Editorial

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Editorial: Precision Medicine in Obstetrics: Pregnancy Complication

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J. Pers. Med. 2023, 13(2), 305; https://doi.org/10.3390/jpm13020305 - 10 Feb 2023

Viewed by 710

Abstract

Millions of women give birth every year worldwide [...] Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

Research

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Open AccessArticle

Polygenic Risk Score and Risk Factors for Preeclampsia and Gestational Hypertension

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J. Pers. Med. 2022, 12(11), 1826; https://doi.org/10.3390/jpm12111826 - 03 Nov 2022

Cited by 1 | Viewed by 1068

Abstract

Preeclampsia and gestational hypertensive disorders (GHD) are common complications of pregnancy that adversely affect maternal and offspring health, often with long-term consequences. High BMI, advanced age, and pre-existing conditions are known risk factors for GHD. Yet, assessing a woman’s risk of GHD based [...] Read more.

Preeclampsia and gestational hypertensive disorders (GHD) are common complications of pregnancy that adversely affect maternal and offspring health, often with long-term consequences. High BMI, advanced age, and pre-existing conditions are known risk factors for GHD. Yet, assessing a woman’s risk of GHD based on only these characteristics needs to be reevaluated in order to identify at-risk women, facilitate early diagnosis, and implement lifestyle recommendations. This study demonstrates that a risk score developed with machine learning from the case-control genetics dataset can be used as an early screening test for GHD. We further confirm BMI as a risk factor for GHD and investigate a relationship between GHD and genetically constructed anthropometric measures and biomarkers. Our results show that polygenic risk score can be used as an early screening tool that, together with other known risk factors and medical history, would assist in identifying women at higher risk of GHD before its onset to enable stratification of patients into low-risk and high-risk groups for monitoring and preventative programs to mitigate the risks. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Open AccessArticle

Polygenic Risk Score and Risk Factors for Gestational Diabetes

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J. Pers. Med. 2022, 12(9), 1381; https://doi.org/10.3390/jpm12091381 - 26 Aug 2022

Cited by 4 | Viewed by 1442

Abstract

Gestational diabetes mellitus (GDM) is a common complication of pregnancy that adversely affects maternal and offspring health. A variety of risk factors, such as BMI and age, have been associated with increased risks of gestational diabetes. However, in many cases, gestational diabetes occurs [...] Read more.

Gestational diabetes mellitus (GDM) is a common complication of pregnancy that adversely affects maternal and offspring health. A variety of risk factors, such as BMI and age, have been associated with increased risks of gestational diabetes. However, in many cases, gestational diabetes occurs in healthy nulliparous women with no obvious risk factors. Emerging data suggest that the tendency to develop gestational diabetes has genetic and environmental components. Here we develop a polygenic risk score for GDM and investigate relationships between its genetic architecture and genetically constructed risk factors and biomarkers. Our results demonstrate that the polygenic risk score can be used as an early screening tool that identifies women at higher risk of GDM before its onset allowing comprehensive monitoring and preventative programs to mitigate the risks. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Open AccessArticle

Fetal Growth Restriction: Comparison of Biometric Parameters

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J. Pers. Med. 2022, 12(7), 1125; https://doi.org/10.3390/jpm12071125 - 11 Jul 2022

Cited by 1 | Viewed by 1667

Abstract

The aim of this study was to identify growth-restricted fetuses using biometric parameters and to assess the validity and clinical value of individual ultrasound parameters and ratios, such as transcerebellar diameter/abdominal circumference (TCD/AC), head circumference/abdominal circumference (HC/AC), and femur length/abdominal circumference (FL/AC). In [...] Read more.

