Recent Advances in the Diagnosis and Treatment of Eclampsia and Pre-eclampsia

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (25 January 2024) | Viewed by 8648

Special Issue Editor

1. Department of Maternal-Fetal Medicine, Lis Hospital for Women, Sourasksy Medical Center, Tel Aviv, Israel
2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Interests: maternal-fetal medicine; hypertensive disorders of pregnancy; preeclampsia; twins; perinatology; preterm birth
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Special Issue Information

Dear Colleagues,

Hypertensive disorders of pregnancy (including gestational or chronic hypertension, preeclampsia and eclampsia) are among the leading causes of maternal and fetal morbidity and mortality. Although the leading etiology for these complications is abnormal placentation and placental insufficiency, other potential causes including maternal cardiovascular disease have been proposed.   

The purpose of this Special Issue is to highlight theories related to the mechanisms and pathophysiology of hypertensive disorders of pregnancy—mainly preeclampsia and eclampsia. Moreover, we hope that this Special Issue will serve as a platform for exploring new diagnostic tools for the better identification of those at risk of perinatal and long-term complications.

We welcome the submission of recent basic science findings, molecular mechanisms, clinical trials, review manuscripts, sociological approaches, as well as findings following the application of artificial intelligence/machine learning methods. 

Prof. Dr. Liran Hiersch
Guest Editor

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Keywords

  • hypertensive disorders of pregnancy
  • preeclampsia
  • eclampsia
  • prevention
  • gestational hypertension

Published Papers (8 papers)

