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All Journal Indonesian Journal of Obstetrics & Gynecology Science Indonesian Journal of Perinatology
Dudy Aldiansyah
Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, H. Adam Malik General Hospital, Medan, Indonesia
Health Professions Medicine & Pharmacology Nursing Public Health

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Preeclampsia and placental stiffness: a systematic review of elastography as a predictive tool I Nyoman Hariyasa Sanjaya; Wiku Andonotopo; Muhammad Adrianes Bachnas; Julian Dewantiningrum; Mochammad Besari Adi Pramono; Ryan Saktika Mulyana; Evert Solomon Pangkahila; Muhammad Ilham Aldika Akbar; Cut Meurah Yeni; Dudy Aldiansyah; Nuswil Bernolian; Anak Agung Gede Putra Wiradnyana; Sri Sulistyowati; Milan Stanojevic; Asim Kurjak
Indonesian Journal of Perinatology Vol. 7 No. 1 (2026): Available online: 1 June 2026
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v7i1.78

Abstract

Background: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality, responsible for approximately 14% of maternal deaths worldwide. Despite extensive research, early predictive tools remain inadequate. Since the placenta plays a central role in disease pathogenesis and exhibits pathological changes before clinical onset, placental elastography—a non-invasive ultrasound technique that quantifies tissue stiffness—has emerged as a promising modality. Methods: This systematic review synthesized literature published between 2010 and 2025 on placental elastography in preeclampsia. Databases were searched in accordance with PRISMA methodology. Eligible studies using strain or shear wave elastography were analyzed, and methodological quality was assessed using the Newcastle–Ottawa Scale (NOS) for observational studies and ROBIS for the included meta-analysis. Results: Fifty-two studies were included. Across modalities, pregnancies complicated by preeclampsia consistently demonstrated increased placental stiffness compared with normotensive controls. Alterations were detectable as early as the first trimester in some cohorts, supporting the hypothesis that biomechanical placental changes precede clinical manifestations. Although techniques, timing, and stiffness metrics (e.g., Young’s modulus, strain ratio) varied, the majority reported significant associations with early- and late-onset preeclampsia. Conclusions: Placental elastography reveals quantifiable stiffness alterations that may enable earlier risk stratification for preeclampsia. However, heterogeneity in imaging protocols, modest sample sizes, and limited longitudinal validation remain challenges. Given its real-time, bedside applicability, elastography holds promise as a complementary predictive tool. Future research should prioritize multicenter prospective studies, integration with biochemical markers, and assessment of clinical outcomes to validate its role in modern obstetric care.
Cadmium Exposure and Preeclampsia: A Systematic Review of Environmental Risk in Pregnancy I Nyoman Hariyasa Sanjaya; Wiku Andonotopo; Muhammad Adrianes Bachnas; Julian Dewantiningrum; Mochammad Besari Adi Pramono; Ryan Saktika Mulyana; Evert Solomon Pangkahila; Muhammad Ilham Aldika Akbar; Cut Meurah Yeni; Dudy Aldiansyah; Nuswil Bernolian; Anak Agung Gede Putra Wiradnyana; Adhi Pribadi; Sri Sulistyowati; Milan Stanojevic; Asim Kurjak
Indonesian Journal of Obstetrics & Gynecology Science Volume 8 Nomor 3 November 2025
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v8i3.951

