-
European Journal of Clinical Nutrition Dec 2021Gestational diabetes mellitus (GDM) is a common disorder of pregnancy with short- and long-term consequences for mother and baby. Pre-eclampsia is of major concern to... (Review)
Review
Gestational diabetes mellitus (GDM) is a common disorder of pregnancy with short- and long-term consequences for mother and baby. Pre-eclampsia is of major concern to obstetricians due to its sudden onset and increased morbidity and mortality for mother and baby. The incidence of these conditions continues to increase due to widespread maternal obesity. Maternal obesity is a risk factor for GDM and pre-eclampsia, yet our understanding of the role of adipose tissue and adipocyte biology in their aetiology is very limited. In this article, available data on adipose tissue and adipocyte function in healthy and obese pregnancy and how these are altered in GDM and pre-eclampsia are reviewed. Using our understanding of adipose tissue and adipocyte biology in non-pregnant populations, a role for underlying adipocyte dysfunction in the pathological pathways of these conditions is discussed.
Topics: Adipose Tissue; Diabetes, Gestational; Female; Humans; Obesity; Pre-Eclampsia; Pregnancy; Risk Factors
PubMed: 34131300
DOI: 10.1038/s41430-021-00948-9 -
Cells Feb 2022The pathophysiology of pre-eclampsia involves two major pathways, namely systemic oxidative stress and subsequent generalised inflammatory response, which eventually... (Review)
Review
The pathophysiology of pre-eclampsia involves two major pathways, namely systemic oxidative stress and subsequent generalised inflammatory response, which eventually culminates in endothelial cell injury and the syndrome of pre-eclampsia with multi-organ dysfunction. Aspirin has been used to reduce the risk of pre-eclampsia, but it only possesses anti-inflammatory properties without any antioxidant effect. Hence, it can only partially alleviate the problem. Tocotrienols are a unique form of vitamin E with strong antioxidant and anti-inflammatory properties that can be exploited as a preventive agent for pre-eclampsia. Many preclinical models showed that tocotrienol can also prevent hypertension and ischaemic/reperfusion injury, which are the two main features in pre-eclampsia. This review explores the mechanism of action of tocotrienol in relation to the pathophysiology of pre-eclampsia. In conclusion, the study provides sufficient justification for the establishment of a large clinical trial to thoroughly assess the capability of tocotrienol in preventing pre-eclampsia.
Topics: Anti-Inflammatory Agents; Antioxidants; Female; Humans; Oxidative Stress; Pre-Eclampsia; Pregnancy; Tocotrienols
PubMed: 35203265
DOI: 10.3390/cells11040614 -
Tropical Doctor Jan 2023Our case-control study, aiming at identifying the risk factors for placental abruption (PA), looked at variables including maternal age, daily transportation means,...
Our case-control study, aiming at identifying the risk factors for placental abruption (PA), looked at variables including maternal age, daily transportation means, folic acid consumption, smoking, past-history of infertility, number of antenatal visits done, presence of pre-eclampsia and umbilical cord insertion. Significant risk factors for PA were frequent transportation by motorbikes, consumption of haematinic preparation not containing folic acid, passive smoking, past-history of infertility, pre-eclampsia and marginal cord insertion. Pregnant women should be counselled about the above-mentioned risk factors.
Topics: Female; Pregnancy; Humans; Abruptio Placentae; Pre-Eclampsia; Case-Control Studies; Placenta; Risk Factors; Folic Acid
PubMed: 35903928
DOI: 10.1177/00494755221116716 -
BJOG : An International Journal of... Jul 2021
Topics: Female; Humans; Pre-Eclampsia; Pregnancy; Terminology as Topic
PubMed: 33336521
DOI: 10.1111/1471-0528.16632 -
Women and Birth : Journal of the... Feb 2021Pre-eclampsia is a multi-organ disease affecting pregnant women from the second trimester onwards resulting in multiple adverse outcomes. Sub-optimal treatment of... (Review)
Review
BACKGROUND
Pre-eclampsia is a multi-organ disease affecting pregnant women from the second trimester onwards resulting in multiple adverse outcomes. Sub-optimal treatment of pre-eclampsia is linked with unfavorable outcomes. It is critical for midwives as primary providers to be competent in the diagnosis and management of pre-eclampsia especially in low-and middle-income countries.