The aim of this study was to identify growth-restricted fetuses using biometric parameters and to assess the validity and clinical value of individual ultrasound parameters and ratios, such as transcerebellar diameter/abdominal circumference (TCD/AC), head circumference/abdominal circumference (HC/AC), and femur length/abdominal circumference (FL/AC). In a retrospective single-center cross-sectional study, the biometric data of 9292 pregnancies between the 15th and 42nd weeks of gestation were acquired. Statistical analysis included descriptive data, quantile regression estimating the 10th and 90th percentiles, and multivariable analysis. We obtained clinically noticeable results in predicting small-for-gestational-age (SGA) and fetal growth restriction (FGR) fetuses at advanced weeks of gestation using the AC with a Youden index of 0.81 and 0.96, respectively. The other individual parameters and quotients were less suited to identifying cases of SGA and FGR. The multivariable analysis demonstrated the best results for identifying SGA and FGR fetuses with an area under the curve of 0.95 and 0.96, respectively. The individual ultrasound parameters were better suited to identifying SGA and FGR than the ratios. Amongst these, the AC was the most promising individual parameter, especially at advanced weeks of gestation. However, the highest accuracy was achieved with a multivariable model. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Open AccessArticle

Uterine Artery Embolization of Uterine Arteriovenous Malformation: A Systematic Review of Success Rate, Complications, and Posterior Pregnancy Outcomes

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Francisco Javier Ruiz Labarta

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María Pilar Pintado Recarte

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Manuel González Leyte

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Coral Bravo Arribas

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Arturo Álvarez Luque

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Yolanda Cuñarro López

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Cielo García-Montero

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Oscar Fraile-Martinez

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Miguel A. Ortega

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Juan A. De León-Luis

J. Pers. Med. 2022, 12(7), 1098; https://doi.org/10.3390/jpm12071098 - 01 Jul 2022

Viewed by 1074

Abstract

Uterine Arteriovenous Malformation (UAVM) is a rare but life-threating cause of uterine bleeding. The clinical management of this condition is challenging, and there is a need to describe the most adequate approach for these patients. Uterine artery embolization (UAE) is the most widely-published [...] Read more.

Uterine Arteriovenous Malformation (UAVM) is a rare but life-threating cause of uterine bleeding. The clinical management of this condition is challenging, and there is a need to describe the most adequate approach for these patients. Uterine artery embolization (UAE) is the most widely-published treatment in the literature in recent years, although there is a need to update the evidence on this treatment and to compare it with other available therapies. Thus, the objective of this systematic review is to quantify the efficacy of UAE of UAVM. In addition, we evaluated the clinical context of the patients included, the treatment complications, and the pregnancy outcomes after UAE. With this goal in mind, we finally included 371 patients spread over all continents who were included in 95 studies. Our results show that, similar to other medical therapies, the global success rate after embolization treatment was 88.4%, presenting a low risk of adverse outcomes (1.8%), even in women with later pregnancy (77% had no complications). To date, this is the largest systematic review conducted in this field, although there are still some points to address in future studies. The results obtained in our study should be outlined in UAE protocols and guidelines to aid in clinical decision-making in patients with UAVM. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Open AccessArticle

Fetal Doppler Evaluation to Predict NEC Development

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Miriam Duci

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Erich Cosmi

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Pierpaolo Zorzato

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Ambrogio Pietro Londero

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Giovanna Verlato

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Eugenio Baraldi

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Eugenio Ragazzi

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Francesco Fascetti Leon

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Silvia Visentin

J. Pers. Med. 2022, 12(7), 1042; https://doi.org/10.3390/jpm12071042 - 25 Jun 2022

Viewed by 961

Abstract

Antenatal factors play a role in NEC pathogenesis. This study aimed to investigate the predictive value of fetal ductus venosus doppler (DV) for NEC in fetal growth restriction fetuses (FGRF) and to assess the predictive accuracy of IG21 and Fenton curves in NEC [...] Read more.

