomics to test the hypothesis that adducts of OS vary with BPD. We studied 205 preterm infants (≤28 weeks) and 51 full-term infants from an ongoing birth cohort. Infant plasma was collected at birth (cord blood), 1-week, 1-month, and 36-weeks postmenstrual age. HSA was isolated from plasma, trypsin digested, and analyzed using high-performance liquid chromatography–mass spectrometry to quantify previously annotated (known) and unknown adducts. We identified 105 adducts in cord and postnatal blood. A total of 51 known adducts (small thiols, direct oxidation products, and reactive aldehydes) were increased with BPD. Postnatally, serial concentrations of several known OS adducts correlated directly with supplemental oxygen exposure. The application of large-scale adductomics elucidated OS-mediated pathways of BPD. This is the first study to investigate the "neonatal–perinatal exposome" and to identify oxidative stress-related exposure biomarkers that may inform antioxidant strategies to protect the health of future generations of infants. [ABSTRACT FROM AUTHOR]

Background: Pre-term birth, the leading cause of neonatal mortality, has been associated with maternal periodontal disease and the presence of oral pathogens in the placenta. However, the mechanisms that underpin this link are not known. This investigation aimed to identify the origins of placental microbiota and to interrogate the association between parturition complications and immune recognition of placental microbial motifs. 61FbVQciH1C2BbwKYgvy28 Video Abstract Methods: Saliva, plaque, serum, and placenta were collected during 130 full-term (FT), pre-term (PT), or pre-term complicated by pre-eclampsia (PTPE) deliveries and subjected to whole-genome shotgun sequencing. Real-time quantitative PCR was used to measure toll-like receptors (TLR) 1–10 expression in placental samples. Source tracking was employed to trace the origins of the placental microbiota. Results: We discovered 10,007 functionally annotated genes representing 420 taxa in the placenta that could not be attributed to contamination. Placental microbial composition was the biggest discriminator of pregnancy complications, outweighing hypertension, BMI, smoking, and maternal age. A machine-learning algorithm trained on this microbial dataset predicted PTPE and PT with error rates of 4.05% and 8.6% (taxonomy) and 6.21% and 7.38% (function). Logistic regression revealed 32% higher odds of parturition complication (95% CI 2.8%, 81%) for every IQR increase in the Shannon diversity index after adjusting for maternal smoking status, maternal age, and gravida. We also discovered distinct expression patterns of TLRs that detect RNA- and DNA-containing antigens in the three groups, with significant upregulation of TLR9, and concomitant downregulation of TLR7 in PTPE and PT groups, and dense correlation networks between microbial genes and these TLRs. 70–82% of placental microbiota were traced to serum and thence to the salivary and subgingival microbiomes. The oral and serum microbiomes of PTPE and PT groups displayed significant enrichment of genes encoding iron transport, exosome, adhesion, quorum sensing, lipopolysaccharide, biofilm, and steroid degradation. Conclusions: Within the limits of cross-sectional analysis, we find evidence to suggest that oral bacteria might translocate to the placenta via serum and trigger immune signaling pathways capable of inducing placental vascular pathology. This might explain, in part, the higher incidence of obstetric syndromes in women with periodontal disease. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia (PE) is one of the most severe pregnancy-related diseases; however, there is still a lack of reliable biomarkers. In this study, we aimed to develop models for predicting early-onset PE, severe PE, and the gestation duration of patients with PE. Methods: Eligible patients with PE were enrolled and divided into a training (n = 253) and a validation (n = 108) cohort. Multivariate logistic and Cox models were used to identify factors associated with early-onset PE, severe PE, and the gestation duration of patients with PE. Based on significant factors, nomograms were developed and evaluated using the area under the curve (AUC) and a calibration curve. Results: In the training cohort, multiple gravidity experience (p = 0.005), lower albumin (ALB; p < 0.001), and higher lactate dehydrogenase (LDH; p < 0.001) were significantly associated with early-onset PE. Abortion history (p = 0.017), prolonged thrombin time (TT; p < 0.001), and higher aspartate aminotransferase (p = 0.002) and LDH (p = 0.003) were significantly associated with severe PE. Abortion history (p < 0.001), gemellary pregnancy (p < 0.001), prolonged TT (p < 0.001), higher mean platelet volume (p = 0.014) and LDH (p < 0.001), and lower ALB (p < 0.001) were significantly associated with shorter gestation duration. Three nomograms were developed and validated to predict the probability of early-onset PE, severe PE, and delivery time for each patient with PE. The AUC showed good predictive performance, and the calibration curve and decision curve analysis demonstrated clinical practicability. Conclusion: Based on the clinical features and peripheral blood laboratory indicators, we identified significant factors and developed models to predict early-onset PE, severe PE, and the gestation duration of pregnant women with PE, which could help clinicians assess the clinical outcomes early and design appropriate strategies for patients. [ABSTRACT FROM AUTHOR]