Abstract

Objective: To systematically evaluate current scientific evidence on the association between cadmium (Cd) exposure and the risk of preeclampsia in pregnant women, and to explore underlying mechanisms and population-specific patterns.Methods: This systematic review was conducted according to PRISMA guidelines. Comprehensive literature searches were performed across PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar without time restriction, focusing on the past 15 years. Inclusion criteria encompassed original human studies measuring cadmium exposure—biological, dietary, or environmental—and reporting preeclampsia as an outcome. Risk of bias was assessed using the Newcastle-Ottawa Scale.Results: Twenty-five eligible studies were included, spanning case-control, cohort, and cross-sectional designs across diverse geographic regions. Most studies found a positive association between cadmium exposure and increased preeclampsia risk, though methodological heterogeneity exists. Proposed mechanisms include cadmium-induced oxidative stress, endothelial dysfunction, placental insufficiency, and hormonal dysregulation. Evidence also highlights differences in risk based on diet, region, and environmental regulation. However, inconsistencies in exposure metrics and population stratification remain.Conclusion: The cumulative evidence suggests cadmium is a plausible environmental risk factor for preeclampsia. Future research must standardize exposure assessments and address population-specific modifiers. This review provides critical groundwork for hypothesis-driven studies and policy frameworks addressing toxic metal exposure in maternal health.Paparan Kadmium dan Preeklampsia: Tinjauan Sistematis terhadap Risiko Lingkungan pada KehamilanAbstrakTujuan: Penelitian ini bertujuan untuk melakukan tinjauan sistematis terhadap bukti ilmiah terkini mengenai hubungan antara paparan kadmium (Cd) dan risiko preeklampsia pada ibu hamil, serta mengeksplorasi mekanisme biologis yang mendasari dan pola risiko spesifik populasi.Metode: Tinjauan sistematis ini disusun berdasarkan pedoman PRISMA. Pencarian literatur dilakukan secara menyeluruh melalui basis data PubMed, Scopus, Web of Science, ScienceDirect, dan Google Scholar tanpa batasan waktu, dengan fokus pada publikasi 15 tahun terakhir. Kriteria inklusi meliputi penelitian asli pada manusia yang mengukur paparan kadmium—baik secara biologis, dietetik, maupun lingkungan—dan melaporkan preeklampsia sebagai luaran. Risiko bias dinilai menggunakan Newcastle-Ottawa Scale.Hasil: Sebanyak 25 studi memenuhi kriteria dan dianalisis, mencakup desain studi kasus-kontrol, kohort, dan potong lintang dari berbagai wilayah geografis. Mayoritas studi menunjukkan adanya hubungan positif antara paparan kadmium dan peningkatan risiko preeklampsia, meskipun terdapat heterogenitas metodologis. Mekanisme yang diusulkan meliputi stres oksidatif akibat kadmium, disfungsi endotel, insufisiensi plasenta, dan disregulasi hormonal. Bukti juga menunjukkan perbedaan risiko berdasarkan pola diet, lokasi geografis, dan tingkat pengawasan lingkungan. Namun, masih terdapat ketidakkonsistenan dalam metrik paparan dan stratifikasi populasi.Kesimpulan: Bukti kumulatif mendukung bahwa kadmium merupakan faktor risiko lingkungan yang potensial terhadap preeklampsia. Penelitian selanjutnya perlu menstandarkan metode pengukuran paparan dan mempertimbangkan faktor-faktor spesifik populasi. Tinjauan ini memberikan landasan penting bagi studi berbasis hipotesis dan penyusunan kebijakan terkait paparan logam toksik dalam kesehatan maternal.Kata kunci: Komplikasi kehamilan; paparan kadmium; preeklampsia; stres oksidatif; toksikologi lingkungan
Co-Authors Adhi Pribadi Anak Agung Gede Putra Wiradnyana Anak Agung Gede Putra Wiradnyana Asim Kurjak Asim Kurjak Cut Meurah Yeni Cut Meurah Yeni Evert Solomon Pangkahila Evert Solomon Pangkahila I Nyoman Hariyasa Sanjaya I Nyoman Hariyasa Sanjaya Julian Dewantiningrum Julian Dewantiningrum Milan Stanojevic Milan Stanojevic Mochammad Besari Adi Pramono Mochammad Besari Adi Pramono Muhammad Adrianes Bachnas Muhammad Adrianes Bachnas Muhammad Ilham Aldika Akbar Muhammad Ilham Aldika Akbar Nuswil Bernolian Nuswil Bernolian Ryan Saktika Mulyana Ryan Saktika Mulyana Sri Sulistyowati Sri Sulistyowati Wiku Andonotopo Wiku Andonotopo