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Micro-RNAs (miRNAs) are short non-coding single-stranded RNAs that modulate the expression of various target genes after transcription. The expression and distribution of kinds of miRNAs have been characterized in human placenta during different gestational stages. The identified miRNAs are recognized as key mediators in the regulation of placental development and in the maintenance of human pregnancy. Aberrant expression of miRNAs is associated with compromised pregnancies in humans, and dysregulation of those miRNAs contributes to the occurrence and development of related diseases during pregnancy, such as pre-eclampsia (PE), fetal growth restriction (FGR), gestational diabetes mellitus (GDM), recurrent miscarriage, preterm birth (PTB) and small-for-gestational-age (SGA). Thus, having a better understanding of the expression and functions of miRNAs in human placenta during pregnancy and thereby developing novel drugs targeting the miRNAs could be a potentially promising method in the prevention and treatment of relevant diseases in future. Here, we summarize the current knowledge of the expression pattern and function regulation of miRNAs in human placental development and related diseases.

Background Previous studies have focused on pregnancy outcomes after frozen embryo transfer (FET) performed using different endometrial preparation protocols. Few studies have evaluated the effect of endometrial preparation on pregnancy-related complications. This study was designed to explore the association between different endometrial preparation protocols and adverse obstetric and perinatal complications after FET. Methods We retrospectively included all FET cycles ( n  = 12,950) in our hospital between 2010 and 2017, and categorized them into three groups, natural cycles (NC), hormone replacement therapy (HRT) and ovarian stimulation (OS) protocols. Pregnancy-related complications and subsequent neonatal outcomes were compared among groups. Results Among all 12,950 FET cycles, the live birth rate was slightly lower for HRT cycles than for NC (HRT vs. NC: 28.15% vs. 31.16%, p  < 0.001). The pregnancy loss rate was significantly higher in OS or HRT cycles than in NC (HRT vs. NC: 17.14% vs. 10.89%, p  < 0.001; OS vs. NC: 16.44% vs. 10.89%, p  = 0.001). Among 3864 women with live birth, preparing the endometrium using OS or HRT protocols increased the risk of preeclampsia, and intrahepatic cholestasis of pregnancy (ICP) in both singleton and multiple deliveries. Additionally, OS and HRT protocols increased the risk of low birth weight (LBW) and small for gestational age (SGA) in both singletons and multiples after FET. Conclusion Compared with HRT or OS protocols, preparing the endometrium with NC was associated with the decreased risk of pregnancy-related complications, as well as the decreased risk of LBW and SGA after FET.

A normal pregnancy is essential to establishing a healthy start to life. Complications during have been associated with adverse perinatal outcomes and lifelong health problems. The ability to identify risk factors associated with pregnancy complications early in gestation is vitally important for preventing negative foetal outcomes. Maternal nutrition has been long considered vital to a healthy pregnancy, with micronutrients and trace elements heavily implicated in maternofoetal metabolism. This study proposed the use of elemental metabolomics to study multiple elements at 18 weeks gestation from blood plasma and urine to construct models that could predict outcomes such as small for gestational age (SGA) (n = 10), low placental weight (n = 18), and preterm birth (n = 13) from control samples (n = 87). Samples collected from the Lyell McEwin Hospital in Adelaide, South Australia, were measured for 27 plasma elements and 37 urine elements by inductively coupled plasma mass spectrometry. Exploratory analysis indicated an average selenium concentration 20 μg/L lower than established reference ranges across all groups, low zinc in preterm (0.64 μg/L, reference range 0.66–1.10 μg/L), and higher iodine in preterm and SGA gestations (preterm 102 μg/L, SGA 111 μg/L, reference range 40–92 μg/L). Using random forest algorithms with receiver operating characteristic curves, low placental weight was predicted with 86.7% accuracy using plasma, 78.6% prediction for SGA with urine, and 73.5% determination of preterm pregnancies. This study indicates that elemental metabolomic modelling could provide a means of early detection of at-risk pregnancies allowing for more targeted monitoring of mothers, with potential for early intervention strategies to be developed.