Antenatal factors play a role in NEC pathogenesis. This study aimed to investigate the predictive value of fetal ductus venosus doppler (DV) for NEC in fetal growth restriction fetuses (FGRF) and to assess the predictive accuracy of IG21 and Fenton curves in NEC development. Data from FGRF, postnatal findings, and Doppler characteristics were collected between 2010 and 2020 at a single center. Patients were then divided into two groups (i.e., with and without NEC). Bivariate and multivariate analyses were performed. We identified 24 cases and 30 controls. Absent or reversed end-diastolic flow (AREDF) and increased resistance in the DV were more impaired in cases (p < 0.05). Although the median birthweight was not different, the Fenton z-score was lower in NEC (p < 0.05). Fetal cardiopulmonary resuscitation, synchronized intermittent mandatory ventilation, neonatal respiratory distress, persistent patent ductus arteriosus (PDA), and inotropic support were more frequent in the NEC group. Furthermore, NEC patients had lower white blood cells (WBC) (p < 0.05). The predictive model for NEC (model 4), including Fenton z-score, WBC, PDA, and DV had an AUC of 84%. Fetal Doppler findings proved effective in predicting NEC in FGR. The Fenton z-score was the most predictive factor considering the fetal growth assessment showing high sensitivity. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Open AccessArticle

Personalized Model to Predict Small for Gestational Age at Delivery Using Fetal Biometrics, Maternal Characteristics, and Pregnancy Biomarkers: A Retrospective Cohort Study of Births Assisted at a Spanish Hospital

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Peña Dieste-Pérez

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Ricardo Savirón-Cornudella

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Mauricio Tajada-Duaso

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Faustino R. Pérez-López

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Sergio Castán-Mateo

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Gerardo Sanz

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Luis Mariano Esteban

J. Pers. Med. 2022, 12(5), 762; https://doi.org/10.3390/jpm12050762 - 08 May 2022

Cited by 2 | Viewed by 1160

Abstract

Small for gestational age (SGA) is defined as a newborn with a birth weight for gestational age < 10th percentile. Routine third-trimester ultrasound screening for fetal growth assessment has detection rates (DR) from 50 to 80%. For this reason, the addition of other [...] Read more.

Small for gestational age (SGA) is defined as a newborn with a birth weight for gestational age < 10th percentile. Routine third-trimester ultrasound screening for fetal growth assessment has detection rates (DR) from 50 to 80%. For this reason, the addition of other markers is being studied, such as maternal characteristics, biochemical values, and biophysical models, in order to create personalized combinations that can increase the predictive capacity of the ultrasound. With this purpose, this retrospective cohort study of 12,912 cases aims to compare the potential value of third-trimester screening, based on estimated weight percentile (EPW), by universal ultrasound at 35–37 weeks of gestation, with a combined model integrating maternal characteristics and biochemical markers (PAPP-A and β-HCG) for the prediction of SGA newborns. We observed that DR improved from 58.9% with the EW alone to 63.5% with the predictive model. Moreover, the AUC for the multivariate model was 0.882 (0.873–0.891 95% C.I.), showing a statistically significant difference with EPW alone (AUC 0.864 (95% C.I.: 0.854–0.873)). Although the improvements were modest, contingent detection models appear to be more sensitive than third-trimester ultrasound alone at predicting SGA at delivery. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Open AccessArticle

PPARG, TMEM163, UBE2E2, and WFS1 Gene Polymorphisms Are Not Significant Risk Factors for Gestational Diabetes in the Polish Population

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Przemysław Ustianowski

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J. Pers. Med. 2022, 12(2), 243; https://doi.org/10.3390/jpm12020243 - 08 Feb 2022

Cited by 1 | Viewed by 1189

Abstract

Gestational diabetes mellitus (GDM) is a common disorder that occurs in pregnant women, leading to many maternal and neonatal complications. The pathogenesis of GDM is complex and includes risk factors, such as: age, obesity, and family history of diabetes. Studies have shown that [...] Read more.

