Hypertensive disorders in pregnancy, of which the multisystem pathology pre-eclampsia is most sev... more Hypertensive disorders in pregnancy, of which the multisystem pathology pre-eclampsia is most severe, often lead to preterm delivery, maternal mortality and life-long complications<sup>1</sup>. Pre-eclampsia lacks early screening tools<sup>2–4</sup> and causal therapies<sup>5,6</sup>, illustrating the urgent need for a better understanding of early disease dynamics. Here we present the first study comparing single-nuclei transcriptomes of human diseased preterm preeclamptic placentae and healthy controls, embedding the characterisation of the maternal-foetal barrier dysfunction in the context of a comprehensive spatio-temporal study including early and late gestational placentae. Our results highlight and contextualise a disturbed communication from foetal to maternal side during the development of pre-eclampsia starting with a disturbed trophoblast stem-cell maturation. We provide new targets for potential early disease prevention in order to pro...
BackgroundThe neonatal intensive care unit causes maternal stress and postpartum depressive sympt... more BackgroundThe neonatal intensive care unit causes maternal stress and postpartum depressive symptoms in preterm and term mothers. Personal resources like maternal resilience are usually not considered in counselling these women.ObjectiveThis study aims to evaluate the resilience and differences in postpartum depression after admission of newborns at the neonatal intensive care unit.MethodsThis prospective pilot study was conducted in a single teaching hospital in Austria from December 2016 until December 2018. Sixty women completed two internationally validated questionnaires, the Edinburgh Postnatal Depression Scale (EPDS) to evaluate depressive symptoms and the Resilience Scale RS-13 to measure maternal resilience during the postpartum period (3 to 10 days postpartum). Additionally, women answered two open questions about burdens and relief.ResultsTwenty women (34%) showed lower resilience scores. The 39 high-resilient women (66%) showed significantly less depression (p = 0.005). ...
The placenta is an endocrine fetal organ, which secretes a plethora of steroid- and proteo-hormon... more The placenta is an endocrine fetal organ, which secretes a plethora of steroid- and proteo-hormones, metabolic proteins, growth factors, and cytokines in order to adapt maternal physiology to pregnancy. Central to the growth of the fetus is the supply with nutrients, foremost with glucose. Therefore, during pregnancy, maternal insulin resistance arises, which elevates maternal blood glucose levels, and consequently ensures an adequate glucose supply for the developing fetus. At the same time, maternal β-cell mass and function increase to compensate for the higher insulin demand. These adaptations are also regulated by the endocrine function of the placenta. Excessive insulin resistance or the inability to increase insulin production accordingly disrupts physiological modulation of pregnancy mediated glucose metabolism and may cause maternal gestational diabetes (GDM). A growing body of evidence suggests that this adaptation of maternal glucose metabolism differs between pregnancies ...
Journal für Gynäkologische Endokrinologie/Österreich, 2022
ZusammenfassungDie Präeklampsie (PE) ist eine Systemerkrankung der Schwangerschaft und Teil des S... more ZusammenfassungDie Präeklampsie (PE) ist eine Systemerkrankung der Schwangerschaft und Teil des Spektrums der plazentaassoziierten Schwangerschaftserkrankungen. Sie ist durch einen neu aufgetretenen Bluthochdruck und eine weitere Organmanifestation, wie z. B. Proteinurie oder andere, bzw. pathologisch erhöhte PE-spezifische Markersysteme definiert. Entsprechend dem Manifestationszeitpunkt werden frühe und späte Formen unterschieden, welchen auch eine unterschiedliche Pathogenese zugrunde liegt. Insbesondere die frühen Formen können mit schweren Verläufen und Frühgeburtlichkeit einhergehen und sind, über die unmittelbaren peripartalen Komplikationen hinaus, auch mit einer erheblichen Langzeitmorbidität für Mutter und Kind assoziiert. Der PE-Screening-Test, der im ersten Trimenon durchgeführt wird, berechnet die Wahrscheinlichkeit für das Auftreten einer PE und wird aus dem A‑priori-Risiko aus mütterlichen Anamnesedaten sowie aus biophysikalischen (mittlerer arterieller Druck und Farb...
