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Blood Cadmium and Preterm Birth: A Systems Toxicology Review of Molecular Mechanisms, Placental Disruption, and Translational Obstetric Implications Sanjaya, I Nyoman Hariyasa; Andonotopo, Wiku; Bachnas, Muhammad Adrianes; Dewantiningrum, Julian; Pramono, Mochammad Besari Adi; Mulyana, Ryan Saktika; Pangkahila, Evert Solomon; Akbar, Muhammad Ilham Aldika; Yeni, Cut Meurah; Aldiansyah, Dudy; Bernolian, Nuswil; Wiradnyana, Anak Agung Gede Putra; Pribadi, Adhi; Sulistyowati, Sri; Stanojevic, Milan; Kurjak, Asim
Indonesian Journal of Obstetrics & Gynecology Science Volume 8 Nomor 2 July 2025
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v8i2.949

Abstract

Objectives: Preterm birth (PTB) remains a leading global cause of neonatal morbidity and mortality, with multifactorial origins including inflammation, endocrine disruption, and placental dysfunction. Recent evidence identifies cadmium (Cd), a persistent environmental toxicant, as a modifiable contributor to PTB. This review aims to integrate the mechanistic, molecular, and clinical literature on maternal blood cadmium exposure and its role in the pathogenesis of PTB.Methods: A systematic and integrative review was conducted following PRISMA 2020 guidelines. Literature from 2000 to 2025 was retrieved using PubMed, Scopus, Embase, and Web of Science. Eligible studies included molecular toxicology, animal models, human epidemiological data, and placental mechanistic research addressing cadmium exposure and preterm birth. Inclusion criteria emphasized mechanistic clarity, gestational outcome relevance, and measurable cadmium biomarkers. Figures, tables, and mechanistic diagrams were used to illustrate toxicological convergence pathways.Results: Cadmium disrupts placental homeostasis via oxidative stress, endothelial dysfunction, impaired trophoblast invasion, progesterone suppression, and activation of inflammatory cascades such as the NLRP3 inflammasome. Consistent associations between maternal cadmium burden and PTB risk were found across animal, cellular, and human population studies. However, heterogeneity in exposure assessment, absence of unified risk thresholds, and confounding from co-exposures challenge causal inference. Literature remains fragmented, lacking integration between mechanistic insights and clinical risk models.Conclusions: Cadmium should be reclassified as a central agent in the pathophysiology of PTB. We propose a precision obstetrics framework that includes environmental cadmium screening in high-risk pregnancies, implementation of exposome-informed policies, and prospective multicenter studies with molecular endpoints. Obstetric care must evolve to include toxicological risk profiling as standard practice in the prevention of PTB.Kadmium dalam Darah dan Kelahiran Prematur: Tinjauan Toksikologi Sistemik terhadap Mekanisme Molekuler, Disrupsi Plasenta, dan Implikasi Obstetri TranslasiAbstrakTujuan: Kelahiran Prematur (preterm birth/PTB) tetap menjadi penyebab utama morbiditas dan mortalitas neonatal di seluruh dunia dengan etiologi multifaktorial yang mencakup inflamasi, gangguan endokrin, dan disfungsi plasenta. Bukti terbaru mengidentifikasi kadmium (Cd), suatu toksikan lingkungan persisten, sebagai faktor kontribusi yang dapat dimodifikasi terhadap PTB. Tinjauan ini bertujuan untuk mengintegrasikan literatur mekanistik, molekuler, dan klinis mengenai paparan kadmium dalam darah maternal dan perannya dalam patogenesis PTB.Metode: Tinjauan sistematis dan integratif dilakukan sesuai pedoman PRISMA 2020. Literatur dari tahun 2000 hingga 2025 dikumpulkan melalui database PubMed, Scopus, Embase, dan Web of Science. Studi yang memenuhi syarat mencakup toksikologi molekuler, model hewan, data epidemiologi manusia, dan penelitian mekanistik plasenta yang mengevaluasi hubungan antara paparan kadmium dan kelahiran prematur. Kriteria inklusi menekankan kejelasan mekanistik, relevansi terhadap hasil kehamilan, serta penggunaan biomarker kadmium yang terukur. Gambar, tabel, dan diagram mekanistik digunakan untuk mengilustrasikan jalur konvergensi toksikologis.Hasil: Kadmium mengganggu homeostasis plasenta melalui stres oksidatif, disfungsi endotel, gangguan invasi trofoblas, supresi progesteron, dan aktivasi jalur inflamasi seperti inflammasom NLRP3. Hubungan konsisten antara beban kadmium maternal dan risiko PTB ditemukan dalam studi hewan, seluler, dan populasi manusia. Namun, adanya heterogenitas dalam penilaian paparan, belum adanya ambang risiko yang seragam, serta pengaruh faktor pajanan lainnya menjadi tantangan dalam penarikan kesimpulan kausal. Literatur masih terfragmentasi dan belum mengintegrasikan temuan mekanistik dengan model risiko klinis secara menyeluruh.Kesimpulan: Kadmium seharusnya diklasifikasikan ulang sebagai agen sentral dalam patofisiologi PTB. Kami mengusulkan suatu kerangka kerja obstetri presisi yang mencakup skrining lingkungan terhadap kadmium pada kehamilan berisiko tinggi, menerapkan kebijakan berbasis exposome, serta studi prospektif multisentra dengan titik akhir molekuler. Pelayanan kebidanan harus berkembang dengan mengadopsi profil risiko toksikologis sebagai bagian dari praktik standar dalam pencegahan kelahiran prematur.Kata kunci: Disrupsi Plasenta; Interaksi Endokrin-Inflamasi; Kesehatan Reproduksi Lingkungan; Mekanisme Kelahiran Prematur; Toksisitas Kadmium,
Metastatic breast cancer during pregnancy: a case report Widi, Made Yudha Ganesa Wikantyas; Putra, Wayan Artana; Kusuma, Anak Agung Ngurah Jaya; Wiradnyana, Anak Agung Putra; Sanjaya, I Nyoman Hariyasa; Budiana, I Nyoman Gede; Mahayasa, Putu Doster; Marta, Kadek Fajar
Indonesian Journal of Perinatology Vol. 6 No. 1 (2025): (Available online: 1 June 2025)
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v6i1.73