Gestational diabetes mellitus (GDM) is a common disorder that occurs in pregnant women, leading to many maternal and neonatal complications. The pathogenesis of GDM is complex and includes risk factors, such as: age, obesity, and family history of diabetes. Studies have shown that genetic factors also play a role in the pathogenesis of GDM. The present study investigated whether polymorphisms in the PPARG (rs1801282), TMEM163 (rs6723108 and rs998451), UBE2E2 (rs6780569), and WFS1 (rs4689388) genes are risk factors for the development of GDM and whether they affect selected clinical parameters in women with GDM. This study included 204 pregnant women with GDM and 207 pregnant women with normal glucose tolerance (NGT). The diagnosis of GDM was based on a 75 g oral glucose tolerance test (OGTT) at 24–28 weeks gestation, according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. There were no statistically significant differences in the distribution of polymorphisms studied between women with GDM and pregnant women with normal carbohydrate tolerance, which suggests that these polymorphisms are not risk factors for GDM. We also examined the associations between studied gene polymorphisms and clinical parameters: fasting glucose, daily insulin requirement, body mass before pregnancy, body mass at birth, body mass increase during pregnancy, BMI before pregnancy, BMI at birth, BMI increase during pregnancy, new-born body mass, and APGAR score in women with GDM. We observed lower BMI values before pregnancy and at birth in women with PPARG rs17036160 TT genotype. The results of this study suggest that the PPARG (rs1801282), TMEM163 (rs6723108 and rs998451), UBE2E2 (rs6780569), and WFS1 (rs4689388) gene polymorphisms are not significant risk factors for GDM development in the Polish population and do not affect the clinical parameters in women with GDM; only rs1801282 of the PPARG gene may influence BMI values in women with GDM. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

Open AccessArticle

STRA6 and Placental Retinoid Metabolism in Gestational Diabetes Mellitus

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J. Pers. Med. 2021, 11(12), 1301; https://doi.org/10.3390/jpm11121301 - 05 Dec 2021

Cited by 1 | Viewed by 1132

Abstract

Background: Recent reports indicate the potential role of the stimulated by retinoic acid 6 (STRA6) protein in developing insulin resistance. The study’s objective was to assess placental STRA6 expression and staining pattern in human pregnancy complicated by gestational diabetes mellitus (GDM). The expression [...] Read more.

Background: Recent reports indicate the potential role of the stimulated by retinoic acid 6 (STRA6) protein in developing insulin resistance. The study’s objective was to assess placental STRA6 expression and staining pattern in human pregnancy complicated by gestational diabetes mellitus (GDM). The expression pattern of further relevant genes involved in retinoid metabolism was also evaluated. Methods: A retrospective case–control study on paraffin-embedded placental tissue. Twenty-two human pregnancies affected by GDM, namely, 11 insulin-treated (iGDM) and 11 diet-controlled (dGDM), were compared with 22 normal-developed pregnancies (controls). An RT-PCR was performed in a random sample of 18 patients (six iGDM, six dGDM, and six controls) to assess RNA expression of STRA6 and further markers of retinoid metabolism. A semi-quantitative intensity evaluation at immunohistochemistry was performed for STRA6 in all 44 recruited patients. Results: STRA6 showed a decreased placental staining (9.09% vs. 68.18% positively stained samples, p < 0.05) and augmented RNA expression in dGDM patients than controls (ΔCT expression 0.473, IQR 0.403–0.566 vs. 0.149, IQR 0.092–0.276, p < 0.05). The protein staining pattern in patients affected by iGDM was comparable to controls. A reduced RNA expression of LPL, LRP1, VLDLR, and MTTP besides an augmented expression of LDLR was found in dGDM, while overexpression of LRP1 and LPL was found in iGDM patients. Unlike in the control group, significant positive correlations were found between RXRα and the proteins involved in the intracellular uptake of ROH, such as STRA6, LRP1, LRP2, and VLDLR. Conclusions: An altered placental expression and staining pattern of STRA6 were found in pregnancies complicated by GDM compared to the controls. These changes were coupled to an altered expression pattern of several other genes involved in the retinoid metabolism. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Open AccessFeature PaperArticle

Interaction of Polygenetic Variants for Gestational Diabetes Mellitus Risk with Breastfeeding and Korean Balanced Diet to Influence Type 2 Diabetes Risk in Later Life in a Large Hospital-Based Cohort

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Sunmin Park

J. Pers. Med. 2021, 11(11), 1175; https://doi.org/10.3390/jpm11111175 - 10 Nov 2021

Cited by 1 | Viewed by 1454

Abstract

The etiologies of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) are similar. Genetic and environmental factors interact to influence the risk of both types of diabetes. We aimed to determine if the polygenetic risk scores (PRS) for GDM risk interacted [...] Read more.

