This review contributes to the existing literature by filling gaps and inconsistencies in the understanding of oxidative stress in pregnancy. It serves as a valuable resource for researchers and healthcare professionals interested in this field, paving the way for further research to explore the mechanisms and implications of OS during pregnancy.

Basu J, Bendek B, Agamasu E, et al. Placental oxidative status throughout normal gestation in women with uncomplicated pregnancies. Obstet Gynecol Int. 2015;2015:276095. https://doi.org/10.1155/2015/276095.

Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia

In the final study study, Hamzaoglu et al. 2023 measured SOD, TOS, OSI, and TAS. The results indicate an increase in SOD, TOS, and OSI within the case group, along with a decrease in TAS compared to the control group. Notably, TAS exhibited higher levels in the control group in contrast to the case group [48].

Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia

Li H, Yin Q, Li N, Ouyang Z, Zhong M. Plasma markers of oxidative stress in patients with gestational diabetes mellitus in the second and third trimester. Obstet Gynecol Int. 2016;2016:3865454. https://doi.org/10.1155/2016/3865454.

However, the scope extends beyond these highlighted markers, encompassing a diverse array of molecules and enzymes that collectively contribute to our understanding of OS in pregnancy. Each marker, meticulously studied and analyzed, enriches our comprehension of the underlying mechanisms and pathways implicated in pregnancy-related complications. For a comprehensive overview of the OS markers explored in the literature, please refer to Table 2.

Cindrova-Davies T, Fogarty NME, Jones CJP, Kingdom J, Burton GJ. Evidence of oxidative stress-induced senescence in mature, post-mature and pathological human placentas. Placenta. 2018;68:15–22. https://doi.org/10.1016/j.placenta.2018.06.307.

Jan H, Ling LS, Sirajudeen KNS. Association between maternal oxidative stress markers during pregnancy and risk of postpartum adiposity. Obes Res Clin Pract. 2013;7:16. https://doi.org/10.1016/j.orcp.2013.08.053.

Sharma JB, Sharma A, Bahadur A, Vimala N, Satyam A, Mittal S. Corrigendum to “Oxidative stress markers and antioxidant levels in normal pregnancy and pre-eclampsia” [Int J Gynecol Obstet 94 (2006) 23–27]. Int J Gynecol Obstet. 2013;121(1):96. https://doi.org/10.1016/j.ijgo.2013.01.001.

This systematic review explores the level of oxidative stress (OS) markers during pregnancy and their correlation with complications. Unlike previous studies, it refrains from directly investigating the role of OS but instead synthesises data on the levels of these markers and their implications for various pregnancy-related complications such as preeclampsia, intrauterine growth restrictions, preterm premature rupture of membranes, preterm labour, gestational diabetes mellitus and miscarriages.

The findings of these studies underscored the relative importance of these markers in both physiological and pathological pregnancy conditions.

On top of this, harmful UV radiation from the sun coming through your glass is the leading cause of premature fading of furniture, curtains, wooden floors, carpets, rugs, artwork, etc. This has the potential to damage people as well. We have the solution – our solar window film blocks almost all UV rays.

These studies, while valuable, exhibit certain limitations. One significant constraint lies in the absence of a comprehensive assessment of all potential OS markers that may fluctuate during pregnancy. Each study tends to focus on specific markers, and their selection is not standardized or in a specific order. For example, some studies only assessed MDA, TBARS or 8-OHdG while many other markers could provide a more holistic view of OS during pregnancy. This lack of consistency and comprehensiveness in marker evaluation poses a considerable challenge when attempting to perform a meta-analysis within the scope of this review (Table 3). The absence of a holistic approach to oxidative stress assessment limits the ability to draw comprehensive and interconnected conclusions.

In PE, studies consistently demonstrate significant elevations in oxidative stress markers such as MDA, 8-isoPG F2α, and SOD compared to normal pregnancies. These findings suggest a potential role of OS in the pathogenesis of PE and highlight the need for further investigation into specific markers [11, 13, 16, 18, 67, 68, 6, 69].