Abstract

Introduction: Breast cancer is the most prevalent malignancy among women and a notable comorbidity during pregnancy. Pregnancy-associated breast cancer (PABC) presents unique challenges due to physiological breast changes that complicate early diagnosis. This case report aimed to present a 31-year-old female with a diagnosis of bilateral breast tumors, pleural effusion, and multiple thoracic soft tissue tumors during her second pregnancy, highlighting the complexities and treatment considerations involved. Case presentation: A 31-year-old female patient, referred to Prof. Dr. I. G.N.G Ngoerah General Hospital, Denpasar, was in her second pregnancy at 20-21 weeks of gestation. She presented with bilateral breast lumps, worsening pain, and shortness of breath. Her obstetric history included a previous cesarean delivery and two abortions. Clinical examination revealed pleural effusion and multiple nodules suggestive of metastases. Biopsies confirmed tubular adenoma in the right breast and invasive breast carcinoma in the left breast. Ultrasound and chest x-ray findings indicated metastases to the liver and lungs. The patient was diagnosed with G4P1021 at 20 weeks of gestation with pregnancy-associated bilateral breast cancer and metastases. Conclusion: PABC diagnosis and treatment are fraught with challenges due to the need to balance maternal and fetal health. Delays in diagnosis, limited antenatal care, and the aggressive nature of PABC contribute to poor outcomes. This case underscores the necessity of early detection, prompt multidisciplinary intervention, and tailored treatment strategies to improve PABC patients' prognoses.
Co-Authors Adhi Pribadi Aldiansyah, Dudy Aldika Akbar, Muhammad Ilham Aloysius Suryawan Anak Agung Ngurah Anantasika Anak Agung Wahyu Putri Agustini Anak Agung Wahyu Putri Agustini Anak Agung Wahyu Putri Agustini Anak Agung Wahyu Putri Agustini Andonotopo, Wiku Bachnas, Muhammad Adrianes Bambang Rahardjo Cokorda Istri Mirayani Pemayun Cokorda Istri Mirayani Pemayun Cokorda Istri Mirayani Pemayun Cokorda Istri Mirayani Pemayun Cut Meurah Yeni Daniel H. Susanto Denni Prasetyo Dyah Pradnyaparmita Duarsa Eka Setiawan, Putu Pandu Endang Sri Widiyanti Evert Solomon Pangkahila Firsta Sesarina Mintariani Firsta Sesarina Mintariani Firsta Sesarina Mintariani Hartanto Hartanto I G A A Novya Dewi I Gede Ngurah Harry Wijaya Surya I Gusti Kamasan Arijana I Ketut Surya Negara I Made Gede Widnyana I Made Mahardika I Nyoman Gede Budiana I Nyoman Wirata I Wayan Murdita Ida Bagus Gde Fajar Manuaba Ida Bagus Putra Adnyana Ida Bagus Putra Adnyana, Ida Bagus IGP Surya, IGP Julian Dewantiningrum Kadek Budi Juliantari Kamajaya, I Gusti Ngurah Agung Trisnu Ketut Widyani Astuti Kurjak, Asim Kusuma, Anak Agung Ngurah Jaya luh sudiarmini Made Adi Kusuma Made Diah Vendita Sakuntari Made Diah Vendita Sakuntari Made Diah Vendita Sakuntari Made Wiryana Marta, Kadek Fajar Murdita, I Wayan Ni Kadek Mulyantari Ni Komang Anik Pirgantari Ni Komang Anik Pirgantari Ni Komang Anik Pirgantari Ni Komang Erny Astiti Ni Luh Made Diah Mas Cahyani Putri Ni Luh Made Diah Mas Cahyani Putri Ni Luh Made Diah Mas Cahyani Putri Ni Luh Md Dwi Laxmi Satriani Ni Luh Md Dwi Laxmi Satriani Ni Luh Md Dwi Laxmi Satriani Ni Luh Putu Yulia Padmawati Ni Nyoman Dewi Purwanti Ni Nyoman Sri Budayanti Ni Putu Nining Gianni Ni Putu Nining Gianni Ni Putu Nining Gianni Ni Wayan Dewi Purwanti Ni Wayan Dewi Purwanti Ni Wayan Dewi Purwanti Ni Wayan Dewi Purwanti Nuswil Bernolian Pramono, Mochammad Besari Adi Putra, Wayan Artana Putu Doster Mahayasa Putu Pandu Eka Setiawan Rey Jauwerissa Ryan S. Mulyana Ryan Saktika Mulyana Sri Sulistyowati Stanojevic, Milan Sutandi, Chatrine Syauta, Fetrisya Tasa Riszkia Theresia Monica Rahardjo Tjokorda Gde Agung Suwardewa Utarini, Gusti Ayu Eka Widi, Made Yudha Ganesa Wikantyas Wijaya Surya, I Gede Ngurah Harry Wiradnyana, Anak Agung Gede Putra Wiradnyana, Anak Agung Putra