The etiologies of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) are similar. Genetic and environmental factors interact to influence the risk of both types of diabetes. We aimed to determine if the polygenetic risk scores (PRS) for GDM risk interacted with lifestyles to influence type 2 diabetes risk in women aged >40 years in a large hospital-based city cohort. The participants with GDM diagnosis without T2DM before pregnancy were considered the case group (n = 384) and those without GDM and T2DM as the control (n = 33,956) to explore GDM-related genetic variants. The participants with T2DM were the case (n = 2550), and the control (n = 33,956) was the same as GDM genetic analysis for the interaction analysis of GDM genetic risk with lifestyles to influence T2DM risk. The genetic variants for the GDM risk were selected from a genome-wide association study (GWAS), and their PRS from the best model with gene-gene interactions were generated. GDM was positively associated with age at first pregnancy, body mass index (BMI) at age 20, and education level. A previous GDM diagnosis increased the likelihood of elevated fasting serum glucose concentrations and HbA1c contents by 8.42 and 9.23 times in middle-aged and older women. However, it was not associated with the risk of any other metabolic syndrome components. Breast-feeding (≥1 year) was inversely associated with the T2DM risk in later life. In the genetic variant-genetic variant interaction, the best model with 5-SNPs included PTPRD_rs916855529, GPC6_rs9589710, CDKAL1_rs7754840, PRKAG2_rs11975504, and PTPRM_rs80164908. The PRS calculated from the 5-SNP model was positively associated with the GDM risk by 3.259 (2.17–4.89) times after adjusting GDM-related covariates. The GDM experience interacted with PRS for the T2DM risk. Only in non-GDM women PRS was positively associated with T2DM risk by 1.36-times. However, long breastfeeding did not interact with the PRS for T2DM risk. Among dietary patterns, only a Korean-style balanced diet (KBD) showed an interaction with PRS for the T2DM risk. Participants with a low-PRS had the lowest serum glucose concentrations in the high KBD intake but not low KBD intake. In conclusion, participants with a high PRS for GDM risk are positively associated with T2DM risk, and breastfeeding for ≥1 year and consuming KBD offset the PRS for GDM risk to influence T2DM risk in middle-aged and older. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Open AccessArticle

Access to Prenatal Testing and Ethically Informed Counselling in Germany, Poland and Russia

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Galina Lvovna Mikirtichan

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Alexandr Zinovievich Lichtshangof

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Florian Steger

J. Pers. Med. 2021, 11(9), 937; https://doi.org/10.3390/jpm11090937 - 20 Sep 2021

Cited by 3 | Viewed by 1837

Abstract

The development of new methods in the field of prenatal testing leads to an expansion of information that needs to be provided to expectant mothers. The aim of this research is to explore opinions and attitudes of gynecologists in Germany, Poland and Russia [...] Read more.

The development of new methods in the field of prenatal testing leads to an expansion of information that needs to be provided to expectant mothers. The aim of this research is to explore opinions and attitudes of gynecologists in Germany, Poland and Russia towards access to prenatal testing and diagnostics in these countries. Semi-structured interviews were conducted with n = 18 gynecologists in Germany, Poland and Russia. The interviews were analyzed using the methods of content analysis and thematic analysis. Visible in all three countries is a connection of prenatal medicine with the politically and socially contentious issue of pregnancy termination. Respondents in Poland and Russia concentrated on the topic of inadequate resources. Quality of information for expectant mothers is an important point in all three countries. Only in Germany was the issue of language barriers in communication raised. With regard to non-invasive prenatal testing (NIPT) respondents in Germany focused on the ethical issues of routinization of testing; in Poland and Russia they concentrated on fair access to NIPT. Challenges in all three countries arise from structural factors such as imprecise and prohibitive regulations, lack of resources or organization of healthcare services. These should be addressed on a political and medico-ethical level. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

Open AccessArticle

Risk Factors in Third and Fourth Degree Perineal Tears in Women in a Tertiary Centre: An Observational Ambispective Cohort Study

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Juan A. Barca

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Coral Bravo

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Maria P. Pintado-Recarte

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Ignacio Cueto-Hernández

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J. Pers. Med. 2021, 11(8), 685; https://doi.org/10.3390/jpm11080685 - 21 Jul 2021

Cited by 3 | Viewed by 2124

Abstract

Objectives: To analyze the main risk factors associated with third and fourth degree postpartum perineal tears in women attended to in our obstetrics service. Methods: An observational, retrospective, hospital cohort study was carried out in women whose deliveries were attended to in the [...] Read more.