AIM
To identify what midwives' around the world know about pre-eclampsia management.
METHODS
A scoping review using the JBI three-step search strategy was used to identify relevant research articles and grey literature on the subject. Database searches in PubMed, CINAHL, Cochrane Databases, Web of Science, and Scopus yielded twenty papers in addition to nine guidelines from Google Scholar. The findings were synthesised using a metasynthesis approach and presented as themes.
FINDINGS
Four themes were identified from the extracted data: Foundational knowledge of pre-eclampsia; Knowledge and management of a woman with pre-eclampsia according to guidelines; Knowledge of being prepared for emergency procedures and management of emergencies; Factors influencing knowledge. The first three themes addressed diagnosis and management whilst the last theme described how contextual factors led to either increased or decreased knowledge of pre-eclampsia.
CONCLUSION
Worldwide, practicing midwives lack knowledge on several aspects of pre-eclampsia diagnosis and care. Policies on in-service training should be oriented to include innovative non-traditional methods that have the potential to increase midwives' knowledge.
Topics: Adult; Female; Health Knowledge, Attitudes, Practice; Humans; Middle Aged; Midwifery; Nurse Midwives; Pre-Eclampsia; Pregnancy; Quality of Health Care
PubMed: 32928690
DOI: 10.1016/j.wombi.2020.08.010 -
International Journal of Molecular... Oct 2022Epigenetics modification such as DNA methylation can affect maternal health during the gestation period. Furthermore, pregnancy can drive a range of physiological and... (Review)
Review
Epigenetics modification such as DNA methylation can affect maternal health during the gestation period. Furthermore, pregnancy can drive a range of physiological and molecular changes that have the potential to contribute to pathological conditions. Pregnancy-related risk factors include multiple environmental, behavioral, and hereditary factors that can impact maternal DNA methylation with long-lasting consequences. Identification of the epigenetic patterns linked to poor pregnancy outcomes is crucial since changes in DNA methylation patterns can have long-term effects. In this review, we provide an overview of the epigenetic changes that influence pregnancy-related molecular programming such as gestational diabetes, immune response, and pre-eclampsia, in an effort to close the gap in current understanding regarding interactions between the environment, the genetics of the fetus, and the pregnant woman.
Topics: Pregnancy; Female; Humans; Epigenesis, Genetic; Epigenomics; DNA Methylation; Pre-Eclampsia; Diabetes, Gestational
PubMed: 36293556
DOI: 10.3390/ijms232012698 -
BMC Health Services Research Dec 2022Pre-eclampsia and eclampsia are the leading causes of perinatal morbidity and mortality worldwide. Early detection and treatment of preeclampsia is lifesaving; however,...
BACKGROUND
Pre-eclampsia and eclampsia are the leading causes of perinatal morbidity and mortality worldwide. Early detection and treatment of preeclampsia is lifesaving; however, evidence suggests that the majority of women in low and middle income-countries are not routinely screened for high blood pressure during antenatal care, that those with severe and mild pre-eclampsia are not monitored for blood pressure and proteinuria as needed, and the magnesium sulphate is not administered as needed. The purpose of this study was therefore to assess knowledge and skills in pre-eclampsia and eclampsia management and their associated factors among healthcare providers working in antenatal clinics in Zanzibar.
METHODS
This was a cross-sectional analytical study conducted in all levels of healthcare facilities in Zanzibar. The study involved 176 healthcare providers (nurses and doctors) who were randomly selected. A self-administered questionnaire was used to collect data and descriptive and inferential statistics were used in the analysis whereby logistic regression models were employed. The Chi-square coefficient, odds ratio, and 95% confidence intervals were reported, and the level of significance was set at p < 0.05.
RESULTS
The mean age of healthcare providers was 35.94 (SD ± 7.83) years. The proportion of healthcare providers with adequate knowledge was 49.0%, and 47% had adequate skills. Knowledge level was predicted by working in higher healthcare facility levels (AOR: 3.28, 95% CI: 1.29-8.29), and having attended on-the-job training on pre-eclampsia (AOR: 7.8, 95% CI: 2.74 - 22.75). Skills were predicted by having attended on-job training (AOR: 8.6, 95% CI: 2.45 - 30.16), having working experience of five years or above in antenatal care units (AOR: 27.89, 95% CI: 5.28 - 148.89) and being a medical doctor or assistant medical doctor (AOR: 18.9, 95% CI: 2.1-166).