Bartakova V, Kollarova R, Kuricova K, Sebekova K, Belobradkova J, Kankova K. Serum carboxymethyl-lysine, a dominant advanced glycation end product, is increased in women with gestational diabetes mellitus. Biomed Pap Med Fac Univ Palacky Olomouc Czechoslov. 2016;160(1):70–5. https://doi.org/10.5507/bp.2015.045.

Usluoğullari B, Usluogullari CA, Balkan F, Orkmez M. Role of serum levels of irisin and oxidative stress markers in pregnant women with and without gestational diabetes. Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol. 2017;33(5):405–7. https://doi.org/10.1080/09513590.2017.1284789.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Freire VAF, de Melo AD, de Lima Santos H, Barros-Pinheiro M. Evaluation of oxidative stress markers in subtypes of preeclampsia: a systematic review and meta-analysis. Placenta. 2023;132:55–67. https://doi.org/10.1016/j.placenta.2022.12.009.

The complex interplay between OS and pregnancy conditions remains an area of ongoing investigation, and this systematic review offers a solid foundation for future research endeavors in this vital area of women’s health. It is clear that OS markers hold the key to unraveling the mysteries of various pregnancy-related complications, and further exploration is necessary to fully comprehend their role in maternal and fetal health.

In this systematic review, we meticulously examined the landscape of OS markers studied during pregnancy, aiming to unravel the intricate mechanisms underlying these complications.

In the fifth study, [16] ventured into the assessment of SOD, CAT, and GPx, all of which exhibited substantial increases in PE cases as opposed to normal conditions [16]. In the sixth study, Bogavac et al. 2016 delved into the measurement of SOD, GSH-Px1, and TAS, revealing significant elevations in these markers in PE compared to control [53].

Cochrane handbook for systematic reviews of interventions. Accessed 31 Oct 2023. https://training.cochrane.org/handbook/archive/v6.3.

Yoshida A, Watanabe K, Iwasaki A, Kimura C, Matsushita H, Wakatsuki A. Placental oxidative stress and maternal endothelial function in pregnant women with normotensive fetal growth restriction. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2018;31(8):1051–7. https://doi.org/10.1080/14767058.2017.1306510.

Hu XQ, Song R, Zhang L. Effect of oxidative stress on the Estrogen-NOS-NO-KCa channel pathway in uteroplacental dysfunction: its implication in pregnancy complications. Oxid Med Cell Longev. 2019;2019:9194269. https://doi.org/10.1155/2019/9194269.

Zhang H, Luo Q, Hu C, et al. Trimester-specific exposure to triclocarban during pregnancy: Associations with oxidative stress and size at birth. Sci Total Environ. Published online October 28, 2023:168100. https://doi.org/10.1016/j.scitotenv.2023.168100.

This radiation is potentially the most damaging because of its high energy levels.  Fortunately, at this time, all UVC is absorbed by oxygen and ozone in the atmosphere and never reaches the Earth’s surface. Glass reflects UVC light.

Venkatesh KK, Cantonwine DE, Ferguson K, Arjona M, Meeker J, McElrath TF. 816: Inflammatory and oxidative stress markers associated with decreased cervical length in pregnancy. Am J Obstet Gynecol. 2016;214(1, Supplement):S425. https://doi.org/10.1016/j.ajog.2015.10.866.

Phoswa WN, Khaliq OP. The role of oxidative stress in hypertensive disorders of pregnancy (Preeclampsia, Gestational Hypertension) and metabolic disorder of pregnancy (Gestational Diabetes Mellitus). Oxid Med Cell Longev. 2021;2021:5581570. https://doi.org/10.1155/2021/5581570.

A critical evaluation was conducted to gauge the quality of data in the context of JBI Systematic Reviews, using The Joanna Briggs Institute Critical Appraisal tools [60]. Three independent reviewers assessed biases. They categorized bias risk as low when more than 70% of the responses were affirmative, moderate when 50%-69% were affirmative, and high when up to 49% were affirmative. Studies demonstrating high or moderate bias risk were omitted from the review.