Objectives: To analyze the main risk factors associated with third and fourth degree postpartum perineal tears in women attended to in our obstetrics service. Methods: An observational, retrospective, hospital cohort study was carried out in women whose deliveries were attended to in the obstetrics service of the Hospital General Universitario Gregorio Marañón de Madrid (HGUGM), during the period from January 2010 to April 2017. Results: During the study period, a total of 33,026 patients were included in the study. For maternal variables, the associated increased risk of severe perineal tearing in nulliparous women is OR = 3.48, for induced labor OR = 1.29, and for instrumental delivery by forceps OR = 4.52 or spatulas OR = 4.35; for the obstetric variable of episiotomy, it is OR = 3.41. For the neonatal variables, the weight of the newborns has a directly proportional relationship with the risk of severe tears, and for birth weights of 3000 g (OR = 2.41), 3500 g (OR = 1.97), and 4000 g (OR = 2.17), statistically significant differences were found in each of the groups (p < 0.05). Conclusion: Primiparity, induction of labor, episiotomy, instrumental delivery with forceps or spatula, and a birth weight of 3000 g or more are significantly associated with an increased risk of third and fourth degree perineal tears. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Review

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Open AccessReview

Is It Time to Redefine Fetal Decelerations in Cardiotocography?

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Serena Xodo

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Ambrogio P. Londero

J. Pers. Med. 2022, 12(10), 1552; https://doi.org/10.3390/jpm12101552 - 21 Sep 2022

Cited by 2 | Viewed by 1492

Abstract

Historically, fetal heart rate (FHR) decelerations were classified into “early”, “late”, and “variable” based on their relationship with uterine contractions. So far, three different putative etiologies were taken for granted. Recently, this belief, passed down through generations of birth attendants, has been questioned [...] Read more.

Historically, fetal heart rate (FHR) decelerations were classified into “early”, “late”, and “variable” based on their relationship with uterine contractions. So far, three different putative etiologies were taken for granted. Recently, this belief, passed down through generations of birth attendants, has been questioned by physiologists. This narrative review aimed to assess the evidence on pathophysiology behind intrapartum FHR decelerations. This narrative review is based on information sourced from online peer-reviewed articles databases and recommendations from the major scientific societies in the field of obstetrics. Searches were performed in MEDLINE/PubMed, EMBASE, and Scopus and selection criteria included studies in animals and humans, where the physiology behind FHR decelerations was explored. The greater affinity for oxygen of fetal hemoglobin than the maternal, the unicity of fetal circulation, and the high anaerobic reserve of the myocardium, ensure adequate oxygenation to the fetus, under basal conditions. During acute hypoxic stress the efficiency of these mechanisms are increased because of the peripheral chemoreflex. This reflex, activated at each uterine contraction, is characterized by the simultaneous activation of two neural arms: the parasympathetic arm, which reduces the myocardial consumption of oxygen by decreasing the FHR and the sympathetic component, which promotes an intense peripheric vasoconstriction, thus centralizing the fetal blood volume. This review summarizes the evidence supporting the hypoxic origin of FHR decelerations, therefore archiving the historical belief that FHR decelerations have different etiologies, according to their shape and relationship with uterine contractions. The present review suggests that it is time to welcome the new scientific evidence and to update the CTG classification systems. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Open AccessReview

Nanotechnologies in Obstetrics and Cancer during Pregnancy: A Narrative Review

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Serena Bertozzi

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Bruna Corradetti

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Luca Seriau

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José Andrés Diaz Ñañez

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J. Pers. Med. 2022, 12(8), 1324; https://doi.org/10.3390/jpm12081324 - 17 Aug 2022

Cited by 2 | Viewed by 1237

Abstract

Nanotechnology, the art of engineering structures on a molecular level, offers the opportunity to implement new strategies for the diagnosis and management of pregnancy-related disorders. This review aims to summarize the current state of nanotechnology in obstetrics and cancer in pregnancy, focusing on [...] Read more.

