Low vitamin B12 in pregnancy is associated with adipose derived circulating miRs targeting PPARγ and insulin resistance

Context: Low vitamin B12 (B12) during pregnancy is associated with higher maternal obesity, insulin resistance(IR) and gestational diabetes(GDM). B12 is a key co-factor in 1-carbon metabolism. Objective: We hypothesize that B12 plays a role in epigenetic regulation by altering circulating miRNAs(miRs) during adipocyte differentiation and results in an adverse metabolic phenotype. Design, settings and main-outcome measure: Human pre-adipocyte cell-line(Chub-S7) were differentiated in various B12 concentrations: Control(500nM), LowB12(0.15nM) and NoB12(0nM). Maternal blood samples(n=91) and subcutaneous adipose tissue (SAT)(n=42) were collected at delivery. Serum B12, folate, lipids, plasma 1-carbon metabolites, miR profiling, miR expression and gene expression were measured. Results: Our in vitro model demonstrated that adipocytes in B12 deficient conditions accumulated more lipids, had higher triglyceride levels and increased gene expression of adipogenesis and lipogenesis. MiR array screening revealed differential expression of 133miRs involving several metabolic pathways (adjusted p<0.05). Altered miR expression were observed in 12miRs related to adipocyte differentiation and function in adipocytes. Validation of this data in pregnant women with low B12, confirmed increased expression of adipo/lipogenic genes and altered miRs in SAT, and altered levels of 11 of the 12miRs in circulation. After adjusting for other possible confounders, multiple regression analysis revealed an independent association of B12 with BMI (β: -0.264; 95% CI: -0.469, -0.058; p=0.013) and was mediated by four circulating miRs targeting PPARγ and IR. Conclusions: Low B12 levels in pregnancy alters adipose derived circulating miRs, which may mediate an adipogenic and IR phenotype leading to obesity

Impact of haemostatic mechanisms on pathophysiology of preeclampsia

Preeclampsia (PE) is disorder of new onset hypertension and proteinuria during the second half of pregnancy. There is increasing evidence to implicate placental over-expression of tissue factor and PAR-1 in the pathophysiology of PE. Excessive activation of platelets, neutrophils and the complement system may also contribute to the placental pathology and maternal endothelial responsible for the symptoms of PE. Increased knowledge in this field may identify new therapeutic strategies for the treatment of PE

Low maternal vitamin B12 status is associated with lower cord blood HDL cholesterol in white Caucasians living in the UK

Background and Aims: Studies in South Asian population show that low maternal vitamin B12 associates with insulin resistance and small for gestational age in the offspring. Low vitamin B12 status is attributed to vegetarianism in these populations. It is not known whether low B12 status is associated with metabolic risk of the offspring in whites, where the childhood metabolic disorders are increasing rapidly. Here, we studied whether maternal B12 levels associate with metabolic risk of the offspring at birth. Methods: This is a cross-sectional study of 91 mother-infant pairs (n = 182), of white Caucasian origin living in the UK. Blood samples were collected from white pregnant women at delivery and their newborns (cord blood). Serum vitamin B12, folate, homocysteine as well as the relevant metabolic risk factors were measured. Results: The prevalence of low serum vitamin B12 (<191 ng/L) and folate (<4.6 μg/L) were 40% and 11%, respectively. Maternal B12 was inversely associated with offspring’s Homeostasis Model Assessment 2-Insulin Resistance (HOMA-IR), triglycerides, homocysteine and positively with HDL-cholesterol after adjusting for age and BMI. In regression analysis, after adjusting for likely confounders, maternal B12 is independently associated with neonatal HDL-cholesterol and homocysteine but not triglycerides or HOMA-IR. Conclusions: Our study shows that low B12 status is common in white women and is independently associated with adverse cord blood cholesterol

Towards Deep Cellular Phenotyping in Placental Histology

The placenta is a complex organ, playing multiple roles during fetal development. Very little is known about the association between placental morphological abnormalities and fetal physiology. In this work, we present an open sourced, computationally tractable deep learning pipeline to analyse placenta histology at the level of the cell. By utilising two deep Convolutional Neural Network architectures and transfer learning, we can robustly localise and classify placental cells within five classes with an accuracy of 89%. Furthermore, we learn deep embeddings encoding phenotypic knowledge that is capable of both stratifying five distinct cell populations and learn intraclass phenotypic variance. We envisage that the automation of this pipeline to population scale studies of placenta histology has the potential to improve our understanding of basic cellular placental biology and its variations, particularly its role in predicting adverse birth outcomes.Comment: Updated MRC funding material. Corrected typo that suggested ensembling and Inception accuracy were the same (updated to reflect the fact the ensemble model is 1% better than previously reported

Vaginal micronised progesterone for the prevention of hypertensive disorders of pregnancy : A systematic review and meta-analysis

ACKNOWLEDGEMENTS The investigators thank all trial authors who provided information about their own studies, including Zarko Alfirevic, Ana Luisa Areia, Camil Castelo-Branco, Ozlem Erdem, Fabio Facchinetti, Luke McLindon, Ben Willem Mol, Kypros Nicolaides and Ariel Weissman.Peer reviewe

Vaginal micronised progesterone for the prevention of hypertensive disorders of pregnancy:A systematic review and meta‐analysis

ACKNOWLEDGEMENTS The investigators thank all trial authors who provided information about their own studies, including Zarko Alfirevic, Ana Luisa Areia, Camil Castelo-Branco, Ozlem Erdem, Fabio Facchinetti, Luke McLindon, Ben Willem Mol, Kypros Nicolaides and Ariel Weissman.Peer reviewe

Randomized Interventional Study on Prediction of Preeclampsia/Eclampsia in Women With Suspected Preeclampsia: INSPIRE.