Background: This study aims to assess the utility of the sFlt-1/PlGF ratio throughout pregnancy in predicting placental dysfunction and neonatal outcomes in twin pregnancies. Methods: Prospective study at a tertiary hospital. All pregnant women with a twin pregnancy who signed the informed consent were included. The sFlt-1/PlGF ratio was measured at 12, 24, and 32 weeks' gestation. Results: Seventy patients were included, and 30% developed placental dysfunction. Differences were found in the mean sFlt-1/PlGF ratios at week 32 (13.6 vs. 31.8, p = 0.007). Optimal cutoffs at 12, 24, and 32 weeks to identify patients who develop placental dysfunction were 32.5, 8.5, and 30.5, respectively, with ORs of 4.25 (1.13–20.69 95% IC; p = 0.044), 13.5 (3.07–67.90 95% IC; p = 0.001), 14.29 (3.59–66.84 95% IC; p < 0.001). The sFlt-1/PlGF ratio at 32 weeks was associated with gestational age at birth. The sFlt-1/PlGF ratio in weeks 24 and 32 had a statistically significant negative correlation with the birth weight percentile in both twins. Conclusions: The potential of the sFlt-1/PlGF ratio as a predictive tool for placental dysfunction in twin pregnancies is underscored. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is a multisystem disorder that presents with a variety of phenotypes involving metabolic, endocrine, reproductive, and psychological symptoms and signs. Women with PCOS are at increased risk of pregnancy complications including implantation failure, miscarriage, gestational diabetes, fetal growth restriction, preterm labor, and pre-eclampsia (PE). This may be attributed to the presence of specific susceptibility features associated with PCOS before and during pregnancy, such as chronic systemic inflammation, insulin resistance (IR), and hyperandrogenism, all of which have been associated with an increased risk of pregnancy complications. Many of the features of PCOS are reversible following lifestyle interventions such as diet and exercise, and pregnant women following a healthy lifestyle have been found to have a lower risk of complications, including PE. This narrative synthesis summarizes the evidence investigating the risk of PE and the role of nutritional factors in women with PCOS. The findings suggest that the beneficial aspects of lifestyle management of PCOS, as recommended in the evidence-based international guidelines, extend to improved pregnancy outcomes. Identifying high-risk women with PCOS will allow targeted interventions, early-pregnancy screening, and increased surveillance for PE. Women with PCOS should be included in risk assessment algorithms for PE. [ABSTRACT FROM AUTHOR]

Background: The objective was to assess the association between early HbA1c levels and pregnancy complications and whether this relationship is affected when HbA1c thresholds are greater than or less than 39 mmol/mol (5.7%). Methods: Electronic searches of the MEDLINE and EMBASE databases up to October 2022 were conducted. We included retrospective and prospective observational studies. The inclusion criteria were as follows: HbA1c measurements taken at <20 weeks' gestation, singleton pregnancy, and no pre-existing diabetes mellitus. Results: We assessed the certainty of the evidence with the GRADE system. We determined the proportion of patients in each group who met the criteria for obstetrical outcomes and pooled data into two subgroups according to the HbA1c threshold: <39 mmol/mol or >39 mmol/mol (5.7%). Sixteen studies with a total of 43,627 women were included. An association between elevated early HbA1c levels and pre-eclampsia, large for gestational age (LGA), macrosomia, and preterm delivery (RR 2.02, 95% CI 1.53–2.66; RR 1.38, 95% CI 1.15–1.66; RR 1.40, 95% CI 1.07–1.83; and RR 1.67, 95% CI 1.39–2.0, respectively) was shown, with a moderate–high grade of certainty. According to the subgroup analysis of all studies, LGA, pre-eclampsia, and labour induction were associated with elevated HbA1c levels only in studies using an HbA1c threshold >39 mmol/mol (5.7%). The association between HbA1c levels and premature birth was statistically significant in studies using both higher and lower HbA1c thresholds. Conclusions: Women with high early HbA1c levels below the range of diabetes presented an increased risk of pregnancy complications such as macrosomia, LGA, and pre-eclampsia. An early HbA1c threshold of >39 mmol/mol (5.7%) showed the strongest association with pregnancy complications. [ABSTRACT FROM AUTHOR]

Gestational hypoxia adversely affects uterine artery function, increasing complications. However, an effective therapy remains unidentified. Here, we show in rodent uterine arteries that hypoxic pregnancy promotes hypertrophic remodelling, increases constrictor reactivity via protein kinase C signalling, and triggers compensatory dilatation via nitric oxide‐dependent mechanisms and stimulation of large conductance Ca2+‐activated K+‐channels. Maternal in vivo oral treatment with the mitochondria‐targeted antioxidant MitoQ in hypoxic pregnancy normalises uterine artery reactivity and prevents vascular remodelling. From days 6–20 of gestation (term ∼22 days), female Wistar rats were randomly assigned to normoxic or hypoxic (13–14% O2) pregnancy ± daily maternal MitoQ treatment (500 µm in drinking water). At 20 days of gestation, maternal, placental and fetal tissue was frozen to determine MitoQ uptake. The uterine arteries were harvested and, in one segment, constrictor and dilator reactivity was determined by wire myography. Another segment was fixed for unbiased stereological analysis of vessel morphology. Maternal administration of MitoQ in both normoxic and hypoxic pregnancy crossed the placenta and was present in all tissues analysed. Hypoxia increased uterine artery constrictor responses to norepinephrine, angiotensin II and the protein kinase C activator, phorbol 12,13‐dibutyrate. Hypoxia enhanced dilator reactivity to sodium nitroprusside, the large conductance Ca2+‐activated K+‐channel activator NS1619 and ACh via increased nitric oxide‐dependent mechanisms. Uterine arteries from hypoxic pregnancy showed increased wall thickness and MitoQ treatment in hypoxic pregnancy prevented all effects on uterine artery reactivity and remodelling. The data support mitochondria‐targeted therapy against adverse changes in uterine artery structure and function in high‐risk pregnancy. Key points: Dysfunction and remodelling of the uterine artery are strongly implicated in many pregnancy complications, including advanced maternal age, maternal hypertension of pregnancy, maternal obesity, gestational diabetes and pregnancy at high altitude.Such complications not only have immediate adverse effects on the growth of the fetus, but also they can also increase the risk of cardiovascular disease in the mother and offspring. Despite this, there is a significant unmet clinical need for therapeutics that treat uterine artery vascular dysfunction in adverse pregnancy.Here, we show in a rodent model of gestational hypoxia that in vivo oral treatment of the mitochondria‐targeted antioxidant MitoQ protects against uterine artery vascular dysfunction and remodelling, supporting the use of mitochondria‐targeted therapy against adverse changes in uterine artery structure and function in high‐risk pregnancy. [ABSTRACT FROM AUTHOR]

