Hypertensive disorders of pregnancy (HDP) are the most common medical complication in pregnancy, affecting approximately 10–15% of pregnancies worldwide. HDP are a major cause of maternal and perinatal morbidity and mortality, and each year, worldwide, around 70,000 mothers and 500,000 babies die because of HDP. Up-to-date high-quality systematic reviews quantifying the role of exercise and the risks of developing HDP are currently lacking. Physical exercise is considered to be safe and beneficial to pregnant women. Supervised exercise has been shown to be safe and to be more beneficial than unsupervised exercise in the general population, as well as during pregnancy in women with obesity and diabetes. Therefore, we undertook a systematic review and meta-analysis to investigate the effects of women performing supervised exercise during pregnancy compared to a control group (standard antenatal care or unsupervised exercise) on the development of HDP. We searched Medline, Embase, CINHAL, and the Cochrane Library, which were searched from inception to December 2021. We included only randomized controlled trials (RCTs) investigating the development of HDP compared to a control group (standard antenatal care or unsupervised exercise) in pregnant women performing supervised exercise. Two independent reviewers selected eligible trials for meta-analysis. Data collection and analyses were performed by two independent reviewers. The PROSPERO registration number is CRD42020176814. Of 6332 articles retrieved, 16 RCTs met the eligibility criteria, comparing a total of 5939 pregnant women (2904 pregnant women in the intervention group and 3035 controls). The risk for pregnant women to develop HDP was significantly reduced in the intervention compared to the control groups, with an estimated pooled cumulative incidence of developing HDP of 3% in the intervention groups (95% CI: 3 to 4) and of 5% in the control groups (95% CI: 5 to 6), and a pooled odds ratio (OR) comparing intervention to control of 0.54 (95% CI:0.40 to 0.72, p < 0.001). A combination of aerobic and anaerobic exercise, or yoga alone, had a greater beneficial effect compared to performing aerobic exercise only (mixed-OR = 0.50, 95% CI:0.33 to 0.75, p = 0.001; yoga-OR = 0.28, 95% CI:0.13 to 0.58, p = 0.001); aerobic exercise only-OR = 0.87, 95% CI:0.55 to 1.37, p = 0.539). Pregnancy is an opportunity for healthcare providers to promote positive health activities, thus optimizing the health of pregnant women with potential short- and long-term benefits for both mother and child. This systematic review and meta-analysis support a beneficial effect of either structured exercise (combination of aerobic, strength, and flexibility workouts) or yoga for preventing the onset of HDP. Yoga, considered a low-impact physical activity, could be more acceptable and safer for women in pregnancy in reducing the risk of developing HDP.

Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy. GDM is associated with serious maternal and fetal complications, in particular, fetal macrosomia and large for gestational age (LGA), which predisposes to a higher risk of childhood obesity and type 2 diabetes mellitus later in life. Early prediction and diagnosis of GDM leads to early interventions such as diet and lifestyle, which could mitigate the maternal and fetal complications associated with GDM. Glycated haemoglobin A1c (HbA1c) has been widely used for monitoring, screening for and diagnosing diabetes and prediabetes. Increasing evidence has also showed that HbA1c could indicate fetal glucose supply. Thus, we hypothesise that the HbA1c level at around 24 to 28 weeks may predict the development of fetal macrosomia or an LGA baby in women with GDM, which could be useful for better prevention of fetal macrosomia and LGA. We searched MEDLINE, EMBASE, Cochrane and Google Scholar databases from inception to November 2022 for relevant studies that reported at least one HbA1c level during 24–28 weeks of pregnancy and fetal macrosomia or an LGA baby. We excluded studies that were not published in the English language. No other search filters were applied during the search. Two independent reviewers selected eligible studies for meta-analysis. Two independent reviewers performed data collection and analyses. The PROSPERO registration number is CRD42018086175. A total of 23 studies were included in this systematic review. Of these, 8 papers reported data of 17,711 women with GDM that allowed for inclusion in a meta-analysis. The obtained results demonstrated the prevalence of fetal macrosomia was 7.4% and of LGA, 13.36%. Meta-analyses showed that the estimated pooled risk ratio (RR) for LGA in women with high HbA1c values compared to normal or low values was 1.70 (95% CI: 1.23–2.35), p = 0.001; and the pooled RR for fetal macrosomia was 1.45 (95% CI: 0.80 to 2.63), p = 0.215. Further research is needed to evaluate the utility of HbA1c levels in predicting the delivery of a baby with fetal macrosomia or LGA in pregnant women.

