Placental hypoplasia and maternal organic vascular disorder in pregnant women with gestational hypertension and preeclampsia

J Matern Fetal Neonatal Med. 2021 Feb;34(3):353-359. doi: 10.1080/14767058.2019.1608175. Epub 2019 May 2.

Abstract

Objective: This study aimed to investigate the etiology and pathology of preeclampsia (PE), a two-stage disorder involving uteroplacental dysfunction resulting from abnormal implantation and placentation, and gestational hypertension (GH), for which maternal organic vascular disorder is often an underlying factor.Methods: We assessed concentrations of oxygen free radicals (d-ROMs), maternal angiogenic factor (PlGF), and antiangiogenic factor (sFlt-1), placental hypoxic changes, oxidative DNA damage, and maternal organic vascular disorders in 23 women with PE (PE group), 13 with GH (GH group), and 16 with uncomplicated pregnancies (normal group). Intima-media thickness (IMT) of the carotid artery was assessed as a proxy for maternal organ vascular disorder. Immunohistochemical analysis was performed to measure the proportion of placental trophoblast cell nuclei staining positive for hypoxia-inducible factor-1α (HIF-1α), which reflects hypoxic changes, and 8-hydroxy-2'-deoxyguanosine (8-OHdG), which reflects oxidative DNA damage.Results: Maternal serum d-ROM concentrations were significantly increased in both GH and PE groups relative to the normal group. Maternal serum d-ROM concentrations were significantly increased in both GH and PE groups relative to the normal group. Maternal serum sFlt-1 concentrations, ratio of sFlt-1/PlGF, and proportions of HIF-1α-positive nuclei and 8-OHdG-positive nuclei were significantly higher in the PE group compared to GH and normal groups. IMT was significantly greater in GH and PE groups compared to the normal group, and was higher in the GH group compared to the PE group.Conclusions: Our findings suggest that placental hypoxic changes and oxidative DNA damage are severe in patients with PE and accompanied by an increase in antiangiogenic factors. Moreover, maternal organ vascular disorder was more severe in patients with GH compared to those with PE, as assessed by IMT.Key message: PE is a two-stage disorder that involves uteroplacental dysfunction, and organic vascular disorder underlies GH.

Keywords: Gestational hypertension; IMT; PlGF; preeclampsia; sFlt-1.

MeSH terms

  • Biomarkers
  • Carotid Intima-Media Thickness
  • Female
  • Humans
  • Hypertension, Pregnancy-Induced*
  • Placenta
  • Placenta Growth Factor
  • Pre-Eclampsia*
  • Pregnancy
  • Pregnant Women
  • Vascular Endothelial Growth Factor Receptor-1

Substances

  • Biomarkers
  • Placenta Growth Factor
  • Vascular Endothelial Growth Factor Receptor-1