Simple Summary: Human reproduction, as well as that of all mammals, involves the union of two cells, the male sperm and the female egg, which give rise to a new organism that will grow for about 280 days inside the mother's body. Most research on pregnancy, its complications, and diseases of the unborn child and newborn has focused, appropriately enough, on maternal conditions and the interaction between mother and child, leaving the father with only the role of depositing his genetic material at the moment of conception. This study aims to compile the research that has dealt with the father's role in determining a good or bad course of pregnancy and birth. From this perspective, the father can be a "good father" or a "bad father" not only because of his hereditary genetic heritage, but also because of how he lives, how he feeds, and how he eats; in short, if a man takes care of his health, he is already taking care of his children's health. Pregnancy is generally studied as a biological interaction between a mother and a fetus; however, the father, with his characteristics, lifestyle, genetics, and living environment, is by no means unrelated to the outcome of pregnancy. The half of the fetal genetic heritage of paternal derivation can be decisive in cases of inherited chromosomal disorders, and can be the result of de novo genetic alterations. In addition to the strictly pathological aspects, paternal genetics may transmit thrombophilic traits that affect the implantation and vascular construction of the feto-placental unit, lead to placenta-mediated diseases such as pre-eclampsia and fetal growth retardation, and contribute to the multifactorial genesis of preterm delivery. Biological aspects of immunological tolerance to paternal antigens also appear to be crucial for these pathologies. Finally, this review describes the biological findings by which the environment, exposure to pathogens, lifestyle, and nutritional style of the father affect fetal pathophysiological and epigenetic definition. [ABSTRACT FROM AUTHOR]

Objective: To evaluate microvascular function in women with previous hypertensive disorders of pregnancy (HDP). Design: Retrospective population‐based cohort study. Setting: Linköping, Sweden. Population: Women aged 50–65 years, participating in the Swedish CArdioPulmonary bioImage Study (SCAPIS) at one site (Linköping) 2016–18, who underwent microcirculatory assessment (N = 1222). Methods: Forearm skin comprehensive microcirculatory assessment was performed with a PeriFlux PF6000 EPOS (Enhanced Perfusion and Oxygen Saturation) system measuring oxygen saturation and total speed resolved perfusion. Obstetric records were reviewed to identify women with previous HDP. Data on cardiovascular risk factors, comorbidities, medication, lifestyle, anthropometric data, and biochemical analyses were obtained from SCAPIS. The microcirculatory data were compared between women with and without previous HDP. Main outcome measures: Skin microcirculatory oxygen saturation and total speed resolved perfusion at baseline and post‐ischaemic peak. Results: Women with previous pre‐eclampsia displayed impaired post‐ischaemic peak oxygen saturation compared with women with normotensive pregnancies (88%, interquartile range [IQR] 84–89% vs 91%, IQR 87–94%, p = 0.001) 6–30 years after pregnancy. The difference remained after multivariable adjustment (β −2.69, 95% CI −4.93 to −0.45). Conclusions: The findings reveal microvascular dysfunction at long‐term follow up in women with previous pre‐eclampsia and strengthen the possible role of endothelial dysfunction as a link to the increased risk of cardiovascular disease in women with HDP. [ABSTRACT FROM AUTHOR]

Objective: To report the predictive performance for preterm birth (PTB) of the Fetal Medicine Foundation (FMF) triple test and National Institute for health and Care Excellence (NICE) guidelines used to screen for pre‐eclampsia and examine the impact of aspirin in the prevention of PTB. Design: Secondary analysis of data from the SPREE study and the ASPRE trial. Setting: Multicentre studies. Population: In SPREE, women with singleton pregnancies had screening for preterm pre‐eclampsia at 11–13 weeks of gestation by the FMF method and NICE guidelines. There were 16 451 pregnancies that resulted in delivery at ≥24 weeks of gestation and these data were used to derive the predictive performance for PTB of the two methods of screening. The results from the ASPRE trial were used to examine the effect of aspirin in the prevention of PTB in the population from SPREE. Methods: Comparison of performance of FMF method and NICE guidelines for pre‐eclampsia in the prediction of PTB and use of aspirin in prevention of PTB. Main outcome measure: Spontaneous PTB (sPTB), iatrogenic PTB for pre‐eclampsia (iPTB‐PE) and iatrogenic PTB for reasons other than pre‐eclampsia (iPTB‐noPE). Results: Estimated incidence rates of sPTB, iPTB‐PE and iPTB‐noPE were 3.4%, 0.8% and 1.6%, respectively. The corresponding detection rates were 17%, 82% and 25% for the triple test and 12%, 39% and 19% for NICE guidelines, using the same overall screen positive rate of 10.2%. The estimated proportions prevented by aspirin were 14%, 65% and 0%, respectively. Conclusion: Prediction of sPTB and iPTB‐noPE by the triple test was poor and poorer by the NICE guidelines. Neither sPTB nor iPTB‐noPE was reduced substantially by aspirin. [ABSTRACT FROM AUTHOR]

Objective: Observational studies have described associations between obesity and adverse outcomes of pregnancy but observational results are liable to influence by residual confounding. Mendelian randomisation (MR) leverages the 'natural' genetic randomisation to risk of an exposure occurring at allele assortment and conception. Similar to randomisation in a clinical trial, this limits the potential for the influence of confounding. Design: A two‐sample MR study. Setting: Summary statistics from published genome wide association studies (GWAS) in European ancestry populations. Population or Sample: Instrumental variants for body mass index (BMI) were obtained from a study on 434 794 females. Methods: Inverse‐variance weighted MR was used to assess the association between BMI and all outcomes. Sensitivity analyses with weighted median and MR‐Egger were also performed. Main outcome measures: Female‐specific genetic association estimates for outcomes were extracted from the sixth round of analysis of the FINNGEN cohort data. Results: Higher genetically predicted BMI was associated with higher risk of pre‐eclampsia (odds ratio [OR] per standard deviation 1.68, 95% confidence interval [CI] 1.46–1.94, P = 8.74 × 10−13), gestational diabetes (OR 1.67, 95% CI 1.46–1.92, P = 5.35 × 10−14), polyhydramnios (OR 1.40, 95% CI 1.00–1.96, P = 0.049). There was evidence suggestive of a potential association with higher risk of premature rupture of membranes (OR 1.16, 95% CI 1.00–1.36, P = 0.050) and postpartum depression (OR 1.12, 95% CI 0.99–1.27, P = 0.062). Conclusions: Higher genetically predicted BMI is associated with marked increase in risk of pre‐eclampsia, gestational diabetes and polyhydramnios. The relation between genetically predicted BMI and premature rupture of membranes and postpartum depression should be assessed in further studies. Our study supports efforts to target BMI as a cardinal risk factor for maternal morbidity in pregnancy. [ABSTRACT FROM AUTHOR]