Summary: Vascular adhesion protein-1 (VAP-1) also known as amino oxidase copper containing 3 (AOC3) is a pro-inflammatory and versatile molecule with adhesive and enzymatic properties. VAP-1 is a primary amine oxidase belonging to the semicarbazide-sensitive amine oxidase (SSAO) family, which catalyzes the oxidation of primary amines leading to the production of ammonium, formaldehyde, methylglyoxal, and hydrogen peroxide. VAP-1 is mainly expressed by endothelial cells, smooth muscle cells, adipocytes and pericytes. It is involved in a repertoire of biological functions, e.g., immune cell extravasation, angiogenesis, and vascularization. Research into VAP-1 has intensified within the last decade on its role as a novel clinical biomarker and as a potential therapeutic target of vascular inflammatory disorders such as atherosclerosis, stroke, diabetes, neurovascular disorders (e.g., Alzheimer’s Disease), hepatic disease (e.g., non-alcoholic steatohepatitis), and skin conditions (e.g., psoriasis). This is the most up-to-date and comprehensive review on VAP-1 focusing on the translational aspects of VAP-1. Compared to recent reviews, our review provides novel insights on VAP-1 and heart failure, stroke and frailty, diabetes, endometriosis, osteoarthritis, COVID-19, conjunctivitis associated systemic lupus erythematosus, hematopoietic stem cells, gliomas, treatment of colorectal cancer with a novel VAP-1 inhibitor (U-V269), promoting recovery of motor functions and habit learning with a novel VAP-1 inhibitor (PXS-4681A), and 68Ga-DOTA-Siglec-9, a labelled peptide of Siglec-9 (a VAP-1 ligand), which appears to be a safe PET tracer for inflammation in rheumatoid arthritis. Finally, we present the emerging role of VAP-1 in pregnancy as a gatekeeper of immune cells, which are critical for spiral arterial remodeling, the deficiency of which could lead to vascular disorders of pregnancy such as preeclampsia. Future research should prioritize clinical trials on VAP-1 small-molecule inhibitors and monoclonal antibodies, thus, maximizing the potential of VAP-1 targeted therapy as well as research into sVAP-1 as a clinical biomarker of diseases and its prognosis.

Aims: Hypertensive disorders of pregnancy (HDP) are a leading cause of adverse maternal and perinatal outcomes worldwide. This systematic review aims to compare international practice guidelines for the management gestational hypertension (GH) and pre-eclampsia (PE). Our objective is to identify similarities and differences in the classification, diagnosis and management of these condition. Methods and results: Published guidelines from January 2010 to April 2024 were searched, utilising MEDLINE, EMBASE, the Emergency Care Research Institute Guidelines Trust, and the Guidelines International Network's website as databases. Guidelines were included if in English and not derived from other guidelines. All the guidelines were compared for definitions, diagnostic criteria, recommendations for pharmacological and non-pharmacological management, and contraindications. The AGREE II score tool was used to assess quality of included guidelines. The 12 included guidelines were consistent in their definition of GH and PE and which antihypertensive agents to avoid. Guidelines differed in the recommended blood pressure thresholds for initiation of antihypertensive medication and treatment targets. The use of aspirin was universally recommended, but guidance on non-pharmacological interventions was controversial. Conclusion: All guidelines acknowledge the significant morbidity associated with HDP and advocate for timely diagnosis and management. However, there are significant discrepancies in many aspects including definition and pharmacological management. More research is needed to understand optimal blood pressure thresholds at which to initiate antihypertensive medication regimens, the choice of antihypertensive, and the efficacy and benefits of non-pharmacological interventions in HDP. These findings exhibit knowledge gaps, which should be addressed in future research.

