Increased fetal DNA in the maternal circulation in early pregnancy is associated with an increased risk of preeclampsia

ObjectiveIt remains unclear what roles placenta-originated angiogenic factors play in the pathogenesis of preeclampsia among hypertensive women. We compared maternal soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) levels throughout pregnancy in women with normal blood pressure (BP), elevated BP and hypertension in early pregnancy and their risks of developing preeclampsia.DesignA prospective cohort study.SettingKK Women’s and Children’s Hospital, Singapore.Participants923 women with singleton pregnancy <14 weeks of gestation were included in the prospective Neonatal and Obstetrics Risks Assessment cohort between September 2010 and October 2014. Systolic, diastolic, mean arterial blood pressure (MAP) were measured at 11–14 weeks.Primary and secondary outcomesMaternal serum sFlt-1, PlGF and sFlt-1/PlGF ratio were tested at 11–14, 18–22, 28–32 and 34 weeks onwards of gestation. Preeclampsia was main pregnancy outcome.ResultsWomen were divided based on their BP in early pregnancy: normal (n=750), elevated BP (n=98) and hypertension (n=75). Maternal sFlt-1 levels and sFlt-1/PlGF ratios were higher in hypertensive women throughout pregnancy, but maternal PlGF levels were not significantly lower. Rise in maternal systolic, diastolic BP and MAP at 11–14 weeks were significantly associated with higher sFlt-1/PlGF ratios during pregnancy. A 10 mm Hg increase in MAP was associated with a 5.6-fold increase in risk of preterm preeclampsia and a 3.3-fold increase in risk of term preeclampsia, respectively.ConclusionWomen with elevated BP in early pregnancy already had a higher sFlt-1/PlGF ratio in early gestation and throughout pregnancy, and an increased risk of preeclampsia. In contrast, PlGF levels in these women remained normal.

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1421-P: Associations of Sleep Disturbances Before and During Early Pregnancy with Increased Risk of Gestational Diabetes

Diabetes ◽

10.2337/db19-1421-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1421-P

Author(s):

SYLVIA E. BADON ◽

FEI XU ◽

ASSIAMIRA FERRARA ◽

MONIQUE M. HEDDERSON

Keyword(s):

Gestational Diabetes ◽

Early Pregnancy ◽

Sleep Disturbances ◽

Increased Risk

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Diagnostic accuracy of placental alkaline phosphatase concentrations in gingival crevicular fluid at early pregnancy in predicting the risk of preeclampsia: a prospective cohort study

Authorea ◽

10.22541/au.158630016.66298135 ◽

2020 ◽

Author(s):

Alejandra Chaparro ◽

Max Monckeberg ◽

Ornella Realini ◽

Marcela Hern ndez ◽

Fernanda Param ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Cohort Study ◽

Diagnostic Accuracy ◽

Prospective Cohort Study ◽

Early Pregnancy ◽

Prospective Cohort ◽

Gingival Crevicular Fluid ◽

Placental Alkaline Phosphatase ◽

Crevicular Fluid ◽

Risk Of Preeclampsia

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A case of minimal change disease during pregnancy – Benefits of early diagnosis and use of corticosteroids

Obstetric Medicine ◽

10.1177/1753495x21990214 ◽

2021 ◽

pp. 1753495X2199021

Author(s):

Priyanka S Sagar ◽

Eddy Fischer ◽

Muralikrishna Gangadharan Komala ◽

Bhadran Bose

Keyword(s):

Nephrotic Syndrome ◽

Early Diagnosis ◽

Renal Biopsy ◽

Early Pregnancy ◽

Minimal Change Disease ◽

Minimal Change ◽

Risk Of Bleeding ◽

Increased Risk ◽

Prompt Diagnosis ◽

In Pregnancy

Nephrotic syndrome presenting in pregnancy is rare and poses a diagnostic and therapeutic challenge. Timing of renal biopsy is important given the increased risk of bleeding and miscarriage, and the choice of immunosuppression is limited due to the teratogenicity profiles of standard drugs. We report and discuss a case of minimal change disease diagnosed by renal biopsy during early pregnancy and treated with corticosteroids throughout the pregnancy. Prompt diagnosis and treatment of glomerular disease in pregnancy are vital to prevent poor maternal and fetal outcomes.

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Increased risk of preeclampsia after use of paracetamol during pregnancy – causal or coincidence?

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03490-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hetti von Hellens ◽

Leea Keski-Nisula ◽

Heidi Sahlman

Keyword(s):

Third Trimester ◽

Retrospective Case ◽

Reverse Causation ◽

Gestational Period ◽

The Third ◽

Precise Data ◽

Increased Risk ◽

Study Population ◽

The Difference ◽

Risk Of Preeclampsia

Abstract Background The maternal use of paracetamol during pregnancy has been associated with the development of preeclampsia. This study aims to clarify whether the connection is causal or whether it is due to reverse causation. Methods This study is a continuation of the retrospective case cohort study examining 2,508 pregnant women using a variety of drugs and the development of preeclampsia (1,252 women with preeclampsia and 1,256 controls). For the purposes of this study, more precise data was collected from several hospital databases of the women among this cohort who had reported taking paracetamol during pregnancy (indications, gestational period etc.); this was evaluated in association with the development of preeclampsia. Results 5.5% (100 cases and 37 controls) of all the study population (2,508) had clearly reported paracetamol use. Women with preeclampsia had used significantly more often paracetamol during pregnancy compared to controls (cases 8.0%, controls 2.9%, p < 0.001). The difference was most evident in the third trimester (after the 29th GW) and the use of paracetamol was associated with both mild and severe preeclampsia. Headache and “general pain” were the most common indications for medication among all paracetamol users. Conclusions The use of paracetamol in the third trimester of pregnancy was associated with preeclampsia. This observation indicates that association between paracetamol use and preeclampsia is probably due to reverse causation, i.e. women with preeclampsia experience more headaches due to preeclampsia symptoms since this association was not detected with the use of paracetamol in earlier stages of pregnancy.