Objective To establish a clinical prediction model for preeclampsia by monitoring risk rating of MP gestation and levels of placental growth factor (PLGF) combined with uterine artery pulsatility index (PI) measured during examination of fetal nuchal translucency (NT). Methods Twenty-four patients with preeclampsia who met the inclusion criteria were selected as the case group, and 95 healthy pregnant women during the same period were randomly selected as the control group. Serum concentrations of PLGF, uterine artery PI values measured by quantitative immunofluorescence assay at 11-14 weeks of gestation, risk ratings for MP hypertension monitoring at 11-20 weeks of gestation, and other relevant data, BMI, age, gestation, mode of delivery, neonatal birth weight and Apgar score were collected in the two groups. Results Results of univariate regression analysis showed that BMI, age, high risk of PI, MP and PLGF<12 were influencing factors for adverse outcomes. Results of multivariate regression analysis showed that high PI, medium high risk in MP and PLGF<12 were independent risk factors for adverse outcomes. The prediction model of PE established was logit (P) = -15.767 + 0.020 × PI + 0.072 × MP risk (medium-high risk = 1, low risk = 0) + 0.181 × PLGF classification (＜12 = 1, ≥12 = 0), with an AUC area of 0.883, specificity of 0.816 and sensitivity of 0.846. Conclusion The combination of PI, MP risk and PLGF to establish a clinical predictive model for preeclampsia has certain value, and its combined predictive value is higher than that of single application. [ABSTRACT FROM AUTHOR]

Pre-eclampsia is a serious complication of pregnancy characterized by a state of multiorgan hypertensive disorders, with or without proteinuria and possible multiorgan dysfunction. Chronic kidney disease is an established risk factor for the development of pre-eclampsia, as angiogenic homeostasis is altered and the maternal circulation is already hypertensive. Facing pre-eclampsia in the context of chronic kidney disease is a challenging emergency for both the mother and the fetus. The clinical features and the management of this multi-organ disorder are clearly defined in the modern literature but the underlying pathophysiologic mechanisms remain not fully elucidated. Understanding the pathophysiology that mediates the onset of pre-eclampsia itself and in synergy with chronic kidney disease is fundamental for developing prompt prevention strategies, treatment planning, and patient counseling. This review aims to summarize the main molecular mechanisms involved in the process of pre-eclampsia, with a particular focus on the role of the kidneys and hormonal pathways related to renal function in normal pregnancy and pre-eclamptic syndromes. [ABSTRACT FROM AUTHOR]

Objective: To visually analyze the prediction model of early-onset preeclampsia based on the knowledge map drawn by CiteSpace software. Methods: CNKI, Wanfang, VIP, PubMed and Web of Science (WoS) databases from January 1st, 2004 to December 31st, 2023, were searched on the relevant research on the prediction model of early -onset preeclampsia. CiteSpace software was used to visually analyze the authors, institutions and keywords of the literature. Logarithmic likelihood rate (LLR) clustering is used to perform cluster analysis on Chinese and English data keywords. Results: A total of 693 articles were included, including 327 articles in Chinese and 366 in English. The number of published studies on the prediction of early -onset preeclampsia at home and abroad was generally on the rise. The cooperation between authors and institutions of the English literature database was relatively close, while the cooperation between authors and institutions of the Chinese literature database was relatively scattered. Two clusters were obtained from Chinese literatures, which were early onset and prediction. Seven clusters were obtained from English literatures. which were DNA methylation, early pregnancy screening, early onset preeclampsia, oxidative stress, multiple immunoassay, fetal body mass estimation and HELLP syndrome. The outburst word analysis showed that the Chinese literature database mainly focused on the analysis of clinical characteristics and treatment strategies of early -onset preeclampsia in 2019 and before, and focused on the construction of prediction models using traditional markers of eclampsia in 2020 and after. The English literature database mainly focused on the independent risk factors of early-onset preeclampsia, not only including maternal factors (history of onset preeclampsia, gestational hypertension, fetal growth restriction, etc.), traditional markers (uterine artery Doppler ultrasound, biochemical markers, vascular growth factor, placental growth factor, etc.) and other clinically reliable and practical specific indicators, but also using some specific indicators of immunity, DNA methylation, oxidative stress that could be widely used in future clinical practice. In this paper, a model was built for predicting the occurrence of early-onset preeclampsia, based on the traditional statistical methods and innovative integration of machine learning algorithms. Conclusions: At present, the construction of predictive models for the onset of early-onset preeclampsia is still a research hotspot at home and abroad. To discover the specific indicators will further enhance the reliability of the predictive models constructed under the background of fusion machine learning algorithms. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pandemic has influenced health care delivery. We conducted an observational study to understand how obstetric medicine (ObM) physicians utilized home blood pressure monitoring (HBPM) to manage hypertension in pregnancy. Methods: Pregnant participants with risk factors or diagnosis of hypertensive disorders of pregnancy (HDP) were enrolled, May 2020–December 2021, and provided with validated home blood pressure (BP) monitor. ObM physicians completed questionnaires to elicit how home BP readings were interpreted to manage HDP. Results: We enrolled 103 people: 44 antepartum patients (33.5 ± 5 years, gestational age of 24 ± 5 weeks); 59 postpartum patients (35 ± 6 years, enrolled 6 ± 4 days post-partum). ObM physicians used range of home BP readings (70%) for management of HDP. Conclusions: HBPM to manage HDP is acceptable and can be used to manage hypertension during pregnancy. Further studies are needed to assess the generalizability of our findings and the safety of HBPM reliance alone in management of HDP. [ABSTRACT FROM AUTHOR]