Vascular adhesion protein 1 (VAP-1) has been implicated in a wide range of clinical conditions. Moreover, serum levels are associated with disease prediction and progression in several clinical studies. There is a paucity of data on VAP-1 and pregnancy. Given the emerging role of VAP-1 in pregnancy, the aim of this study was to examine sVAP-1 as an early biomarker of pregnancy complications, especially hypertension during pregnancy. The objectives of the study are to associate sVAP-1 levels with other pregnancy complications, patient demographics and blood tests performed throughout pregnancy. We conducted a pilot study in a cohort of pregnant women (gestational week lower than 20 at the time of recruitment) attending their first antenatal ultrasound scan at the Leicester Royal Infirmary (LRI, UK). Data were both prospectively generated (from blood sample analysis) and retrospectively collected (from hospital records). From July and October 2021, a total of 91 participants were enrolled. Using ELISA (enzyme-linked immunosorbent assay), we found reduced serum levels of sVAP-1 in pregnant women with either pregnancy induced hypertension (PIH) (310 ng/mL) or GDM (366.73 ng/mL) as compared to controls (427.44 ng/mL and 428.34 ng/mL, respectively). No significant difference was found between women with FGR compared to controls (424.32 ng/mL vs 424.52 ng/mL), and patients with any pregnancy complications compared to healthy pregnancies (421.28 ng/mL vs 428.34 ng/mL). Further studies are needed to establish whether or not sVAP-1 might be considered as an early, non-invasive, and affordable biomarker to screen women who will develop PIH or GDM. Our data will aid sample size calculations for such larger studies.

Importance: Randomised-controlled trials (RCTs) suggest glucagon-like-peptide-1 receptor agonists (GLP-1RAs) reduce the risk of stroke in type 2 diabetes (T2DM); however, the mechanisms remain unclear. If benefits were driven principally by blood pressure (BP) lowering, similar effects on cognitive impairment may be expected. Evaluating data from trials with robust ascertainment and prespecified stroke and/or cognitive outcomes may provide greater clarity. Objective: To confirm the effect of GLP-1RAs on stroke risk in RCTs with prespecified, adjudicated stroke endpoints; to explore whether risk reduction is associated with trial-level changes in systolic BP (SBP), glycated haemoglobin (HbA1c), or body weight; to establish whether a parallel cognitive signal exists. Data Sources: PubMed, Cochrane, Embase, and CINAHL, from inception to August 2026 (PROSPERO CRD420261305938). Study Selection: RCTs comparing GLP-1RAs with placebo/usual care in adults, with ≥12 months follow-up, and prespecified stroke and/or cognitive outcomes. Data Extraction and Synthesis: Hazard ratios (HRs) for stroke were pooled using inverse-variance random-effect meta-analysis. Univariable meta-regression related logHR for stroke to trial-level between-group differences in SBP, HbA1c and weight, with permutation-based inference and leave-one-out sensitivity analyses. The pooled effect was benchmarked against that predicted from achieved SBP differences. Heterogeneous cognitive outcomes were synthesized narratively. Main Outcomes and Measures: Adjudicated stroke events and prespecified cognitive endpoints. Results: Among 7 RCTs (n=50,617), GLP-1RA therapy was associated with 17% lower stroke risk (pooled HR 0.83; [95% CI 0.75-0.92]; p<.001). Meta regression showed an association with SBP (β = 0.371; [95% CI 0.013-0.729]; p=.043), but not HbA1c (0.432; [-0.064-0.928]; p=.088) or weight (0.109; [-0.038-0.256]; p=.148). The mean between-group SBP difference (∼1.45 mmHg) predicts a stroke reduction of roughly 4%, versus the 17% observed, leaving approximately three quarters of the log-effect unexplained by BP lowering. Four trials (n=4,206) in established neurodegenerative disease showed no cognitive benefit. Conclusions and Relevance: GLP-1RA therapy reduces stroke risk by 17% among individuals with T2DM at high cardiovascular risk, a benefit not fully accounted for by conventional cardiometabolic risk factor change. Additional mechanisms warrant evaluation. The absence of cognitive signal suggests the benefit may have cerebrovascular origin, but whether GLP-1RAs prevent vascular cognitive impairment in cardiometabolic populations remains untested.