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Early Risk Factors for Obesity in the First 1000 Days—Relationship with Body Fat and BMI at 2 Years

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158179 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8179

Author(s):

Mercedes Díaz-Rodríguez ◽

Celia Pérez-Muñoz ◽

Jesús Carretero-Bravo ◽

Catalina Ruíz-Ruíz ◽

Manuel Serrano-Santamaría ◽

...

Keyword(s):

Risk Factors ◽

Weight Gain ◽

Body Fat ◽

Early Pregnancy ◽

Body Fat Percentage ◽

Z Score ◽

Fat Percentage ◽

Early Risk ◽

Early Risk Factors ◽

Increased Risk

(1) Background: Obesity is defined as an excessive accumulation of body fat. Several early developmental factors have been identified which are associated with an increased risk of childhood obesity and increased adiposity in childhood. The primary objective of the present study is to analyse the effect of various early risk factors on Body Mass Index (BMI) and body fat percentage at 2 years of age. (2) Methods: A prospective cohort study design was used, with the sample consisting of 109 mother-child pairs from whom data were collected between early pregnancy and 2 years old. Adiposity was determined based on skinfold measurements using the Brooks and Siri formulae. Mean comparison tests (Student’s t-test and ANOVAs) and multiple linear regression models were used to analyse the relationship between early programming factors and dependent variables. (3) Results: Maternal excess weight during early pregnancy (β = 0.203, p = 0.026), gestational smoking (β = 0.192, p = 0.036), and accelerated weight gain in the first 2 years (β = − 0.269, p = 0.004) were significantly associated with high body fat percentage. Pre-pregnancy BMI and accelerated weight gain in the first 2 years were associated with high BMI z-score (β = 0.174, p = 0.047 and β = 0.417, p = 0.000 respectively). The cumulative effect of these variables resulted in high values compared to the baseline zero-factor group, with significant differences in BMI z-score (F = 8.640, p = 0.000) and body fat percentage (F = 5.402, p = 0.002) when three factors were present. (4) Conclusions: The presence of several early risk factors related to obesity in infancy was significantly associated with higher BMI z-score and body fat percentage at 2 years of age. The presence of more than one of these variables was also associated with higher adiposity at 2 years of age. Early prevention strategies should address as many of these factors as possible.

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Free Fetal DNA in Maternal Circulation

JAMA ◽

10.1001/jama.292.23.2835-a ◽

2004 ◽

Vol 292 (23) ◽

pp. 2835 ◽

Cited By ~ 3

Keyword(s):

Maternal Circulation ◽

Fetal Dna

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A prospective study of early-pregnancy thyroid markers, lipid species, and risk of gestational diabetes mellitus

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab637 ◽

2021 ◽

Author(s):

Yi Wang ◽

Fengjiang Sun ◽

Ping Wu ◽

Yichao Huang ◽

Yi Ye ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Early Pregnancy ◽

Maternal Serum ◽

Thyroid Peroxidase ◽

Free Triiodothyronine ◽

Composite Effect ◽

Lipid Species ◽

Increased Risk

Abstract Context While the associations between thyroid markers and gestational diabetes mellitus (GDM) have been extensively studied, the results are inconclusive and the mechanisms remain unclear. Objective We aimed to investigate the prospective associations of thyroid markers in early gestation with GDM risk, and examine the mediating effects through lipid species. Methods This study included 6068 pregnant women from the Tongji-Shuangliu Birth Cohort. Maternal serum thyroid markers (free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone, thyroid peroxidase antibody, and thyroglobulin antibody) were measured before 15 weeks. Deiodinase activity was assessed by fT3/fT4 ratio. Plasma lipidome were quantified in a subset of 883 participants. Results Mean age of the participants was 26.6 ± 3.7 years, and mean gestational age was 10.3 ± 2.0 weeks. Higher levels of fT4 were associated with a decreased risk of GDM (OR=0.73 comparing the extreme quartiles; 95% CI 0.54, 0.98, Ptrend =0.043), while higher fT3/fT4 ratio was associated with an increased risk of GDM (OR=1.43 comparing the extreme quartiles; 95% CI 1.06, 1.93, Ptrend =0.010) after adjusting for potential confounders. Multiple linear regression suggested that fT3/fT4 ratio was positively associated with alkylphosphatidylcholine 36:1, phosphatidylethanolamine plasmalogen 38:6, diacylglyceride 18:0/18:1, sphingomyelin 34:1, and phosphatidylcholine 40:7 (false discovery rate adjusted P<0.05). Mediation analysis indicated 67.9% of the association between fT3/fT4 ratio and GDM might be mediated through the composite effect of these lipids. Conclusions Lower concentration of serum fT4 or higher fT3/fT4 ratio in early pregnancy was associated with an increased risk of GDM. The association of fT3/fT4 ratio with GDM was largely mediated by specific lipid species.

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