Different morphological and gene expression profile in placentas of the same sickle cell anemia patient in pregnancies of opposite outcomes.

IMPACT STATEMENT: Environmentally induced changes in placental morphological and molecular phenotypes may provide relevant insight towards pathophysiology of diseases. The rare opportunity to evaluate the same patient, with sickle cell anemia (SCA), in two different pregnancies, of opposite outcomes (one early onset severe preeclampsia (PE) and the other mostly non-complicated) can prove such concept. In addition, the comparison to other conditions of known placental and vascular/inflammatory involvement strengthens such findings. Our results suggest that the clinical association between SCA and PE can be supported by common pathophysiological mechanisms, but that pathways involving response to copper and triglyceride metabolism may be important drivers of the pathophysiology of PE. Future studies using in a larger number of samples should confirm these findings and explore pathways involved in the pathophysiology of PE and its relationship with SCA.

Longitudinal reference intervals for Doppler velocimetric parameters of the fetal renal artery correlated with amniotic fluid index among low-risk pregnancies.

OBJECTIVE: To establish longitudinal reference intervals for pulsatility index (PI) and systolic velocity (SV) of the fetal renal artery, and to evaluate their correlation with the amniotic fluid index (AFI). METHODS: A prospective longitudinal study was conducted among women with low-risk pregnancies who attended outpatient clinics at the University of Campinas Medical School, Brazil, at 16-19 weeks of pregnancy between April 1, 2008, and March 31, 2010. Doppler velocimetric measurements of the fetal renal artery and assessments of the AFI were undertaken at 4-week intervals to 36 weeks, and every 2 weeks thereafter until delivery. RESULTS: A total of 63 women were enrolled. The PI of the fetal renal artery showed little variation during pregnancy, whereas SV values increased to 36-37 weeks of pregnancy and decreased thereafter. No correlations were found between the AFI and the fetal renal artery Doppler velocimetric parameters (P>0.05 for all). The intraclass correlation coefficients for intra-observer and inter-observer variability indicated good reproducibility of SV, but the reproducibility of PI was lower. CONCLUSIONS: The AFI did not correlate with fetal renal artery Doppler velocimetric measures among low-risk pregnancies. However, investigations are needed among high-risk pregnancies.