Aim: There has been limited research about the associations between pre‐eclampsia and neonatal complications in relation to gestational age. This register‐based study aimed to address that gap in our knowledge. Methods: We used Swedish Medical Birth Register to carry out a population‐based study on primiparas with singleton pregnancies from 1999 to 2017. Descriptive statistics and logistic regressions were used to study the associations between pre‐eclampsia and neonatal complications in different gestational ages. The data is presented as adjusted odds ratios (aORs) with 95% CI. Results: The study comprised 805 591 primiparas: 2.9% had mild to moderate pre‐eclampsia and 1.4% had severe pre‐eclampsia. Neonates born to women with pre‐eclampsia had increased risks of several complications compared to those born to mothers without pre‐eclampsia. After adjustment for confounding variables, the risk of being small for gestational age (aOR 5.3, CI: 5.1–5.5) and needing resuscitation (aOR 2.6, CI: 2.4–2.7) were increased. The risk of a low Apgar score and convulsions/hypoxic ischemic encephalopathy was increased at 32–41 weeks of gestation. Moreover, the overall risk of sepsis (aOR 1.9. CI: 1.8–2.1) and perinatal death (aOR 1.2, CI: 1.1–1.5) was also increased. Conclusion: Compared with infants of mothers without pre‐eclampsia, those exposed to pre‐eclampsia had higher risks of all the studied neonatal complications. [ABSTRACT FROM AUTHOR]

Aim: To investigate how the aetiology of very preterm birth/very low birth weight is associated with mortality and later neurodevelopmental outcomes. Methods: Very preterm/very low‐birth weight singletons were categorised based on the aetiology of preterm birth: spontaneous preterm birth (n = 47, 28.1%), preterm premature rupture of membranes (n = 56, 33.5%) or placental vascular pathology (n = 64, 38.3%). Mortality, cerebral palsy, severe cognitive impairment by 11 years of age (<2SD) and mean full‐scale intelligence quotient at 11 years were studied in association with birth aetiology. Results: There was no difference in mortality or rate of cerebral palsy according to birth aetiologies. The rate of severe cognitive impairment was lower (4.9% vs. 15.3%) in the preterm premature rupture of the membrane group in comparison to the placental vascular pathology group (OR 0.2, 95% CI 0.03–0.9, adjusted for gestational age). At 11 years, there was no statistically significant difference in the mean full‐scale intelligence quotient. Conclusion: Placental vascular pathology, as the aetiology of very preterm birth/very low birth weight, is associated with a higher rate of severe cognitive impairments in comparison to preterm premature rupture of membranes, although there was no difference in the mean full‐scale intelligence quotient at 11 years. The aetiology of very preterm birth/very low birth weight was not associated with mortality or the rate of cerebral palsy. [ABSTRACT FROM AUTHOR]