Various studies found an association of different renin-angiotensin system (RAS) components with ... more Various studies found an association of different renin-angiotensin system (RAS) components with gestational duration and preterm birth, as well as with preeclampsia. Approximately 25% of first-time pregnant women develop a mild to severe hypertension in pregnancy or even preeclampsia. Based on recently published single-cell RNA-sequencing, we hypothesized an alternative RAS function in placenta and furthermore, an implication in hypertensive disorders in pregnancy. Placental RAS expression and localization was analyzed via quantitative polymerase chain reaction and in situ mRNA padlock probes. Tissue was collected from first-trimester elective termination (n=198), from healthy third-trimester controls (n=54), from early-onset preeclamptic (n=54) and age-matched controls (n=29), as well as first-trimester placentae from women with a high uterine artery resistance index (high-risk for preeclampsia, n=9) and controls (n=8). Serum levels of Ang (angiotensin) I to IV from women before a...
Ultraschall in der Medizin - European Journal of Ultrasound
Fetal neurosonography and the assessment of the posterior fossa have gained in importance during ... more Fetal neurosonography and the assessment of the posterior fossa have gained in importance during the last 2 decades primarily due to the development of high-resolution ultrasound probes and the introduction of 3 D sonography. The anatomical development of the posterior fossa can be visualized well with the newest ultrasound technologies. This allows better knowledge of the anatomical structures and helps with understanding of the development of malformations of the posterior fossa. In this article the longitudinal development of the posterior fossa structures will be reviewed. The embryologic description will be compared with ultrasound descriptions. These embryologic and anatomic illustrations form the basis for the screening and diagnosis of malformations of the posterior fossa. During the first trimester, screening for open spina bifida as well as cystic malformations of the posterior fossa is possible. In the second and third trimester, malformations of the posterior fossa can b...
Background: Soluble FMS-like Tyrosine Kinase 1 (sFlt-1) and placental growth factor (PlGF) have b... more Background: Soluble FMS-like Tyrosine Kinase 1 (sFlt-1) and placental growth factor (PlGF) have been reported to be highly predictive several weeks before the onset of preeclampsia. Objective: To investigate longitudinal changes of serum levels sFlt-1 and PlGF in pregnant women at high risk for the development of preeclampsia and to reveal an impact of aspirin on maternal serum concentrations of sFlt-1 and PlGF. Methods: This was a prospective longitudinal study in 394 women with various risk factors for the development of preeclampsia (chronic hypertension, antiphospholipid syndrome/APS or systemic lupus erythematosus/SLE, thrombophilia, women with a history of preeclampsia, pathologic first trimester screening for preeclampsia) and 68 healthy women. Serum levels of sFlt-1 and PlGF were measured prospectively at 4-week intervals (from gestational weeks 12 until postpartum). Results: The sFlt-1/PlGF ratio was significantly higher in women with an adverse obstetric outcome compared t...
An imbalance of angiogenic placental factors such as endoglin, soluble fms-like tyrosine kinase 1... more An imbalance of angiogenic placental factors such as endoglin, soluble fms-like tyrosine kinase 1(sFlt-1) and placental growth factor (PlGF) has been implicated in the pathophysiology of preeclampsia. This study aimed to evaluate serum levels of sFlt-1, PlGF and endoglin in women with primary and secondary antiphospholipid Syndrome (APS) and systemic lupus erythematosus (SLE) longitudinally through pregnancy. Serum levels of sFlt-1, PlGF and endoglin were measured prospectively at 4-week intervals (from gestational weeks 12-36) in 17 women with primary APS (PAPS), 18 women with secondary APS (SAPS), and 23 women with SLE. 6/17 (35%) of women with PAPS, 3/18 (17%) of women with SAPS, and 2/23 (9%) of women with SLE developed early-onset preeclampsia. Women who developed preeclampsia had significantly higher mean sFlt-1 and endoglin levels, higher sFlt-1/PlGF ratios, and lower mean PlGF-levels than women who did not. These changes became statistically significant at 12 weeks for sFlt-...
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 3, 2017
We analyzed outcome of women screened for preeclampsia with two different multifactorial risk alg... more We analyzed outcome of women screened for preeclampsia with two different multifactorial risk algorithms (Predictor(®)Software by PerkinElmer, PerkinElmer, Waltham, MA; PERK-group: n = 214 and Viewpoint(®) by GE Healthcare, Dornstadt, Germany; VIEW-group: n = 209) in first trimester. Women at high risk for developing preeclampsia were advised to take low-dose acetylsalicylic acid (LDA). Screening positive rates for early onset preeclampsia differed significantly between the two groups (7.9% versus 26.3%; p = 0.000). According the clinical use of screening test criteria, LDA was prescribed in 63 (29.4%) women in the PE-group and 55 (26.3%) in the VP-group (p = 0.516). There were no differences in onset of preeclampsia [4 (1.9%) versus 6 (2.9%); p = 0.540]. No early or severe preeclampsia occurred in the whole population.