Background Gestational weight gain (GWG) has implications for perinatal outcomes, the guidelines for maternal weight gain, however, remain understudied among twin pregnancies. This study aimed to assess the associations between perinatal outcomes and GWG among twin pregnancies, based on the US institute of Medicine (IOM) 2009 guidelines. Methods A retrospective cohort study of pregnant women with viable twins ≥26 weeks of gestation, was conducted in Foshan, China, during July 2015 and June 2018. Maternal BMI was categorized based on Chinese standard and GWG was categorized as below, within and above the IOM 2009 recommendations. Underweight women were excluded for analysis. Perinatal outcomes were compared among these groups. To assess the independent impact of GWG on the perinatal outcomes, conventional multivariable regression and general estimated equation (GEE) were utilized for maternal outcomes and neonatal outcomes, respectively. Results A total of 645 mothers with twin pregnancies were included, of whom 15.0, 41.4 and 43.6% gained weight below, within and above guidelines, respectively. Compared to weight gain within guidelines, inadequate weight gain was associated with increased risks in spontaneous preterm birth < 37 weeks (aOR:3.55; 95% CI: 1.73–7.28) and < 35 weeks (aOR:2.63; 95% CI: 1.16–5.97). Women who gained weight above guidelines were more likely to have gestational hypertension disorder (aOR: 2.36; 95% CI: 1.32–4.21), pre-eclampsia (aOR: 2.59; 95% CI: 1.29–5.21) and have fetuses weighted >90th percentile and less likely to have fetuses weighted < 2500 g and < 1500 g. Conclusions Maintenance of gestational weight gain within the normal range could decrease the risk of adverse perinatal outcomes. However, the causality between pre-eclampsia and gestational weight gain requires further investigations.

Purpose To evaluate the impact of hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and their combined presence (GDM-HDP) as perinatal risk factors for severe retinopathy of prematurity (ROP). Methods The hospital records of all premature infants referred to a tertiary center between 2020 and 2022 were retrospectively reviewed. Infants born to mothers with GDM, HDP, or both were selected for analysis. Demographic variables, perinatal risk factors, as well as clinical and treatment characteristics of the infants were collected and analyzed. Results A total of 1161 infants and 2322 eyes, including HDP group (1110 eyes from 555 infants), GDM group (944 eyes from 472 infants), and GDM-HDP group (268 eyes from 134 infants), were enrolled. The mean gestational age (GA) and birth weight (BW) for all infants were 31.6 ± 2.5 weeks and 1572 ± 427 g, respectively. A higher percentage of eyes (76.5%) in the GDM group were classified as ROP or incomplete vascularization compared to the HDP group (71.6%), with the prevalence of severe ROP also higher in the GDM group (13.5%) than in the HDP group (9.9%; P  < 0.05 for both comparisons). The rates of ROP and severe ROP were similar between the GDM and GDM-HDP groups. When considering only infants with BW < 1500, the GDM group still exhibited a higher rate of ROP and severe ROP compared to the HDP group. Treatment was required in 17.5% of eyes in the GDM group, 16.8% in the GDM-HDP group, and 13.9% in the HDP group ( P  = 0.071). Conclusion GDM is a higher risk factor for ROP and developing severe ROP than HDP. However, the data indicate that careful monitoring and management of both GDM and HDP during pregnancy may be crucial in mitigating the risk of severe ROP.

