Helicobacter pylori and pregnancy-related disorders

Helicobacter pylori(H.pylori)infection is investigated in gastric diseases even during pregnancy.In particular,this Gram-negative bacterium seems to be associated with hyperemesis gravidarum,a severe form of nausea and vomiting during pregnancy.During the last decade,the relationship among H.pylori and several extra-gastric diseases strongly emerged in literature.The correlation among H.pylori infection and pregnancy-related disorders was mainly focused on iron deficiency anemia,thrombocytopenia,fetal malformations,miscarriage,pre-eclampsia and fetal growth restriction.H.pylori infection may have a role in the pathogenesis of various pregnancy-related disorders through different mechanisms:depletion of micronutrients(iron and vitamin B12)in maternal anemia and fetal neural tube defects;local or systemic induction of pro-inflammatory cytokines release and oxidative stress in gastrointestinal disorders and pre-eclampsia;cross-reaction between specific anti-H.pylori antibodies and antigens localized in placental tissue and endothelial cells(preeclampsia,fetal growth restriction,miscarriage).Since H.pylori infection is most likely acquired before pregnancy,it is widely believed that hormonal and immunological changes occurring during pregnancy could activate latent H.pylori with a negative impact not only on maternal health(nutritional deficiency,organ injury,death),but also on the fetus(insufficient growth,malformation,death)and sometime consequences can be observed later in life.Another important issue addressed by investigators was to determine whether it is possible to transmit H.pylori infection from mother to child and whether maternal anti-H.pylori antibodies could prevent infant’s infection.Studies on novel diagnostic and therapeutic methods for H.pylori are no less important,since these are particularly sensitive topics in pregnancy conditions.It could be interesting to study the possible correlation between H.pylori infection and other pregnancy-related diseases of unknown etiology,such as gestational diabetes mellitus,obstetric cholestasis and spontaneous preterm delivery.Since H.pylori infection is treatable,the demonstration of its causative role in pregnancy-related disorders will have important social-economic implications.

Helicobacter pylori's virulence and infection persistence define pre-eclampsia complicated by fetal growth retardation

AIM: To better understand the pathogenic role of Helicobacter pylori (H. pylori) in pre-eclampsia (PE), and whether it is associated or not with fetal growth retardation (FGR). METHODS: Maternal blood samples were collected from 62 consecutive pregnant women with a diagnosis of PE and/or FGR, and from 49 women with uneventful pregnancies (controls). Serum samples were evaluated by immunoblot assay for presence of specific antibodies against H. pylori antigens [virulence: cytotoxin-associated antigen A (CagA); ureases; heat shock protein B; flagellin A; persistence: vacuolating cytotoxin A (VacA)]. Maternal complete blood count and liver enzymes levels were assessed at delivery by an automated analyzer. RESULTS: A significantly higher percentage of H. pyloriseropositive women were found among PE cases (85.7%) compared to controls (42.9%, P < 0.001). There were no differences between pregnancies complicated by FGR without maternal hypertension (46.2%) and controls. Importantly, persistent and virulent infections (VacA/ CagA seropositive patients, intermediate leukocyte blood count and aspartate aminotransferase levels) were exclusively associated with pre-eclampsia complicated by FGR, while virulent but acute infections (CagA positive/ VacA negative patients, highest leukocyte blood count and aspartate aminotransferase levels) specifically correlated with PE without FGR. CONCLUSION: Our data strongly indicate that persistent and virulent H. pylori infections cause or contribute to PE complicated by FGR, but not to PE without feto-placental compromise.