Hypertensive disorders in pregnancy, of which the multisystem pathology pre-eclampsia is most sev... more Hypertensive disorders in pregnancy, of which the multisystem pathology pre-eclampsia is most severe, often lead to preterm delivery, maternal mortality and life-long complications<sup>1</sup>. Pre-eclampsia lacks early screening tools<sup>2–4</sup> and causal therapies<sup>5,6</sup>, illustrating the urgent need for a better understanding of early disease dynamics. Here we present the first study comparing single-nuclei transcriptomes of human diseased preterm preeclamptic placentae and healthy controls, embedding the characterisation of the maternal-foetal barrier dysfunction in the context of a comprehensive spatio-temporal study including early and late gestational placentae. Our results highlight and contextualise a disturbed communication from foetal to maternal side during the development of pre-eclampsia starting with a disturbed trophoblast stem-cell maturation. We provide new targets for potential early disease prevention in order to pro...
BackgroundThe neonatal intensive care unit causes maternal stress and postpartum depressive sympt... more BackgroundThe neonatal intensive care unit causes maternal stress and postpartum depressive symptoms in preterm and term mothers. Personal resources like maternal resilience are usually not considered in counselling these women.ObjectiveThis study aims to evaluate the resilience and differences in postpartum depression after admission of newborns at the neonatal intensive care unit.MethodsThis prospective pilot study was conducted in a single teaching hospital in Austria from December 2016 until December 2018. Sixty women completed two internationally validated questionnaires, the Edinburgh Postnatal Depression Scale (EPDS) to evaluate depressive symptoms and the Resilience Scale RS-13 to measure maternal resilience during the postpartum period (3 to 10 days postpartum). Additionally, women answered two open questions about burdens and relief.ResultsTwenty women (34%) showed lower resilience scores. The 39 high-resilient women (66%) showed significantly less depression (p = 0.005). ...
The placenta is an endocrine fetal organ, which secretes a plethora of steroid- and proteo-hormon... more The placenta is an endocrine fetal organ, which secretes a plethora of steroid- and proteo-hormones, metabolic proteins, growth factors, and cytokines in order to adapt maternal physiology to pregnancy. Central to the growth of the fetus is the supply with nutrients, foremost with glucose. Therefore, during pregnancy, maternal insulin resistance arises, which elevates maternal blood glucose levels, and consequently ensures an adequate glucose supply for the developing fetus. At the same time, maternal β-cell mass and function increase to compensate for the higher insulin demand. These adaptations are also regulated by the endocrine function of the placenta. Excessive insulin resistance or the inability to increase insulin production accordingly disrupts physiological modulation of pregnancy mediated glucose metabolism and may cause maternal gestational diabetes (GDM). A growing body of evidence suggests that this adaptation of maternal glucose metabolism differs between pregnancies ...
Journal für Gynäkologische Endokrinologie/Österreich, 2022
ZusammenfassungDie Präeklampsie (PE) ist eine Systemerkrankung der Schwangerschaft und Teil des S... more ZusammenfassungDie Präeklampsie (PE) ist eine Systemerkrankung der Schwangerschaft und Teil des Spektrums der plazentaassoziierten Schwangerschaftserkrankungen. Sie ist durch einen neu aufgetretenen Bluthochdruck und eine weitere Organmanifestation, wie z. B. Proteinurie oder andere, bzw. pathologisch erhöhte PE-spezifische Markersysteme definiert. Entsprechend dem Manifestationszeitpunkt werden frühe und späte Formen unterschieden, welchen auch eine unterschiedliche Pathogenese zugrunde liegt. Insbesondere die frühen Formen können mit schweren Verläufen und Frühgeburtlichkeit einhergehen und sind, über die unmittelbaren peripartalen Komplikationen hinaus, auch mit einer erheblichen Langzeitmorbidität für Mutter und Kind assoziiert. Der PE-Screening-Test, der im ersten Trimenon durchgeführt wird, berechnet die Wahrscheinlichkeit für das Auftreten einer PE und wird aus dem A‑priori-Risiko aus mütterlichen Anamnesedaten sowie aus biophysikalischen (mittlerer arterieller Druck und Farb...