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Research

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12 pages, 835 KiB  
Article
Chronic Hypertension in Pregnancy and Placenta-Mediated Complications Regardless of Preeclampsia
J. Clin. Med. 2024, 13(4), 1111; https://doi.org/10.3390/jcm13041111 - 16 Feb 2024
Viewed by 255
Abstract
Background: The prevalence of chronic hypertension in women of reproductive age is on the rise mainly due to delayed childbearing. Maternal chronic hypertension, prevailing prior to conception or manifesting within the early gestational period, poses a substantial risk for the development of preeclampsia [...] Read more.
Background: The prevalence of chronic hypertension in women of reproductive age is on the rise mainly due to delayed childbearing. Maternal chronic hypertension, prevailing prior to conception or manifesting within the early gestational period, poses a substantial risk for the development of preeclampsia with adverse maternal and fetal outcomes, specifically as a result of placental dysfunction. We aimed to investigate whether chronic hypertension is associated with placenta-mediated complications regardless of the development of preeclampsia in pregnancy. Methods: This was a population-based, retrospective cohort study from ‘Soroka’ university medical center (SUMC) in Israel, of women who gave birth between 1991 and 2021, comparing placenta-mediated complications (including fetal growth restriction (FGR), placental abruption, preterm delivery, and perinatal mortality) in women with and without chronic hypertension. Generalized estimating equation (GEE) models were used for each outcome to control for possible confounding factors. Results: A total of 356,356 deliveries met the study’s inclusion criteria. Of them, 3949 (1.1%) deliveries were of mothers with chronic hypertension. Women with chronic hypertension had significantly higher rates of all placenta-mediated complications investigated in this study. The GEE models adjusting for preeclampsia and other confounding factors affirmed that chronic hypertension is independently associated with all the studied placental complications except placental abruption. Conclusions: Chronic hypertension in pregnancy is associated with placenta-mediated complications, regardless of preeclampsia. Therefore, early diagnosis of chronic hypertension is warranted in order to provide adequate pregnancy follow-up and close monitoring for placental complications, especially in an era of advanced maternal age. Full article
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10 pages, 1013 KiB  
Article
Factors Associated with Progression to Preeclampsia with Severe Features in Pregnancies Complicated by Mild Hypertensive Disorders
J. Clin. Med. 2023, 12(22), 7022; https://doi.org/10.3390/jcm12227022 - 10 Nov 2023
Viewed by 679
Abstract
In this retrospective cohort study, we aimed to investigate the variables associated with progression to preeclampsia with severe features in parturients already diagnosed with mild hypertensive disorders of pregnancy. The study was conducted in a single university-affiliated medical center between 2018 and 2020. [...] Read more.
In this retrospective cohort study, we aimed to investigate the variables associated with progression to preeclampsia with severe features in parturients already diagnosed with mild hypertensive disorders of pregnancy. The study was conducted in a single university-affiliated medical center between 2018 and 2020. All women admitted due to hypertensive disorders were included. Data collected was compared between parturients who progressed and did not progress to preeclampsia with severe features. Among 359 women presenting without severe features, 18 (5%) developed severe features, delivered smaller babies at lower gestational age, and with higher rates of cesarean delivery (p < 0.001 for all). Chronic hypertension, maternal diabetes, any previous gestational hypertensive disorder, gestational diabetes, number of hospitalizations, earlier gestational age at initial presentation, and superimposed preeclampsia as the preliminary diagnosis were all associated with preeclampsia progression to severe features. Previous delivery within 2–5 years was a protective variable from preeclampsia progression. Following regression analysis and adjustment to confounders, only gestational age at initial presentation and superimposed preeclampsia remained significant variables associated with progression to severe features (aOR 0.74 (0.55–0.96) and 34.44 (1.07–1111.85), aOR (95% CI), respectively, p < 0.05 for both) with combined ROC-AUC prediction performance of 0.89, 95% CI 0.83–0.95, p < 0.001. In conclusion, according to our study results, early gestational age at presentation and superimposed preeclampsia as the preliminary diagnosis are the only independent factors that are associated with progression to severe features in women already diagnosed with mild hypertensive disorders during pregnancy. Full article
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9 pages, 255 KiB  
Article
The Association between Advanced Maternal Age and the Manifestations of Preeclampsia with Severe Features
J. Clin. Med. 2023, 12(20), 6545; https://doi.org/10.3390/jcm12206545 - 16 Oct 2023
Viewed by 696
Abstract
This retrospective cohort study aimed to explore the association between advanced maternal age and the clinical manifestations as well as laboratory parameters of preeclampsia with severe features. This study included 452 patients who were diagnosed with preeclampsia with severe features. The clinical and [...] Read more.
This retrospective cohort study aimed to explore the association between advanced maternal age and the clinical manifestations as well as laboratory parameters of preeclampsia with severe features. This study included 452 patients who were diagnosed with preeclampsia with severe features. The clinical and laboratorial characteristics of patients with preeclampsia with severe features aged ≥40 years old (study group) were compared to those of patients aged <40 years old (control group). Multivariant analysis was applied to assess the association between advanced maternal age and the manifestations of preeclampsia with severe features, adjusting for the variables that exhibited significant differences between the study and control groups. The multivariate analysis revealed that a maternal age of ≥40 years old was an independent risk factor for acute kidney injury (OR = 2.5, CI = 1.2–4.9, p = 0.011) and for new-onset postpartum preeclampsia (OR = 2.4, CI = 1.0–5.6, p = 0.046). Conversely, a maternal age ≥ 40 years old was associated with a reduced risk of HELLP syndrome (OR = 0.4, CI = 0.2–0.9, p = 0.018) and thrombocytopenia (OR = 0.5, CI = 0.3–0.9, p = 0.016) compared to that of the patients < 40 years of age. In conclusion, this study demonstrates that maternal age is significantly associated with the clinical manifestations and laboratory parameters of preeclampsia with severe features, highlighting the importance of age-specific management. Full article