The ratio of maternal serum sFlt-1 (soluble fms-like tyrosine kinase 1) to PlGF (placental growth factor) has been used retrospectively to rule out the occurrence of preeclampsia, a pregnancy hypertensive disorder, within 7 days in women presenting with clinical suspicion of preeclampsia. A prospective, interventional, parallel-group, randomized clinical trial evaluated the use of sFlt-1/PlGF ratio in women presenting with suspected preeclampsia. Women were assigned to reveal (sFlt-1/PlGF result known to clinicians) or nonreveal (result unknown) arms. A ratio cutoff of 38 was used to define low (≤38) and elevated risk (>38) of developing the condition in the subsequent week. The primary end point was hospitalization within 24 hours of the test. Secondary end points were development of preeclampsia and other adverse maternal-fetal outcomes. We recruited 370 women (186 reveal versus 184 nonreveal). Preeclampsia occurred in 85 women (23%). The number of admissions was not significantly different between groups (n=48 nonreveal versus n=60 reveal; P=0.192). The reveal trial arm admitted 100% of the cases that developed preeclampsia within 7 days, whereas the nonreveal admitted 83% (P=0.038). Use of the test yielded a sensitivity of 100% (95% CI, 85.8-100) and a negative predictive value of 100% (95% CI, 97.1-100) compared with a sensitivity of 83.3 (95% CI, 58.6-96.4) and negative predictive value of 97.8 (95% CI, 93.7-99.5) with clinical practice alone. Use of the sFlt-1/PlGF ratio significantly improved clinical precision without changing the admission rate. Clinical Trial Registration- URL: http://www.isrctn.com. Unique identifier: ISRCTN87470468

Lower cerebrospinal fluid/plasma fibroblast growth factor 21 (FGF21) ratios and placental FGF21 production in gestational diabetes

Objectives: Circulating Fibroblast Growth Factor 21 (FGF21) levels are increased in insulin resistant states such as obesity, type 2 diabetes mellitus and gestational diabetes mellitus (GDM). In addition, GDM is associated with serious maternal and fetal complications. We sought to study human cerebrospinal fluid (CSF) and corresponding circulating FGF21 levels in women with gestational diabetes mellitus (GDM) and in age and BMI matched control subjects. We also assessed FGF21 secretion from GDM and control human placental explants. Design: CSF and corresponding plasma FGF21 levels of 24 women were measured by ELISA [12 GDM (age: 26–47 years, BMI: 24.3–36.3 kg/m2) and 12 controls (age: 22–40 years, BMI: 30.1–37.0 kg/m2)]. FGF21 levels in conditioned media were secretion from GDM and control human placental explants were also measured by ELISA. Results: Glucose, HOMA-IR and circulating NEFA levels were significantly higher in women with GDM compared to control subjects. Plasma FGF21 levels were significantly higher in women with GDM compared to control subjects [234.3 (150.2–352.7) vs. 115.5 (60.5–188.7) pg/ml; P<0.05]. However, there was no significant difference in CSF FGF21 levels in women with GDM compared to control subjects. Interestingly, CSF/Plasma FGF21 ratio was significantly lower in women with GDM compared to control subjects [0.4 (0.3–0.6) vs. 0.8 (0.5–1.6); P<0.05]. FGF21 secretion into conditioned media was significantly lower in human placental explants from women with GDM compared to control subjects (P<0.05). Conclusions: The central actions of FGF21 in GDM subjects maybe pivotal in the pathogenesis of insulin resistance in GDM subjects. The significance of FGF21 produced by the placenta remains uncharted and maybe crucial in our understanding of the patho-physiology of GDM and its associated maternal and fetal complications. Future research should seek to elucidate these points

In sickness and in health : The functional role of extracellular vesicles in physiology and pathology in vivo Part II: Pathology

It is clear from Part I of this series that extracellular vesicles (EVs) play a critical role in maintaining the homeostasis of most, if not all, normal physiological systems. However, the majority of our knowledge about EV signalling has come from studying them in disease. Indeed, EVs have consistently been associated with propagating disease pathophysiology. The analysis of EVs in biofluids, obtained in the clinic, has been an essential of the work to improve our understanding of their role in disease. However, to interfere with EV signalling for therapeutic gain, a more fundamental understanding of the mechanisms by which they contribute to pathogenic processes is required. Only by discovering how the EV populations in different biofluids change-size, number, and physicochemical composition-in clinical samples, may we then begin to unravel their functional roles in translational models in vitro and in vivo, which can then feedback to the clinic. In Part II of this review series, the functional role of EVs in pathology and disease will be discussed, with a focus on in vivo evidence and their potential to be used as both biomarkers and points of therapeutic intervention.Peer reviewe