Article

Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy

Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
Best practice & research. Clinical obstetrics & gynaecology (Impact Factor: 3). 02/2011; 25(4):391-403. DOI: 10.1016/j.bpobgyn.2011.01.006
Source: PubMed

ABSTRACT Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, pre-eclampsia and chronic hypertension with superimposed pre-eclampsia. Pre-eclampsia complicates about 3% of pregnancies, and all hypertensive disorders affect about five to 10% of pregnancies. Secular increases in chronic hypertension, gestational hypertension and pre-eclampsia have occurred as a result of changes in maternal characteristics (such as maternal age and pre-pregnancy weight), whereas declines in eclampsia have followed widespread antenatal care and use of prophylactic treatments (such as magnesium sulphate). Determinants of pre-eclampsia rates include a bewildering array of risk and protective factors, including familial factors, sperm exposure, maternal smoking, pre-existing medical conditions (such as hypertension, diabetes mellitus and anti-phospholipid syndrome), and miscellaneous ones such as plurality, older maternal age and obesity. Hypertensive disorders are associated with higher rates of maternal, fetal and infant mortality, and severe morbidity, especially in cases of severe pre-eclampsia, eclampsia and haemolysis, elevated liver enzymes and low platelets syndrome.

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    • "However upon withdrawal of FGF-4, Activin A induced the formation of the labyrinth layer [31], highlighting the multifunctional roles of Activin A in both trophoblast stem cell maintenance and differentiation depending on the cellular context. Collectively these data show that Activin A can influence trophoblasts whose abnormal migration plays an essential role in development of pre-eclampsia [5], suggesting that changes in the Activin A system may be evident in pre-eclampsia. Two major factors that have been extensively in this context are genetic polymorphisms in ACRV2A and changes in the serum and placental concentrations of Activin A in vivo. "
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    ABSTRACT: Pre-eclampsia is a multi-system condition in pregnancy that is characterised by the onset of hypertension and proteinuria in women after the 20th week and it remains a leading cause of maternal and fetal mortality. Despite this the causative molecular basis of pre-eclampsia remains poorly understood. As a result, an intensive research effort has focused on understanding the molecular mechanisms involved in pre-eclampsia and using this information to identify new pre-symptomatic bio-markers of the condition. Activin A and its receptor, ACVR2A, have been extensively studied in this regard. Activin A is a member of the transforming growth factor (TGF)-β superfamily that has a wide range of biological functions depending on the cellular context. Recent work has shown that polymorphisms in ACVR2A may be a genetic risk factor for pre-eclampsia. Furthermore, both placenta and serum levels of Activin A are significantly increased in pre-eclampsia suggesting that Activin A may be a possible biomarker for the condition. Here we review the latest advances in this field and link these with new molecular data that suggest that the oxidative stress and pro-inflammatory cytokine production seen in pre-eclampsia may result in increased placental Activin A secretion in an attempt to maintain placental function. Copyright © 2014 Elsevier Ltd. All rights reserved.
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    • "However upon withdrawal of FGF-4, Activin A induced the formation of the labyrinth layer [31], highlighting the multifunctional roles of Activin A in both trophoblast stem cell maintenance and differentiation depending on the cellular context. Collectively these data show that Activin A can influence trophoblasts whose abnormal migration plays an essential role in development of pre-eclampsia [5], suggesting that changes in the Activin A system may be evident in pre-eclampsia. Two major factors that have been extensively in this context are genetic polymorphisms in ACRV2A and changes in the serum and placental concentrations of Activin A in vivo. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pre-eclampsia is a multi-system condition in pregnancy that is characterised by the onset of hypertension and proteinuria in women after the 20th week and it remains a leading cause of maternal and fetal mortality. Despite this the causative molecular basis of pre-eclampsia remains poorly understood. As a result, an intensive research effort has focused on understanding the molecular mechanisms involved in pre-eclampsia and using this information to identify new pre-symptomatic bio-markers of the condition. Activin A and its receptor, ACVR2A, have been extensively studied in this regard. Activin A is a member of the transforming growth factor (TGF)-b superfamily that has a wide range of biological functions depending on the cellular context. Recent work has shown that polymorphisms in ACVR2A may be a genetic risk factor for pre-eclampsia. Furthermore, both placenta and serum levels of Activin A are significantly increased in pre-eclampsia suggesting that Activin A may be a possible biomarker for the condition. Here we review the latest advances in this field and link these with new molecular data that suggest that the oxidative stress and pro-inflammatory cytokine production seen in pre-eclampsia may result in increased placental Activin A secretion in an attempt to maintain placental function.
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