In the structure of maternal mortality causes, hypertensive disorders of pregnant women rank third. Hypertensive disorders of pregnant women can cause abortion and premature birth, fetal growth retardation, fetal hypotrophy, fetal hypoxia, premature detachment of a normally located placenta, and even fetal death. The aim of the study is to develop a mathematical model for predicting the risk of obstetric complications in women with gestational hypertensive disorders. Determination of independent predictors of obstetric complications of pregnancy and creation of a mathematical model for predicting the risk of obstetric complications in women with hypertensive disorders of pregnancy was performed using multiple stepwise linear regression analysis. Statistical analysis of the data was carried out according to standard methods using the «STATISTICA 5.5». In order to develop a mathematical model for predicting obstetric complications of pregnancy from the point of view of the influence of hypertensive disorders of pregnancy, data from a retrospective analysis of 60 women with hypertensive disorders of pregnancy were included in the multivariate statistical analysis. Women who had adverse obstetric outcomes of pregnancy (n=15) formed the main group (1-М). The group of women without complications of pregnancy and childbirth consisted of 45 people and was defined as a control group (1-C). The most significant independent predictors of obstetric complications of gestation in pregnant women with hypertensive disorders were identified, namely: systolic blood pressure, risk of preterm birth, primary manifestation of hypertensive abnormalities at 31-32 weeks of pregnancy, endothelin-1 concept in blood plasma and umbilical cord artery pulsatility index. It was found that the value of the multiple regression equation of the proposed model ≥503.38 points makes it possible to predict adverse obstetric outcomes of pregnancy in women with gestational hypertensive disorders in this pregnancy with a sensitivity of 73.3% and a specificity of 68.9%. Thus, the prognostic model developed by us with a fairly high sensitivity and specificity allows predicting obstetric outcomes of pregnancy in women with hypertensive disorders of pregnancy.

Background Maternal overweight and gestational metabolic disorders are established risk factors for adverse pregnancy outcomes and may influence the risk of overweight or obesity in offspring. However, the extent to which these factors independently or jointly affect early childhood adiposity remains unclear, particularly in Asian populations. This study examined the independent and combined effects of maternal pre-pregnancy body mass index (BMI), gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and excessive gestational weight gain (EGWG) on offspring adiposity, with an emphasis on population-level and policy implications. Methods Data were derived from the Taiwan Birth Cohort Study (TBCS), a nationally representative longitudinal dataset of 20,764 mother–child pairs followed from birth to 66 months. Generalized estimating equation (GEE) models were used to analyze BMI trajectories across seven time points, and logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for childhood overweight and obesity at 66 months. Analyses were conducted in SAS 9.4; a two-sided p value < 0.001 was considered statistically significant. Results Children born to mothers with overweight or obesity showed persistently higher BMI trajectories and an earlier adiposity rebound than those of mothers with normal weight. At 66 months, adjusted ORs for overweight or obesity (OWOB) were 1.39 (95% CI 1.22–1.58) and 1.49 (95% CI 1.27–1.74) for maternal overweight and obesity, respectively; corresponding ORs for obesity were 1.58 (95% CI 1.30–1.91) and 1.82 (95% CI 1.46–2.28). The effects of GDM and HDP were attenuated after adjusting for maternal BMI, suggesting mediation through maternal adiposity. In continuous analyses, maternal overweight and obesity were associated with increases of 0.62 (SE 0.10) and 1.26 (SE 0.13) in offspring BMI z-scores, respectively (both p  < 0.001). Conclusions Maternal pre-pregnancy adiposity emerged as the strongest and most consistent predictor of early-childhood adiposity in this cohort. Integrating preconception weight management and structured gestational weight gain monitoring into maternal health services may help prevent early-onset overweight and break the intergenerational cycle of obesity.

Background: Severe fetal growth restriction (sFGR) and preeclampsia (PE) are major pregnancy complications that often share placental dysfunction. This study aimed to compare maternal and neonatal outcomes among sFGR cases with or without gestational hypertensive disorders (GHD), with particular emphasis on PE. Methods: A retrospective analysis was conducted on 371 singleton pregnancies with sFGR delivered at Suzhou Municipal Hospital between January 2020 and December 2024. Patients were categorized into three groups: sFGR with PE (sFGR-PE; n = 69), sFGR with gestational hypertension (sFGR-GH; n = 15), and normotensive sFGR (n = 287). Maternal characteristics, pregnancy complications, and neonatal outcomes were compared using Analysis of Variance (ANOVA), and chi-square tests, as appropriate. Multivariate logistic regression was used to obtain adjusted odds ratios (aORs). Results: The patients in PE group were older, and had higher body mass index (BMI), higher rates of gestational diabetes mellitus (GDM), and preterm delivery (p < 0.05). Neonates in the PE group had significantly lower gestational age and birth weight, and higher incidences of metabolic acidosis, and respiratory complications (p < 0.001). Multivariable regression analysis revealed that, compared with normotensive sFGR, the other two groups showed no significant increase in the risk of adverse neonatal outcomes but had a significantly higher risk of cesarean or instrumental delivery. Conclusions: Although sFGR with hypertensive disorders showed increased crude risks of adverse outcomes, multivariable analysis indicated that most adverse effects were mediated by earlier delivery and lower birthweight. Only the risk of operative delivery remained independently elevated, highlighting the importance of optimal delivery timing in these pregnancies.

PurposeThis study aimed to identify the optimal cutoff values of each component of metabolic syndrome (MetS) in the first trimester of pregnancy for predicting adverse pregnancy outcomes. MethodsA total of 1076 pregnant women in the first trimester of gestation were recruited in this prospective longitudinal cohort study. Specifically, 993 pregnant women at 11–13 weeks of gestation who were followed up until the end of pregnancy were included in the final analysis. The cutoff values of each component of MetS in the occurrence of adverse pregnancy outcomes including gestational diabetes (GDM), gestational hypertensive disorders, and preterm birth were obtained via receiver operating characteristic (ROC) curve analysis using the Youden’s index.ResultsAmong the 993 pregnant women studied, the significant associations between the first trimester MetS components and adverse pregnancy outcomes were as follows: triglyceride (TG) and body mass index (BMI) with preterm birth; mean arterial pressure (MAP), TG, and high-density lipoprotein cholesterol (HDL-C) with gestational hypertensive disorders; BMI, fasting plasma glucose (FPG), and TG with GDM (all p values < 0.05). The cutoff point values for the above-mentioned MetS components were: TG > 138 mg/dl and BMI < 21 kg/m2 for the occurrence of preterm birth; TG > 148 mg/dL, MAP > 84, and HDL-C < 84 mg/dl for gestational hypertensive disorders; BMI > 25 kg/m2, FPG > 84 mg/dl, and TG > 161 mg/dl for GDM.ConclusionThe study findings imply the importance of early management of metabolic syndrome in pregnancy to improve maternal–fetal outcomes.

Preeclampsia (PE) is a multifactorial hypertensive disorder that typically manifests after the twentieth week of pregnancy, significantly impacting perinatal mortality and neonatal morbidity. Its development is influenced by immunological components, systemic inflammation, and genetic factors, with placental malfunction playing a crucial role. While many aspects of its pathophysiology have been elucidated, its key mechanisms remain incompletely understood. MicroRNAs (miRNAs), small noncoding RNA molecules that regulate gene expression, have emerged as promising biomarkers and therapeutic targets in PE. Dysregulated miRNAs have been identified in pregnant PE patients, highlighting their role in disease onset. Placenta-specific miRNAs, such as miR-210 and miR-155, influence inflammation, endothelial function, and hypoxia responses, which are closely associated with PE development. These miRNAs play a crucial role in regulating trophoblast invasion, angiogenesis, and immune modulation, further linking their dysregulation to the pathophysiology of PE. This review aims to provide a comprehensive overview of the role of miRNAs in PE, focusing on their potential as diagnostic biomarkers and therapeutic targets. By integrating recent advancements in molecular research, we explore their implications in clinical practice, particularly in risk assessment, early detection, and novel treatment strategies.