CONCLUSION
Approximately half of Zanzibar's ANC healthcare workers demonstrated inadequate knowledge and skills in preeclampsia care, indicating a critical need for targeted interventions to reduce maternal morbidity and mortality. Knowledge is predicted by attending on-the-job training and working in higher healthcare facility level, while skills is predicted by attending on job training, more years of working experience in antenatal care units and being a medical doctor or assistant medical doctor The study recommends the healthcare facility institutions to provide on-the-job training to for the healthcare providers working in lower healthcare facility levels.
Topics: Female; Pregnancy; Humans; Adult; Pre-Eclampsia; Cross-Sectional Studies; Eclampsia; Prenatal Care; Health Personnel; Ambulatory Care Facilities
PubMed: 36510295
DOI: 10.1186/s12913-022-08892-5 -
Acta Paediatrica (Oslo, Norway : 1992) Mar 2024There has been limited research about the associations between pre-eclampsia and neonatal complications in relation to gestational age. This register-based study aimed...
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.
Topics: Pregnancy; Infant, Newborn; Infant; Female; Humans; Pre-Eclampsia; Gestational Age; Perinatal Death; Infant, Small for Gestational Age; Mothers; Infant, Newborn, Diseases
PubMed: 38140818
DOI: 10.1111/apa.17080 -
The Journal of Maternal-fetal &... Oct 2022Mirror syndrome is a rare disease associated with high fetal mortality of up to 67.2%. It is thought to be underdiagnosed and is often associated with preeclampsia.... (Review)
Review
INTRODUCTION
Mirror syndrome is a rare disease associated with high fetal mortality of up to 67.2%. It is thought to be underdiagnosed and is often associated with preeclampsia. Mirror syndrome is characterized by "triple edema": generalized maternal, placental, and fetal edema.
OBJECTIVE
This comprehensive review aims to thoroughly summarize the existing data and provide a broad update on the topic to help accurate diagnosis and encourage further research.
METHODS
A comprehensive search of several databases (Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus) was conducted.
RESULTS
The last systematic review of mirror syndrome cases was conducted in 2016 and included 113 patients. Much is still unknown about the pathophysiology of the disease and it remains underdiagnosed.
CONCLUSIONS AND RELEVANCE
Mirror syndrome is likely more prevalent than current data suggests for it is often misdiagnosed as pre-eclampsia. The differential of Mirror syndrome should be considered in anomalous presentations of pre-eclampsia as intervention may save the fetus and improve maternal symptoms. It is important to further the study on the pathophysiology of the disease to better understand, diagnose and potentially treat it, to avoid its high morbidity and mortality.
Topics: Edema; Female; Humans; Hydrops Fetalis; Placenta; Pre-Eclampsia; Pregnancy; Syndrome; Systematic Reviews as Topic
PubMed: 33722118
DOI: 10.1080/14767058.2020.1844656 -
Hematology. American Society of... Dec 2019Antiphospholipid syndrome (APS) is a rare systemic autoimmune disease, the obstetric features of which include recurrent early miscarriage, fetal death at or beyond 10... (Review)
Review
Antiphospholipid syndrome (APS) is a rare systemic autoimmune disease, the obstetric features of which include recurrent early miscarriage, fetal death at or beyond 10 weeks of gestation, and early delivery for severe preeclampsia or placental insufficiency. Controversies regarding the specificity of these obstetric clinical features, as well as the laboratory diagnostic criteria, are the subject of current debate and reanalysis. Clinical and laboratory features can be used to stratify women with APS in terms of risk of adverse second and third trimester pregnancy outcomes. Numerous "treatments" have been used in high-risk and refractory patients, but rigorously designed clinical trials are needed. APS is a rare disease that requires innovative investigative approaches to provide credible results.
Topics: Adult; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Female; Humans; Placental Insufficiency; Pre-Eclampsia; Pregnancy
PubMed: 31808896
DOI: 10.1182/hematology.2019000043