This study was funded by the Ministry of Higher Education, Malaysia, under the Fundamental Research Grant Scheme (FRGS) (203.PPSP.6171292).

Our search strategy retrieved all relevant records, which were then imported into Zotero and EndNote software. Duplicate articles were eliminated. Three separate reviewers evaluated the titles and abstracts of the identified articles. For eligible studies, the full-text articles were carefully reviewed to determine their suitability. In cases of disagreement between the three reviewers, a consensus discussion was held, and a fourth reviewer was consulted when necessary.

Kurlak LO, Green A, Loughna P, Pipkin FB. Oxidative stress markers in hypertensive states of pregnancy: preterm and term disease. Front Physiol. 2014;5:310. https://doi.org/10.3389/fphys.2014.00310.

In this systematic review, we meticulously dissect the findings into distinct sections, offering a captivating exploration of OS markers. Our examination encompasses both the realm of normal physiological pregnancies and the intricate web of pathological conditions, including pre-eclampsia (PE), intrauterine growth restrictions (IUGR), preterm labor, preterm birth (PTBs), preterm-premature rupture of membrane (pPROM), gestational diabetes mellıtus (GDM), miscarriages. We really hope this systematic review will stand as a beacon of thorough exploration and a testament to the evolving landscape of scientific inquiry.

Department of Obstetrics and Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia

Lin YJ, Chang WH, Kuo PL, Chen HC, Chang WT, Huang PC. Oxidative/nitrosative stress increased the risk of recurrent pregnancy loss–Taiwan Recurrent Pregnancy Loss and Environmental Study (TREPLES). Redox Biol. 2023;68. https://doi.org/10.1016/j.redox.2023.102940.

To ensure the comprehensiveness and relevance of our systematic review, we adopted a comprehensive approach in selecting studies related to OS markers in pregnancy and pregnancy-related complications. This approach involved including a diverse range of studies, both interventional and observational, to provide a thorough understanding of OS markers across different study designs and populations. We also considered studies conducted at healthcare institutions to ensure the clinical relevance of our findings.

In conclusion, this systematic review has provided a comprehensive analysis of OS markers in pregnancy, including both normal and pathological pregnancy conditions. The review identified 45 studies with a low risk of bias that investigated a wide range of OS markers. The findings underscore the significance of these markers in pregnancy and pregnancy-related complications.

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Throughout the literature, researchers have extensively investigated various OS markers to gauge the physiological state of pregnant individuals. Noteworthy among these markers are molecules such as malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OhdG), and thiobarbituric acid reactive substances (TBARS) etc. These markers serve as sentinel indicators, offering unique insights into different facets of OS dynamics during pregnancy.

Bernardi F, Guolo F, Bortolin T, Petronilho F, Dal-Pizzol F. Oxidative stress and inflammatory markers in normal pregnancy and preeclampsia. J Obstet Gynaecol Res. 2008;34(6):948–51. https://doi.org/10.1111/j.1447-0756.2008.00803.x.

Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372. https://doi.org/10.1136/bmj.n160.

Chen X, Scholl TO. Oxidative stress: changes in pregnancy and with gestational diabetes mellitus. Curr Diab Rep. 2005;5(4):282–8. https://doi.org/10.1007/s11892-005-0024-1.

Longini M, Perrone S, Vezzosi P, et al. Association between oxidative stress in pregnancy and preterm premature rupture of membranes. Clin Biochem. 2007;40(11):793–7. https://doi.org/10.1016/j.clinbiochem.2007.03.004.

In the second study, [50] measured TOS, Prolidase, LOOH, TAC, and -SH. The findings showed a significant increase in prolidase, LOOH and TOS, along with a decrease in TAS and -SH in the case group when contrasted with the control group. Interestingly, the control group displayed lower values of Prolidase, LOOH and TOS but higher values of TAS and -SH in comparison to the case group [63].

In pregnancy, the increased metabolic demands and physiological changes can make women more susceptible to OS [4]. These markers are used to evaluate the potential impact of OS on maternal and fetal health and may help in understanding and managing pregnancy complications associated with OS, such as infertility, miscarriage, pre-eclampsia and fetal growth restriction. Researchers and healthcare professionals often use these markers to monitor and study OS during pregnancy [5, 6].

Jadhav A, Khaire A, Joshi S. Exploring the role of oxidative stress, fatty acids and neurotrophins in gestational diabetes mellitus. Growth Factors Chur Switz. 2020;38(3–4):226–34. https://doi.org/10.1080/08977194.2021.1895143.

Five studies investigated various OS markers in complications related to PTBs. In the first study, Cindrova davies et al. 2018 examined 8-OHdG and H2O2, revealing a significant increase in these markers in cases compared to controls [83]. In the second study, [77] analyzed 8-iso-PGF2α in PTB women and normal pregnant women, uncovering a significant increase in this marker in PTBs women [84]. In the third study, Kurlak et al. 2014 measured TBARS, demonstrating a significant increase in these markers in preterm Women compared to the control group [6]. In the fourth study, Venkatesh et al. 2016 assessed 8-OHdG and 8-isoprostane, and the results indicated a significant increase in these markers [85].

Clerici G, Slavescu C, Fiengo S, et al. Oxidative stress in pathological pregnancies. J Obstet Gynaecol J Inst Obstet Gynaecol. 2012;32(2):124–7. https://doi.org/10.3109/01443615.2011.637139.

In addition, Bartakova et al. 2015 investigated Nε-(carboxymethyl)lysine (CML) in GDM. They found significantly elevated protein- and BMI-normalized CML levels during the 24th to 30th week of gestation in women with GDM compared to healthy pregnant controls. These differences were notable even after adjusting for BMI. CML levels also correlated with 1-h and 2-h post-load glycaemia during oral glucose tolerance testing (oGTT) in GDM patients [86]. Moreover, Li and Yang (2018) investigated advanced glycation end products (AGEs) in GDM. They found significantly higher levels of AGEs in maternal plasma during both early and late stages of pregnancy in GDM compared to healthy pregnant controls [87].

In the first study, Zelanzniewick et al 2015, which was conducted during the first trimester, measured 8-isoPG F2α and 8-OHdG, revealing a notable increase in these markers [50]. In the second study, [60] monitored MDA and TAC levels throughout pregnancy, MDA exhibited consistent increases in all trimesters, with the highest levels observed in the first trimester. Meanwhile, TAC levels reached their zenith during the third trimester [61].

We analyzed seven studies that investigated OS markers during physiological pregnancies. Notably, six of these studies diligently controlled factors known to influence OS levels, including vitamin supplementation, age, smoking, alcohol consumption, physical activity, and overall health status. Despite these precautions, there was a discernible elevation in various OS markers.

Negre-Salvayre A, Swiader A, Salvayre R, Guerby P. Oxidative stress, lipid peroxidation and premature placental senescence in preeclampsia. Arch Biochem Biophys. 2022;730. https://doi.org/10.1016/j.abb.2022.109416.

Lin YJ, Chang WH, Kuo PL, Chen HC, Chang WT, Huang PC. Oxidative/nitrosative stress increased the risk of recurrent pregnancy loss–Taiwan Recurrent Pregnancy Loss and Environmental Study (TREPLES). Redox Biol. 2023;68. https://doi.org/10.1016/j.redox.2023.102940.

Stress biomarkersin biological fluids and their point-of-use detection

In the first study, Jjain and Wise 1995 centered on MDA and revealed a significant increase in its levels in cases of PE when compared to normal pregnancies [77]. In the second study, [18] examined 8-isoPG F2α and MDA, also uncovering a noteworthy elevation in these markers in contrast to normal pregnancy [18]. In the third study, [11] assessed SOD, highlighting its significant increase in PE compared to healthy pregnancies [11]. In the fourth, study [13] scrutinized TBARS, and its outcomes demonstrated a significant rise in PE cases in comparison to the control group [13].

This systematic review encompasses 11 articles that investigate OS markers in PE. However, akin to most studies, these research endeavors also exhibit certain limitations as they do not comprehensively cover all potential markers. Instead, each study focuses on a specific subset of these markers.

This systematic review provides valuable insights into the role of OS in pregnancy and their connection to complications. These selected studies delved deeply into OS markers during pregnancy and their implications for associated complications. The comprehensive findings highlighted the significance of OS markers in both normal and pathological pregnancy conditions, paving the way for further research in this field.

Godhamgaonkar A, Joshi S. Early pregnancy oxidative stress is associated with shorter placental telomeres in preeclampsia. Placenta. 2023;140. https://doi.org/10.1016/j.placenta.2023.07.154.

To address this limitation and improve the understanding of OS in pregnancy, future studies should consider assessing a broader range of OS in a standardized manner. Moreover, there is a need to explore various sample types in future studies. Assessing the markers in different sample types such as blood, placenta, amniotic fluid, myometrial tissue, Urine, Plasma, serum, and umbilical cord blood in a single study would provide a more comprehensive understanding of OS in different maternal and fetal compartments. Despite these limitations, the findings underscore the pivotal role of OS in pregnancy-related diseases, prompting further investigations into specific markers and their implications. The review provides valuable insights into the intricate relationship between OS and pregnancy, paving the way for future studies to unravel underlying mechanisms and explore potential therapeutic interventions. However, it’s essential to approach the interpretation of these findings with caution due to variations in study designs, populations, and methodologies, emphasizing the need for continued research to deepen our understanding of OS in pregnancy and its implications for maternal and fetal health.

Research on IUGR reveals significant increases in markers such as MDA, TOS, and TAC. These findings underscore the pervasive influence of OS in IUGR and emphasize the importance of comprehensive marker assessment across different sample types [20, 21, 26, 52, 70,71,72,73,74].

Sikkema JM, Van Rijn BB, Franx A, et al. Placental superoxide is increased in pre-eclampsia. Placenta. 2001;22(4):304–8. https://doi.org/10.1053/plac.2001.0629.

Two studies were included in our analysis of miscarriages, where various OS markers were assessed. In the first study [45], markers such as 8-OHdG, 8-NO2-Gua, HNE-MA, and MDA were examined. The results revealed significant increases in these markers when compared to the normal control group [88].

Hung TH, Lo LM, Chiu TH, et al. A longitudinal study of oxidative stress and antioxidant status in women with uncomplicated pregnancies throughout gestation. Reprod Sci. 2010;17(4):401–9. https://doi.org/10.1177/1933719109359704.

We recommend and install top-quality products supplied by MEP Films and world-leading innovators, 3M™. Excellent results with fast paybacks are achievable, depending on your requirements.

Żelaźniewicz A, Nowak J, Pawłowski B. Woman’s body symmetry and oxidative stress in the first trimester of pregnancy. Am J Hum Biol Off J Hum Biol Counc. 2015;27(6):816–21. https://doi.org/10.1002/ajhb.22730.

In our selection process, we specifically excluded animal experiments, studies with incomplete data on OS markers, genetic studies of antioxidant enzymes, and grey literature such as case series/reports, conference papers, proceedings, abstract-only articles, editorial reviews, letters of communication, and commentaries. These exclusion criteria were put in place to maintain the focus on human pregnancy, ensure data completeness and reliability, and uphold the quality and reliability standards of the included studies.

This radiation is responsible for generating photochemical smog and is the single most destructive UV band on fabrics and plastics – resulting in degradation and colour loss. Half of UVA light penetrates glass.

Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, 56000, Malaysia

Cleaning window film on the inside of the glass requires a bit of care, but nothing special. Our films are almost as hard as glass itself and resist scratching. We recommend cleaning the film with a micropore cloth and mild soap. Avoid using household cleaners, and especially ammonia-based cleaning products, abrasive cloths, or scouring pads.

Many pregnancy-related diseases characterized by OS remain etiologically unidentified. Notably, these conditions exhibit a significant elevation in oxidative stress levels. Consequently, a prevailing hypothesis among obstetricians and gynecologists suggests that OS may play a crucial role in the pathogenesis of these diseases. Therefore, the study of OS markers becomes paramount in understanding the underlying mechanisms.

Mert I, Oruc AS, