Current Women's Health Reviews - Volume 8, Issue 4, 2012

Preeclampsia is now recognized as a risk factor for developing cardiovascular and renal disease in the mother later in life. Recently, certain substances have been identified, that are be either over- or under-expressed in patients with preeclampsia. One of these biomarkers that is over-expressed in the maternal blood is a soluble VEGF receptor, sFlt1. During the first third trimester of that pregnancies which will evolve in preeclampsia, sFtl1 is higher compared to normal; this increase correlates positively with the severity of the disease and decreases significantly after the birth. It has also been demonstrated that a soluble form of endoglin is produced and released into the maternal circulation in women with preeclampsia. This substance is capable of inhibiting the endothelial effects of TGF β 1. It is consistently elevated in women that will develop preeclampsia. Recently two other early markers have been studied: neutrophil gelatinase-associated lipocalin (NGAL) and pregnancyassociated plasma protein A (PAPP-A). The serum concentrations of NGAL appear to be higher in preeclampsia as compared to normal pregnancies and significant differences are seen in each trimester. Decreased levels of PAPP-A in the first trimester appear to be a sensitive marker for early onset preeclampsia in which placental damage occurs. In this review we try to give a look to this pathology and to the biomarkers that might be involved.

The human population continues to grow in some parts of the world, which has severe impact on resources, health and the environment. Individually, contraception enables women to choose their optimal family size and birth spacing, while in resource-poor countries it can help lift families out of poverty. While the oral contraceptive pill revolutionised female contraceptive options, there was a price to pay in terms of increased health risks. Today, improved formulations have been developed, together with non-oral hormonal technologies. This review will examine the history of female contraceptive research and provide an update on the status and future direction of new products.

In the past few decades, the number of multiple pregnancies has increased significantly. Advanced maternal age, use of ovarian stimulation and use of IVF are all responsible for this. A multiple pregnancy carries excess maternal and neonatal risks and is associated with undesired extra health care expenses as well. Up to 1/3 of the pregnancies following IVF are multiple gestations; most being twins. The best way to minimize the risk of twins is to transfer a single embryo only. The majority of the embryos do not implant however and most clinics routinely transfer 2 or even more embryos to maintain high IVF success rates (pregnancy rates). A high success rate despite the transfer of fewer, preferably a single embryo could be maintained if we had better tools to identify the embryo with the highest implantation potential. Current selection criteria based on the cleavage rate and morphology of the embryo are not particularly effective for this. The past decade has seen a lot of research aiming to screen the embryos based on various properties. This review will discuss the perinatal outcome of IVF multiples, available screening tools for embryo selection and the current status of the development of new tools.

In women breast, ovarian, endometrial and cervical are cancers require attention due to high morbidity and mortality. Although the percentage is high in elderly women, even the younger generation can be affected. Early diagnosis can be of great advantage in increasing the survival rate. Newer markers are being reported in recent years based on expression of genetic and epigenetic alterations. Research on involvement of miRNAs in various cancers including those in women has suggested a number of biomarkers for early diagnosis. However, their validation is essential prior to clinical application. Attention has also been focused on cancer stem cells so as to explore their application in diagnosis, prognosis and possible therapy. Latest information in this area is reviewed here with the intention to disseminate the knowledge with future path of research and necessity for more investigation.

Several strategies to prevent preterm birth have been evaluated over the last decades, but prematurity remains frequent, even in industrialized countries. One of the major challenges in obstetrics is to reduce the neonatal morbidity and mortality associated with preterm birth, as well as its associated cost. Progesterone has been used for several decades as a prophylactic treatment to prevent preterm birth, but its efficiency and side-effects have been always questioned. More recent research has demonstrated the usefulness of this treatment in certain pregnant populations and suggests that progesterone is effective for women with a prior history of preterm birth and for those with a short cervix measured by transvaginal ultrasound at midtrimester. In women with multiple gestations, progesterone is not indicated and studies are still ongoing among women with threatened preterm labour. In this article, we reviewed the different indications for the use of progesterone to prevent preterm birth, possible formulations available, and associated economic aspects.

Malaria remains one of the most complex health problems facing humanity and pregnant women are highly vulnerable with substantial risks for the mother, her foetus and the neonate. Plasmodium falciparum is responsible for most of the complications of malaria in pregnancy and maternal anaemia is the most common and potentially lethal consequence of P. falciparum malaria. Central to the pathogenesis of P. falciparum infection in pregnancy is the accumulation of infected erythrocytes in the placenta (placental malaria). Adverse perinatal outcomes associated with placental malaria include congenital malaria, perinatal mortality, preterm delivery, intrauterine growth retardation, low birth weight, reduced neonatal anthropometric parameters, and foetal anaemia. The recommended strategies for controlling malaria in pregnancy include both preventive and curative measures. Sulfadoxine-pyrimethamine (SP) has been extensively used as intermittent preventive chemotherapy in pregnancy, however high rates of resistance to SP reduced its use as therapy for malaria. Artemisin combination therapy (ACT) as well as clindamycin / quinine combinations are important therapeutic schemes used in pregnancy. A major tool currently used for malaria prevention in pregnancy is insecticide-treated net (ITN). Increased international funding and greater political commitment, have led to some level of reduction in malaria burden in pregnancy.