Toward a new taxonomy of obstetrical disease: improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology

Simple item page
dc.contributor.authorRomero, Roberto
dc.contributor.authorJung, Eunjung
dc.contributor.authorChaiworapongsa, Tinnakorn
dc.contributor.authorErez, Offer
dc.contributor.authorGudicha, Dereje W.
dc.contributor.authorKim, Yeon Mee
dc.contributor.authorKim, Jung-Sun
dc.contributor.authorKim, Bomi
dc.contributor.authorKusanovic, Juan Pedro
dc.contributor.authorGotsch, Francesca
dc.contributor.authorTaran, Andreea B.
dc.contributor.authorYoon, Bo Hyun
dc.contributor.authorHassan, Sonia S.
dc.contributor.authorHsu, Chaur-Dong
dc.contributor.authorChaemsaithong, Piya
dc.contributor.authorGomez-Lopez, Nardhy
dc.contributor.authorYeo, Lami
dc.contributor.authorKim, Chong Jai
dc.contributor.authorTarca, Adi L.
dc.date.accessioned2025-01-20T21:01:19Z
dc.date.available2025-01-20T21:01:19Z
dc.date.issued2022
dc.description.abstractBACKGROUND: The major challenge for obstetrics is the prediction and prevention of the great obstetrical syndromes. We propose that defining obstetrical diseases by the combination of clinical presentation and disease mechanisms as inferred by placental pathology will aid in the discovery of biomarkers and add specificity to those already known.
dc.description.abstractOBJECTIVE: To describe the longitudinal profile of placental growth factor (PIGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and the PIGF/sFlt-1 ratio throughout gestation, and to determine whether the association between abnormal biomarker profiles and obstetrical syndromes is strengthened by information derived from placental examination, eg, the presence or absence of placental lesions of maternal vascular malperfusion.
dc.description.abstractSTUDY DESIGN: This retrospective case cohort study was based on a parent cohort of 4006 pregnant women enrolled prospectively. The case cohort of 1499 pregnant women included 1000 randomly selected patients from the parent cohort and all additional patients with obstetrical syndromes from the parent cohort. Pregnant women were classified into six groups: 1) term delivery without pregnancy complications (n=540; control); 2) preterm labor and delivery (n=203); 3) preterm premature rupture of the membranes (n=112); 4) preeclampsia (n=230); 5) small-for-gestational-age neonate (n=334); and 6) other pregnancy complications (n=182). Maternal plasma concentrations of PIGF and sFlt-1 were determined by enzyme-linked immunosorbent assays in 7560 longitudinal samples. Placental pathologists, masked to clinical outcomes, diagnosed the presence or absence of placental lesions of maternal vascular malperfusion. Comparisons between mean biomarker concentrations in cases and controls were performed by utilizing longitudinal generalized additive models. Comparisons were made between controls and each obstetrical syndrome with and without subclassifying cases according to the presence or absence of placental lesions of maternal vascular malperfusion.
dc.description.abstractRESULTS: 1) When obstetrical syndromes are classified based on the presence or absence of placental lesions of maternal vascular malperfusion, significant differences in the mean plasma concentrations of PIGF, sFlt-1, and the PIGF/sFlt-1 ratio between cases and controls emerge earlier in gestation; 2) the strength of association between an abnormal PIGF/sFlt-1 ratio and the occurrence of obstetrical syndromes increases when placental lesions of maternal vascular malperfusion are present (adjusted odds ratio [aOR], 13.6 vs 6.7 for preeclampsia; aOR, 8.1 vs 4.4 for small-for-gestational-age neonates; aOR, 5.5 vs 2.1 for preterm premature rupture of the membranes; and aOR, 3.3 vs 2.1 for preterm labor (all P<0.05); and 3) the PIGF/sFlt-1 ratio at 28 to 32 weeks of gestation is abnormal in patients who subsequently delivered due to preterm labor with intact membranes and in those with preterm premature rupture of the membranes if both groups have placental lesions of maternal vascular malperfusion. Such association is not significant in patients with these obstetrical syndromes who do not have placental lesions.
dc.description.abstractCONCLUSION: Classification of obstetrical syndromes according to the presence or absence of placental lesions of maternal vascular malperfusion allows biomarkers to be informative earlier in gestation and enhances the strength of association between biomarkers and clinical outcomes. We propose that a new taxonomy of obstetrical disorders informed by placental pathology will facilitate the discovery and implementation of biomarkers as well as the prediction and prevention of such disorders.
dc.fuente.origenWOS
dc.identifier.doi10.1016/j.ajog.2022.04.015
dc.identifier.eissn1097-6868
dc.identifier.issn0002-9378
dc.identifier.urihttps://doi.org/10.1016/j.ajog.2022.04.015
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/92856
dc.identifier.wosidWOS:000891582600015
dc.issue.numero4
dc.language.isoen
dc.revistaAmerican journal of obstetrics and gynecology
dc.rightsacceso restringido
dc.subjectangiogenic index-1
dc.subjectclassification of disease
dc.subjectfetal death
dc.subjectliquid biopsy
dc.subjectomics
dc.subjectplacental growth factor
dc.subjectplacental lesions of maternal vascular malperfusion
dc.subjectpreeclampsia
dc.subjectpregnancy
dc.subjectpreterm birth
dc.subjectpreterm labor
dc.subjectpreterm premature rupture of the membranes
dc.subjectsmall for gestational age
dc.subjectsoluble fms-like tyrosine kinase-1
dc.subjectsoluble vascular endothelial growth factor receptor-1
dc.subject.ods03 Good Health and Well-being
dc.subject.ods05 Gender Equality
dc.subject.odspa03 Salud y bienestar
dc.subject.odspa05 Igualdad de género
dc.titleToward a new taxonomy of obstetrical disease: improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology
dc.typeartículo
dc.volumen227
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
Files
Collections
Artículos de revistas