12 pages, 438 KiB  
Article
Anti-Phospholipid Antibodies in Women with Placenta-Mediated Complications Delivered at >34 Weeks of Gestation
J. Clin. Med. 2023, 12(13), 4516; https://doi.org/10.3390/jcm12134516 - 06 Jul 2023
Viewed by 1358
Abstract
Objective: To determine the prevalence of positive antiphospholipid (aPL) antibodies among pregnant women with placenta-mediated complications delivered at >340/7 weeks of gestation. Methods: This was a single-center retrospective observational study conducted between 2017 and 2022. Inclusion criteria included pregnant or post-partum women, [...] Read more.
Objective: To determine the prevalence of positive antiphospholipid (aPL) antibodies among pregnant women with placenta-mediated complications delivered at >340/7 weeks of gestation. Methods: This was a single-center retrospective observational study conducted between 2017 and 2022. Inclusion criteria included pregnant or post-partum women, >18 years, diagnosed with any of the following placenta-mediated complications and delivered at >340/7 weeks of gestation: small-for-gestational-age neonate (SGA ≤ 5th percentile according to local birthweight charts), preeclampsia with severe features, and placental abruption. The primary outcome was the prevalence of positive aPL antibodies: Lupus anticoagulant, Anticardiolipin, or Anti-ß2glycoprotein1. Results: Overall, 431 women met the inclusion criteria. Of them, 378(87.7%) had an SGA neonate, 30 had preeclampsia with severe features (7%), 23 had placental abruption (5.3%), and 21 patients had multiple diagnoses(4.9%). The prevalence of aPL antibodies in the cohort was 4.9% and was comparable between the three subgroups (SGA—3.9%; PET with severe features—3.3%; and placental abruption—13% (p = 0.17)). Conclusion: aPL antibodies prevalence in women with placenta-mediated complications > 34 weeks of gestation was 4.9%, with comparable prevalence rates among the three subgroups. Future prospective studies are needed to delineate the need for treatment in those who tested positive for aPL antibodies and do not meet Anti-Phospholipid Antibody Syndrome clinical criteria. Full article
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10 pages, 220 KiB  
Article
Perinatal Outcomes after Liver Transplantation: Is There a Role for Aspirin Treatment?
J. Clin. Med. 2023, 12(11), 3733; https://doi.org/10.3390/jcm12113733 - 29 May 2023
Viewed by 926
Abstract
Background: We aimed to describe perinatal outcomes and evaluate aspirin treatment effects in liver-transplanted pregnant women. Methods: A retrospective study examining perinatal outcomes in liver transplant recipients at a single center (2016–2022). The effect of low-dose aspirin treatment on the risk of developing [...] Read more.
Background: We aimed to describe perinatal outcomes and evaluate aspirin treatment effects in liver-transplanted pregnant women. Methods: A retrospective study examining perinatal outcomes in liver transplant recipients at a single center (2016–2022). The effect of low-dose aspirin treatment on the risk of developing hypertensive disease in these patients was evaluated. Results: Fourteen deliveries in 11 pregnant liver transplant recipients were identified. Primary liver disease was Wilson’s in 50% of pregnancies. The median age was 23 years at transplant and 30 at conception. Tacrolimus was administered in all, steroids in 10 (71.43%), and aspirin (100 mg daily) in 7 (50.0%). Overall, two women (14.28%) developed preeclampsia, and one (7.14%) developed gestational hypertension. Median gestational age at delivery was 37 weeks (31–39 weeks), with six preterm births (between 31–36 weeks) and a median birthweight of 3004 g(range 1450–4100 g). None of those receiving aspirin developed hypertensive disease or suffered excessive bleeding during pregnancy, compared to two (28.57%) with pre-eclampsia in the non-aspirin group. Conclusion: Liver-transplanted pregnant women comprise a unique and complex patient population with overall favorable pregnancy outcomes. Based on our single-center experience and due to its safety profile and potential benefit, we recommend low-dose aspirin in all liver transplanted patients during pregnancy for preeclampsia prevention. Further large prospective studies are needed to corroborate our findings. Full article
14 pages, 2444 KiB  
Article
Lipidomics Reveals Elevated Plasmalogens in Women with Obesity Who Develop Preeclampsia
J. Clin. Med. 2023, 12(8), 2970; https://doi.org/10.3390/jcm12082970 - 19 Apr 2023
Viewed by 1117
Abstract
Objective: Preeclampsia (PE) is a prevalent pregnancy disorder worldwide with limited preventative treatments available. Obesity triples the risk for PE, yet only 10% of women with obesity develop PE. The factors that distinguish PE from uncomplicated pregnancies in the context of obesity [...] Read more.
Objective: Preeclampsia (PE) is a prevalent pregnancy disorder worldwide with limited preventative treatments available. Obesity triples the risk for PE, yet only 10% of women with obesity develop PE. The factors that distinguish PE from uncomplicated pregnancies in the context of obesity have not been fully established. Methods: We studied a cohort of women with obesity throughout pregnancy to identify lipid mediators and/or biomarkers of PE. Blood samples were collected at each trimester and analyzed by both targeted lipidomics and standard lipid panels. Individual lipid species were compared by PE status at each trimester, as well as by self-identified race (Black vs. White) and fetal sex. Results: Standard lipid panels and clinical measurements revealed few differences between PE and uncomplicated pregnancies. Targeted lipidomics, however, identified plasmalogen, phosphatidylethanolamine, and free fatty acid species that were elevated in the third trimester of women with PE. Furthermore, race and trimester of pregnancy were considerable sources of plasma lipidomic variation in women with obesity. Conclusions: First and second trimester individual plasma lipid species do not predict the development of PE in obese women. In the third trimester, PE patients have elevated levels of plasmalogens—a class of lipoprotein-associated phospholipids that have been implicated in the response to oxidative stress. Full article
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Review