Various studies found an association of different renin-angiotensin system (RAS) components with ... more Various studies found an association of different renin-angiotensin system (RAS) components with gestational duration and preterm birth, as well as with preeclampsia. Approximately 25% of first-time pregnant women develop a mild to severe hypertension in pregnancy or even preeclampsia. Based on recently published single-cell RNA-sequencing, we hypothesized an alternative RAS function in placenta and furthermore, an implication in hypertensive disorders in pregnancy. Placental RAS expression and localization was analyzed via quantitative polymerase chain reaction and in situ mRNA padlock probes. Tissue was collected from first-trimester elective termination (n=198), from healthy third-trimester controls (n=54), from early-onset preeclamptic (n=54) and age-matched controls (n=29), as well as first-trimester placentae from women with a high uterine artery resistance index (high-risk for preeclampsia, n=9) and controls (n=8). Serum levels of Ang (angiotensin) I to IV from women before a...
Ultraschall in der Medizin - European Journal of Ultrasound
Fetal neurosonography and the assessment of the posterior fossa have gained in importance during ... more Fetal neurosonography and the assessment of the posterior fossa have gained in importance during the last 2 decades primarily due to the development of high-resolution ultrasound probes and the introduction of 3 D sonography. The anatomical development of the posterior fossa can be visualized well with the newest ultrasound technologies. This allows better knowledge of the anatomical structures and helps with understanding of the development of malformations of the posterior fossa. In this article the longitudinal development of the posterior fossa structures will be reviewed. The embryologic description will be compared with ultrasound descriptions. These embryologic and anatomic illustrations form the basis for the screening and diagnosis of malformations of the posterior fossa. During the first trimester, screening for open spina bifida as well as cystic malformations of the posterior fossa is possible. In the second and third trimester, malformations of the posterior fossa can b...
Background: Soluble FMS-like Tyrosine Kinase 1 (sFlt-1) and placental growth factor (PlGF) have b... more Background: Soluble FMS-like Tyrosine Kinase 1 (sFlt-1) and placental growth factor (PlGF) have been reported to be highly predictive several weeks before the onset of preeclampsia. Objective: To investigate longitudinal changes of serum levels sFlt-1 and PlGF in pregnant women at high risk for the development of preeclampsia and to reveal an impact of aspirin on maternal serum concentrations of sFlt-1 and PlGF. Methods: This was a prospective longitudinal study in 394 women with various risk factors for the development of preeclampsia (chronic hypertension, antiphospholipid syndrome/APS or systemic lupus erythematosus/SLE, thrombophilia, women with a history of preeclampsia, pathologic first trimester screening for preeclampsia) and 68 healthy women. Serum levels of sFlt-1 and PlGF were measured prospectively at 4-week intervals (from gestational weeks 12 until postpartum). Results: The sFlt-1/PlGF ratio was significantly higher in women with an adverse obstetric outcome compared t...
An imbalance of angiogenic placental factors such as endoglin, soluble fms-like tyrosine kinase 1... more An imbalance of angiogenic placental factors such as endoglin, soluble fms-like tyrosine kinase 1(sFlt-1) and placental growth factor (PlGF) has been implicated in the pathophysiology of preeclampsia. This study aimed to evaluate serum levels of sFlt-1, PlGF and endoglin in women with primary and secondary antiphospholipid Syndrome (APS) and systemic lupus erythematosus (SLE) longitudinally through pregnancy. Serum levels of sFlt-1, PlGF and endoglin were measured prospectively at 4-week intervals (from gestational weeks 12-36) in 17 women with primary APS (PAPS), 18 women with secondary APS (SAPS), and 23 women with SLE. 6/17 (35%) of women with PAPS, 3/18 (17%) of women with SAPS, and 2/23 (9%) of women with SLE developed early-onset preeclampsia. Women who developed preeclampsia had significantly higher mean sFlt-1 and endoglin levels, higher sFlt-1/PlGF ratios, and lower mean PlGF-levels than women who did not. These changes became statistically significant at 12 weeks for sFlt-...
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 3, 2017
We analyzed outcome of women screened for preeclampsia with two different multifactorial risk alg... more We analyzed outcome of women screened for preeclampsia with two different multifactorial risk algorithms (Predictor(®)Software by PerkinElmer, PerkinElmer, Waltham, MA; PERK-group: n = 214 and Viewpoint(®) by GE Healthcare, Dornstadt, Germany; VIEW-group: n = 209) in first trimester. Women at high risk for developing preeclampsia were advised to take low-dose acetylsalicylic acid (LDA). Screening positive rates for early onset preeclampsia differed significantly between the two groups (7.9% versus 26.3%; p = 0.000). According the clinical use of screening test criteria, LDA was prescribed in 63 (29.4%) women in the PE-group and 55 (26.3%) in the VP-group (p = 0.516). There were no differences in onset of preeclampsia [4 (1.9%) versus 6 (2.9%); p = 0.540]. No early or severe preeclampsia occurred in the whole population.
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