Role of perivascular biomarkers at the fetal-maternal interface in hypertensive disorders of pregnancy

Background: Hypertensive disorders of pregnancy (HDP) are a largely common pregnancy complication and, when is diagnosed, a significant threat for the safety of the mother and the new-born baby. Safe and supervised physical activity is an effective instrument for cardiovascular disease prevention outside pregnancy, but its role in HDP has not been fully defined yet. At present, no biomarker for early detection of exists. Vascular adhesion protein 1 (VAP-1) is novel molecule with great potential for disease detection outside pregnancy. Because of its involvement in angiogenesis and inflammation, a VAP-1 role in HDP (pre-eclampsia (PE) in particular) was postulated. This thesis aimed to determine: i. Whether physical activity is effective for prevention and management of HDP (Chapter 2); ii. Which blood biomarkers have been currently explored for PE diagnosis (Chapter 3); iii. Current knowledge of VAP-1 in human pathology, and its role in pregnancy pathophysiology (Chapter 4); iv. Soluble VAP-1 serum levels in a cohort of pregnant women at an early stage of gestation, and correlations between serum levels and pregnancy complications (HDP particularly PE) (Chapter 5). Methods: This dissertation presents two systematic reviews (to address aims i and iii), one narrative review (aim ii) , and a clinical trial (aim iv). Results and conclusions: This PhD focused on HDP early diagnosis and prevention. Firstly, physical activity appeared to be beneficial in HDP management. Secondly, several biomarkers for PE detection were outlined, but none of them was identified as an ideal early predictor of disease. Finally, VAP-1 was discussed and its association to HDP and PE hypothesised and tested. Its potential in early detection of HDP was described, although further studies on a larger scale are necessary before drawing definitive conclusions.