Objectives: First, to compare ophthalmic artery peak systolic velocity (PSV) ratio and biomarkers of impaired placentation at 36 weeks' gestation in women who delivered a small‐for‐gestational‐age (SGA) or growth‐restricted (FGR) neonate, in the absence of hypertensive disorder, with those of women who developed pre‐eclampsia (PE) or gestational hypertension (GH) and of women unaffected by SGA, FGR, PE or GH. Second, to examine the associations of PSV ratio, uterine artery pulsatility index (UtA‐PI), placental growth factor (PlGF) and soluble fms‐like tyrosine kinase‐1 (sFlt‐1) with birth‐weight Z‐score or percentile. Methods: This was a prospective observational study of women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination of fetal anatomy and growth, and measurement of maternal ophthalmic artery PSV ratio, UtA‐PI, PlGF and sFlt‐1. Values of PSV ratio, UtA‐PI, PlGF and sFlt‐1 were converted to multiples of the median (MoM) or delta values. Median MoM or deltas of these biomarkers in the SGA, FGR, PE and GH groups were compared with those in the unaffected group. Regression analysis was used to examine the relationship of PSV ratio delta, UtA‐PI MoM, PlGF MoM and sFlt‐1 MoM with birth‐weight Z‐score, after exclusion of PE and GH cases. Results: The study population of 9033 pregnancies included 7696 (85.2%) that were not affected by FGR, SGA, PE or GH, 182 (2.0%) complicated by FGR in the absence of PE or GH, 698 (7.7%) with SGA in the absence of FGR, PE or GH, 236 (2.6%) with PE and 221 (2.4%) with GH. Compared with unaffected pregnancies, in the FGR and SGA groups, the PSV ratio delta and sFlt‐1 MoM were increased and PlGF MoM was decreased; UtA‐PI MoM was increased in the FGR group but not the SGA group. The magnitude of the changes in biomarker values relative to the unaffected group was smaller in the FGR and SGA groups than that in the PE and GH groups. In non‐hypertensive pregnancies, there were significant inverse associations of PSV ratio delta and UtA‐PI MoM with birth‐weight Z‐score, such that the values were increased in small babies and decreased in large babies. There was a quadratic relationship between PlGF MoM and birth‐weight Z‐score, with low PlGF levels in small babies and high PlGF levels in large babies. There was no significant association between sFlt‐1 MoM and birth‐weight Z‐score. Conclusions: Ophthalmic artery PSV ratio, reflective of peripheral vascular resistance, and UtA‐PI, PlGF and sFlt‐1, biomarkers of impaired placentation, are altered in pregnancies complicated by hypertensive disorder and, to a lesser extent, in non‐hypertensive pregnancies delivering a SGA or FGR neonate. The associations between the biomarkers and birth‐weight Z‐score suggest the presence of a continuous physiological relationship between fetal size and peripheral vascular resistance and placentation, rather than a dichotomous relationship of high peripheral resistance and impaired placentation in small compared to non‐small fetuses. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: Pre‐eclampsia (PE) is a serious complication of pregnancy associated with maternal and fetal morbidity and mortality. As current prediction models have limitations and may not be applicable in resource‐limited settings, we aimed to develop a machine‐learning (ML) algorithm that offers a potential solution for developing accurate and efficient first‐trimester prediction of PE. Methods: We conducted a prospective cohort study in Mexico City, Mexico to develop a first‐trimester prediction model for preterm PE (pPE) using ML. Maternal characteristics and locally derived multiples of the median (MoM) values for mean arterial pressure, uterine artery pulsatility index and serum placental growth factor were used for variable selection. The dataset was split into training, validation and test sets. An elastic‐net method was employed for predictor selection, and model performance was evaluated using area under the receiver‐operating‐characteristics curve (AUC) and detection rates (DR) at 10% false‐positive rates (FPR). Results: The final analysis included 3050 pregnant women, of whom 124 (4.07%) developed PE. The ML model showed good performance, with AUCs of 0.897, 0.963 and 0.778 for pPE, early‐onset PE (ePE) and any type of PE (all‐PE), respectively. The DRs at 10% FPR were 76.5%, 88.2% and 50.1% for pPE, ePE and all‐PE, respectively. Conclusions: Our ML model demonstrated high accuracy in predicting pPE and ePE using first‐trimester maternal characteristics and locally derived MoM. The model may provide an efficient and accessible tool for early prediction of PE, facilitating timely intervention and improved maternal and fetal outcome. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To describe the distributional properties and assess the performance of placental growth factor (PlGF) measured in blood samples collected before 11 weeks' gestation in the prediction of pre‐eclampsia (PE). Methods: The study population consisted of pregnant women included in the Pre‐eclampsia Screening in Denmark (PRESIDE) study with a PlGF measurement from the routine combined first‐trimester screening (cFTS) blood sample collected at 8–14 weeks' gestation. PRESIDE was a prospective multicenter study investigating the predictive performance of the Fetal Medicine Foundation (FMF) first‐trimester screening algorithm for PE in a Danish population. In the current study, serum concentration of PlGF in the cFTS blood samples was analyzed in batches between January and June 2021. Results: A total of 8386 pregnant women were included. The incidence of PE was 0.7% at < 37 weeks' gestation and 3.0% at ≥ 37 weeks. In blood samples collected at 10 weeks' gestation, PlGF multiples of the median (MoM) were significantly lower in pregnancies with preterm PE < 37 weeks compared to unaffected pregnancies. However, PlGF MoM did not differ significantly between pregnancies with PE and unaffected pregnancies in samples collected before 10 weeks' gestation. Conclusions: The gestational‐age range for PlGF sampling may be expanded from 11–14 to 10–14 weeks when assessing the risk for PE using the FMF first‐trimester screening model. There is little evidence to support the use of PlGF in blood samples collected before 10 weeks' gestation. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To examine the external validity of the Fetal Medicine Foundation (FMF) competing‐risks model for the prediction of small‐for‐gestational age (SGA) at 11–14 weeks' gestation in an Asian population. Methods: This was a secondary analysis of a multicenter prospective cohort study in 10 120 women with a singleton pregnancy undergoing routine assessment at 11–14 weeks' gestation. We applied the FMF competing‐risks model for the first‐trimester prediction of SGA, combining maternal characteristics and medical history with measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI) and serum placental growth factor (PlGF) concentration. We calculated risks for different cut‐offs of birth‐weight percentile (< 10th, < 5th or < 3rd percentile) and gestational age at delivery (< 37 weeks (preterm SGA) or SGA at any gestational age). Predictive performance was examined in terms of discrimination and calibration. Results: The predictive performance of the competing‐risks model for SGA was similar to that reported in the original FMF study. Specifically, the combination of maternal factors with MAP, UtA‐PI and PlGF yielded the best performance for the prediction of preterm SGA with birth weight < 10th percentile (SGA < 10th) and preterm SGA with birth weight < 5th percentile (SGA < 5th), with areas under the receiver‐operating‐characteristics curve (AUCs) of 0.765 (95% CI, 0.720–0.809) and 0.789 (95% CI, 0.736–0.841), respectively. Combining maternal factors with MAP and PlGF yielded the best model for predicting preterm SGA with birth weight < 3rd percentile (SGA < 3rd) (AUC, 0.797 (95% CI, 0.744–0.850)). After excluding cases with pre‐eclampsia, the combination of maternal factors with MAP, UtA‐PI and PlGF yielded the best performance for the prediction of preterm SGA < 10th and preterm SGA < 5th, with AUCs of 0.743 (95% CI, 0.691–0.795) and 0.762 (95% CI, 0.700–0.824), respectively. However, the best model for predicting preterm SGA < 3rd without pre‐eclampsia was the combination of maternal factors and PlGF (AUC, 0.786 (95% CI, 0.723–0.849)). The FMF competing‐risks model including maternal factors, MAP, UtA‐PI and PlGF achieved detection rates of 42.2%, 47.3% and 48.1%, at a fixed false‐positive rate of 10%, for the prediction of preterm SGA < 10th, preterm SGA < 5th and preterm SGA < 3rd, respectively. The calibration of the model was satisfactory. Conclusion: The screening performance of the FMF first‐trimester competing‐risks model for SGA in a large, independent cohort of Asian women is comparable with that reported in the original FMF study in a mixed European population. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