Nanotechnology, the art of engineering structures on a molecular level, offers the opportunity to implement new strategies for the diagnosis and management of pregnancy-related disorders. This review aims to summarize the current state of nanotechnology in obstetrics and cancer in pregnancy, focusing on existing and potential applications, and provides insights on safety and future directions. A systematic and comprehensive literature assessment was performed, querying the following databases: PubMed/Medline, Scopus, and Endbase. The databases were searched from their inception to 22 March 2022. Five independent reviewers screened the items and extracted those which were more pertinent within the scope of this review. Although nanotechnology has been on the bench for many years, most of the studies in obstetrics are preclinical. Ongoing research spans from the development of diagnostic tools, including optimized strategies to selectively confine contrast agents in the maternal bloodstream and approaches to improve diagnostics tests to be used in obstetrics, to the synthesis of innovative delivery nanosystems for therapeutic interventions. Using nanotechnology to achieve spatial and temporal control over the delivery of therapeutic agents (e.g., commonly used drugs, more recently defined formulations, or gene therapy-based approaches) offers significant advantages, including the possibility to target specific cells/tissues of interest (e.g., the maternal bloodstream, uterus wall, or fetal compartment). This characteristic of nanotechnology-driven therapy reduces side effects and the amount of therapeutic agent used. However, nanotoxicology appears to be a significant obstacle to adopting these technologies in clinical therapeutic praxis. Further research is needed in order to improve these techniques, as they have tremendous potential to improve the accuracy of the tests applied in clinical praxis. This review showed the increasing interest in nanotechnology applications in obstetrics disorders and pregnancy-related pathologies to improve the diagnostic algorithms, monitor pregnancy-related diseases, and implement new treatment strategies. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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Open AccessReview

MRI in Pregnancy and Precision Medicine: A Review from Literature

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Salvatore Cappabianca

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Luigi Viola

J. Pers. Med. 2022, 12(1), 9; https://doi.org/10.3390/jpm12010009 - 23 Dec 2021

Cited by 11 | Viewed by 3095

Abstract

Magnetic resonance imaging (MRI) offers excellent spatial and contrast resolution for evaluating a wide variety of pathologies, without exposing patients to ionizing radiations. Additionally, MRI offers reproducible diagnostic imaging results that are not operator-dependent, a major advantage over ultrasound. MRI is commonly used [...] Read more.

Magnetic resonance imaging (MRI) offers excellent spatial and contrast resolution for evaluating a wide variety of pathologies, without exposing patients to ionizing radiations. Additionally, MRI offers reproducible diagnostic imaging results that are not operator-dependent, a major advantage over ultrasound. MRI is commonly used in pregnant women to evaluate, most frequently, acute abdominal and pelvic pain or placental abnormalities, as well as neurological or fetal abnormalities, infections, or neoplasms. However, to date, our knowledge about MRI safety during pregnancy, especially about the administration of gadolinium-based contrast agents, which are able to cross the placental barrier, is still limited, raising concerns about possible negative effects on both the mother and the health of the fetus. Contrast agents that are unable to cross the placenta in a way that is safe for the fetus are desirable. In recent years, some preclinical studies, carried out in rodent models, have evaluated the role of long circulating liposomal nanoparticle-based blood-pool gadolinium contrast agents that do not penetrate the placental barrier due to their size and therefore do not expose the fetus to the contrast agent during pregnancy, preserving it from any hypothetical risks. Hence, we performed a literature review focusing on contrast and non-contrast MRI use during pregnancy. Full article

(This article belongs to the Special Issue Pregnancy Complication and Precision Medicine)

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