Urinary tract infection during pregnancy, angiogenic factor profiles, and risk of preeclampsia
Urinary tract infection during pregnancy, angiogenic factor profiles, and risk of preeclampsia
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DOI：
10.1016/j.ajog.2015.09.101
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发表时间：
2016-03-01
影响因子：
9.8
通讯作者：
McElrath, Thomas F.
中科院分区：
文献类型：
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作者：
Easter, Sarah Rae;Cantonwine, David E.;McElrath, Thomas F.
背景技术背景：尽管经过数十年的研究，在识别母体循环中的生物标志物方面取得了很大进展，但先兆子痫（PE）的发病机制仍然难以捉摸。PE的病理生理学被认为涉及异常胎盘形成和相关的全身炎症增加。在这个概念中，当妊娠本身固有的全身炎症负荷水平超过母体补偿这种额外压力的能力时，PE变得更可能。如果是这种情况，那么可以假设增加全身炎症负荷的疾病（如感染性疾病）也会增加PE的风险。由于尿路感染（UTI）是妊娠期间炎症的常见来源，我们测试了妊娠期间UTI的存在是否会增加发生PE的几率。先前的工作已经记录了这种关联。然而，许多这些研究的局限性小的队列规模和控制不足的covariates.OBJECTIVE：本研究是一个强大的当代产科队列招募检查纵向采样的孕产妇血管生成浓度预测PE的能力进行二次分析。我们推测，妊娠期UTI的发生与妊娠后期PE的发生有关。由于PE被认为与全身血管生成水平的畸变相关，（胎盘生长因子和VEGF受体的可溶性同种型），我们进一步假设母体血管生成蛋白水平和UTI的发生之间存在显著的相互作用。招募了年龄≥ 18岁的妇女（n = 2607），并在3个区域学术中心从产前护理开始到分娩进行前瞻性随访。PE由美国妇产科医师大会标准定义，并由一组医生独立验证。UTI的定义是除了支持性实验室证据外，还存在需要治疗的临床症状。采用多变量logistic回归模型，并控制产妇年龄，种族，产次，体重指数，高血压，糖尿病，体外受精，吸烟status.RESULTS：有129名妇女诊断为UTIs和235 PE。妊娠期UTI患者PE发生率较高（31.1%vs7.8%，P
BACKGROUND: Despite decades of research, and much progress in discernment of biomarkers in the maternal circulation, the pathogenesis of preeclampsia (PE) remains elusive. The pathophysiology of PE is believed to involve aberrant placentation and an associated increase in systemic inflammation. In this conceptualization, PE becomes more likely when the level of systemic inflammatory burden inherent in pregnancy itself exceeds the maternal capacity to compensate for this additional stress. If this is the case, then it is possible to hypothesize that conditions, such as infectious disease, that increase systemic inflammatory burden should also increase the risk of PE. As urinary tract infection (UTI) represents a common source of inflammation during pregnancy, we tested whether presence of UTI during pregnancy increased the odds of developing PE. Prior work has documented this association. However many of these studies were limited by small cohort sizes and insufficient control for covariates.OBJECTIVE: The present study is a secondary analysis of a robust contemporary obstetrical cohort recruited to examine the ability of longitudinally sampled maternal angiogenic concentrations to predict PE. We hypothesize that the occurrence of UTI during a pregnancy is associated with the later occurrence of PE in that pregnancy. As PE is believed to be associated with aberrations in systemic angiogenic levels (placental growth factor and soluble isoform of VEGF receptor), we further hypothesize that there will be significant interactions between maternal angiogenic protein levels and the occurrence of UTI.STUDY DESIGN: Women aged >= 18 years (n = 2607) were recruited and followed up prospectively from the initiation of prenatal care through delivery at 3 regional academic centers. PE was defined by American Congress of Obstetricians and Gynecologists criteria and was independently validated by a panel of physicians. UTI was defined by the presence of clinical symptoms necessitating treatment in addition to supportive laboratory evidence. Multivariate logistic regression models were used and controlled for maternal age, race, parity, body mass index, hypertension, diabetes, in vitro fertilization, and smoking status.RESULTS: There were 129 women with diagnosed UTIs and 235 with PE. Patients with UTI in pregnancy had higher rates of PE (31.1% vs 7.8%, P