• Visual dipsticks for proteinuria testing have comparable accuracy to automated colorimetric readers. • Single-test accuracy is not adequate as a rule-out test for proteinuria. • Proteinuria POC testing may still be beneficial when repeated follow-up tests are performed. Objective: To evaluate the diagnostic accuracy of point-of-care (POC) tests for detecting proteinuria in pregnant women. Design: Systematic review and meta -analysis. Data Sources: MEDLINE and EMBASE databases were searched from inception to 13 November 2020. Eligibility Criteria and Data Analysis: Included studies measured the sensitivity and specificity of POC proteinuria testing compared to laboratory reference standards (protein-creatinine ratio (PCR), 24-hour urine collection). Bivariate meta -analyses determined pooled sensitivity and specificity. Random-effects inverse-variance model determined heterogeneity. Main Outcome Measures: The primary outcome was overall sensitivity and specificity, stratified by method of POC testing and reference standard. Secondary outcomes were sensitivity and specificity within the subgroups test brand, reference standard, and hypertension status. Results: 1078 studies were identified, 17 studies comprising 23 comparisons were included. The meta -analysis included 13 studies with 19 comparisons. Pooled sensitivity and specificity of visual dipsticks against PCR was 72 % (95 % CI: 56 % to 84 %) and 92 % (95 % CI: 76 % to 98 %), respectively. Pooled sensitivity and specificity of visual dipsticks against 24-hour collection was 69 % (55 % to 80 %) and 70 % (51 % to 84 %), respectively. Pooled sensitivity and specificity for automated readers against PCR was 73 % (53 % to 86 %) and 91 % (83 % to 95 %), respectively. Pooled sensitivity and specificity of automated readers against 24-hour collection was 65 % (42 % to 83 %) and 82 % (46 % to 96 %), respectively. Conclusion: Visual dipsticks have comparable accuracy to automated readers, yet are not adequate as a rule-out test for proteinuria. Proteinuria POC testing may be beneficial in antenatal care when repeat follow-up tests are performed. PROSPERO Registration Number: CRD42021231914. [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia is a major cause of maternal and fetal morbidity and mortality, accounting for approximately 25% of maternal deaths in Latin America. Preeclampsia is a state of systemic inflammation due to an immunologic imbalance between proinflammatory and regulatory T cells, leading to multiorgan damage. Objective: To describe the clinical features, biochemical markers, and acute phase reactants of inflammation in hypertensive disorders of pregnancy. Materials and methods: An observational, cross-sectional, prospective study was conducted in hypertensive pregnant patients hospitalized at the Women's Hospital of Culiacan, Mexico, from March 2021 to January 2022. These patients were classified according to the type of hypertension based on 24-hour urine protein determination. A toxicologic profile including uric acid, lactate dehydrogenase (LDH), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum lipids, and total leukocytes was obtained to calculate the neutrophil-lymphocyte ratio of patients in each of the study groups. The body mass index (BMI) was also calculated. Data were analyzed using Stata Intercooled 13.1. Results: The mean age of the included patients was 25.43±6.5 years, gestational age was 37.35±2.73, 35.9% were primigravida, and 16.07% were adolescents. Among the 397 cases, 23.17% had severe preeclampsia, 24.69% had non-severe pre-eclampsia, 27.2% had gestational hypertension, and 24.94% were healthy controls. Neutrophil-lymphocyte ratio, uric acid, urea, LDH, and CRP were higher in the most severe cases of hypertensive disease. Changes in serum magnesium levels were mainly observed in severe preeclampsia. Conclusions: In this study, biochemical and inflammatory markers were higher in severe forms of hypertensive disorders of pregnancy. [ABSTRACT FROM AUTHOR]

Like other low- and middle-income countries, Ghana has high maternal mortality stemming from pre-eclampsia. Ghanaian midwives are frontline service providers of emergency care in obstetric complications and have the greatest potential to maximise pre-eclampsia outcomes. Little is known about the potential barriers and challenges to midwives' capacity to provide quality care in pre-eclampsia in Ghana. Therefore, we aimed to explore and gain insights into midwives' experiences of pre-eclampsia care including their knowledge, skills, and psychological aspects such as midwives' resilience. There is a rising global incidence of pre-eclampsia. Quality midwifery care in inter-professional collaborative practice is crucial to reducing pre-eclampsia-related morbidity and mortality. A qualitative descriptive exploratory study. In-depth semi-structured interviews (n = 35) were performed in 2021 and analysed by thematic analysis. There were three main themes. 1) Competence and Confidence in care; midwives provided timely and appropriate care based on sound knowledge and skills; they explained how pre-eclampsia care was organised within a multidisciplinary context and described collaborative working amongst midwives for mutual learning and support. 2) Emotional concerns and empathy; midwives' described fulfillment in achieving positive pre-eclampsia outcomes. In contrast, maternal loss was distressing and traumatic. 3) Call for improved care resources for pre-eclampsia; midwives recommended expansion of continuing professional development opportunities, appropriate infrastructure, resources, tailored public education, and a review of pre-service education to support their participation in pre-eclampsia care. To improve the quality of care in pre-eclampsia, midwives should be capacitated, systems should promptly address barriers, and prioritise midwives' emotional well-being. [ABSTRACT FROM AUTHOR]

Background: Aspirin at 150 mg daily, initiated in the 1st trimester of pregnancy, prevents preterm pre-eclampsia. We aimed to estimate whether a dose of 75 to 81 mg daily can help to prevent preterm pre-eclampsia as well. Methods: A systematic search was conducted using multiple databases and meta-analyses of randomized controlled trials (RCTs) that compared aspirin initiated in the first trimester of pregnancy to placebo or no treatment, following the PRISMA guidelines and the Cochrane risk of bias tool. Results: We retrieved 11 RCTs involving 13,981 participants. Five RCTs had a low risk of bias, one at unclear risk, and fiver had a high risk of bias. A pooled analysis demonstrated that doses of 75 to 81 mg of aspirin, compared to a placebo or no treatment, was not associated with a significant reduction in preterm pre-eclampsia (8 studies; 12,391 participants; relative risk, 0.66; 95% confidence interval: 0.27 to 1.62; p = 0.36), but there was a significant heterogeneity across the studies (I2 = 61%, p = 0.02). Conclusion: It cannot be concluded that taking 75 to 81 mg of aspirin daily reduces the risk of preterm pre-eclampsia. However, given the significant heterogeneity between the studies, the true effect that such a dose of aspirin would have on pregnancy outcomes could not be properly estimated. [ABSTRACT FROM AUTHOR]

Preeclampsia (PE) is one of the most serious complications of pregnancy, which threatens the lives of pregnant women and fetuses. However, the pathogenesis and effective treatments of PE are still unclear. Exosomes are membrane vesicles secreted by cells and contain a variety of components. They have different biological functions, such as cell -to -cell communication and serving as biomarkers, which may provide new models for early screening and treatment of PE. And exosomes of different origins (especially placenta- and mesenchymal stem cell-derived exosomes) can play different roles in PE. For example, placenta-derived exosomes are involved in immune regulation processes in PE, while mesenchymal stem cellderived exosomes promote endothelial cell proliferation and migration. In addition, the relationship between PE and exosomes from other sources still needs to be clarified. This article reviews the research of exosomes from different sources in the pathogenesis and treatment of PE. [ABSTRACT FROM AUTHOR]

Objective: To analyze the risk factors associated with the occurrence of adverse perinatal pregnancy outcomes in preeclampsia, construct a risk prediction model and validate it. Methods: A retrospective analysis was conducted on clinical data of patients who delivered and diagnosed with preeclampsia at General Hospital of Northern Theater Command (our hospital) from January 1st, 2018 to December 31st, 2022. Multivariable logistic regression analysis was used to screen for independent risk factors for adverse perinatal pregnancy outcomes in preeclampsia. The R language was utilized to construct the risk prediction columnar graphical model. The predictive performance and goodness of fit of the model were evaluated based on the area under the receiver operator characteristic curve (AUC) and the Hosmer-Lemeshow test, the calibration curves were assessed for accuracy, decision analysis curve was used to assess the clinical use of the model. Patients with preeclampsia who delivered at our hospital from January 1st, 2023 to June 30th, 2023 were selected for external validation. Results: A total of 1 057 patients with preeclampsia were included for modelling, divided into a training set (739 patients) and a validation set (318 patients) in a 7 ∶3 ratio. 125 patients with preeclampsia were included for external validation. Multifactorial logistic regression analysis showed that the following factors were independent risk factors for adverse pregnancy outcomes in patients with preeclampsia: gestational week of onset ≤34 weeks, mean arterial pressure ≥120 mmHg (1 mmHg=0.133 kPa), fetal growth restriction, fibrinogen ≤4 g/L, urine protein qualification of ++ or higher, serum albumin ≤30 g/L, and lactate dehydrogenase ≥263 U/L (all P＜0.05). Logistic risk prediction model was established accordingly. The AUC of the model was 0.941 (95%CI: 0.925-0.958), with Jordon index 0.382, specificity 87.8%, sensitivity 85.1%, and calibration curves show goodagreement between the probability of predicting the occurrence of adverse pregnancy outcomes in preeclampsia and the probability of actual occurrence, internal validation calibration curves showed good model agreement. The external validation calibration curve showed that the model was well calibrated, and the Hosmer-Lemeshow test showed that the difference between the predicted probability of the model and the actual observed probability was not statistically significant (χ² =12.164, P=0.144), clinical decision analysis curves indicated the clinical utility of nomograms to some extent. Conclusions: The prediction model of adverse pregnancy outcome in preeclampsia constructed has good accuracy, the selected indicators are simple and easy to obtain, and the nomograms are easy to apply, which can provide a certain reference basis for clinicians to assess the maternal and infant outcomes of patients with preeclampsia. [ABSTRACT FROM AUTHOR]

Objective: To analyze the risk factors and perinatal outcomes of early onset preeclampsia patients with absent or reversed end-diastolic velocity (AREDV) in the umbilical artery. Methods: We retrospectively analyzed the clinical data of 416 pregnant women with early onset preeclampsia admitted from January 2017 to September 2021. These patients were divided into AREDV group (58 cases) and non-AREDV group (358 cases) based on the presence or absence of AREDV before delivery. We compared the clinical data and perinatal outcomes between the two groups. We used binary logistic regression analysis to investigate the risk factors of AREDV in pregnant women with early onset preeclampsia. Results: There were statistically significant differences in gestational age of diagnosis of preeclampsia, hemoglobin levels, alanine aminotransferase and platelet distribution width between the two groups (all P＜0.05). Multivariate logistic regression analysis showed that gestational age of diagnosis of preeclampsia and hemoglobin levels were associated with the occurrence of AREDV in preeclampsia patients. The risk of AREDV in patients whose gestational age ＜28 weeks and between 28 and 29+6 weeks is 8.244 times (95%CI: 2.631- 25.832, P＜0.001) and 6.532 times (95%CI: 2.033-20.985, P=0.002) higher, respectively, compared to those diagnosed at 32 to 33+6 weeks. Early onset preeclampsia patients with hemoglobin ≥135 g/L had a 2.438 times (95%CI: 1.173-5.065, P=0.017) higher risk of developing AREDV compared to those with normal hemoglobin levels. The incidence of intrauterine fetal death and induced abortion in the AREDV group were significantly higher than those in the non-AREDV group. The 1 minute Apgar score、birth weight of newborns and termination of pregnancy weeks in the AREDV group were significantly lower than those in the non-AREDV group (all P＜0.05). Conclusions: For early onset preeclampsia pregnant women with early gestational age of diagnosis of preeclampsia and high hemoglobin levels, it is necessary to strengthen intrauterine monitoring of the fetus and be alert to the occurrence of AREDV. [ABSTRACT FROM AUTHOR]

Preeclampsia (PE) is one of the main causes of increased perinatal mortality, and its pathogenesis remains unclear. The present study has found that the levels of multivitamins during pregnancy were correlated with incidence of PE. It has been proved that vitamin D is involved in placental formation, inflammatory reaction, oxidative stress and immune activation in the pathogenesis of PE. Vitamin D deficiency can lead to PE through the above mechanisms. In addition, the levels of vitamin E in patients with PE are lower than those in normal pregnant women, suggesting that the lack of vitamin E may increase the risk of PE, but the specific mechanism is still under investigation, it may be related to its antioxidant activity. The relationship between vitamin A levels and PE is controversial. PE is also associated with homocysteine, folic acid (vitamin B9), vitamin B12 and vitamin B6, also known as carbon metabolism. The deficiency of related vitamins leads to homocysteine metabolism disorder, thus causing PE. Vitamin B3 primarily protects against PE by preserving the endothelium and regulating redox reactions. Vitamin C deficiency is associated with PE, and the use of vitamin C during fluid replacement therapy can partially reduce the incidence of pulmonary edema. [ABSTRACT FROM AUTHOR]