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16 pages, 676 KiB  
Review
Recent Advances in the Prevention and Screening of Preeclampsia
J. Clin. Med. 2023, 12(18), 6020; https://doi.org/10.3390/jcm12186020 - 17 Sep 2023
Cited by 1 | Viewed by 2101
Abstract
Throughout the history of medicine, preeclampsia has remained an enigmatic field of obstetrics. In 2023, despite its prevalence and impact, preeclampsia’s exact cause and effective treatment remain elusive; the current options are limited to delivery. The purpose of this review is to summarize [...] Read more.
Throughout the history of medicine, preeclampsia has remained an enigmatic field of obstetrics. In 2023, despite its prevalence and impact, preeclampsia’s exact cause and effective treatment remain elusive; the current options are limited to delivery. The purpose of this review is to summarize the knowledge of the possible novel prophylactic therapies and screening methods for preeclampsia, thereby providing valuable insights for healthcare professionals and researchers. Aspirin and LMWH have already been widely used; meanwhile, calcium, vitamin D, and pravastatin show promise, and endothelin receptor antagonists are being explored. Stress reduction, dietary changes, and lifestyle modifications are also being investigated. Another interesting and fast-growing area is AI- and software-based screening methods. It is also key to find novel biomarkers, which, in some cases, are not only able to predict the development of the disease, but some of them hold promise to be a potential therapeutic target. We conclude that, while a definitive cure for preeclampsia may not be eligible in the near future, it is likely that the assessment and enhancement of preventive methods will lead to the prevention of many cases. However, it is also important to highlight that more additional research is needed in the future to clarify the exact pathophysiology of preeclampsia and to thus identify potential therapeutic targets for more improved treatment methods. Full article
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16 pages, 313 KiB  
Review
A Balancing Act: Navigating Hypertensive Disorders of Pregnancy at Very Advanced Maternal Age, from Preconception to Postpartum
J. Clin. Med. 2023, 12(14), 4701; https://doi.org/10.3390/jcm12144701 - 15 Jul 2023
Cited by 1 | Viewed by 827
Abstract
The decision to postpone parenting has gained momentum in recent years, a shift driven by evolving social dynamics and improved access to fertility treatments. Despite their increasing prevalence, pregnancies at advanced maternal ages are associated with increased risks of adverse maternal and neonatal [...] Read more.
The decision to postpone parenting has gained momentum in recent years, a shift driven by evolving social dynamics and improved access to fertility treatments. Despite their increasing prevalence, pregnancies at advanced maternal ages are associated with increased risks of adverse maternal and neonatal outcomes. This article addresses the association between advanced maternal age and hypertensive disorders of pregnancies (HDPs), which are more prevalent and a significant cause of maternal morbidity and mortality in this population. This review explores the biological mechanisms and age-related risk factors that underpin this increased susceptibility and offers practical management strategies that can be implemented prior to, as well as during, each stage of pregnancy to mitigate the incidence and severity of HDPs in this group. Lastly, this review acknowledges both the short-term and long-term postpartum implications of HDPs in women of advanced maternal age. Full article
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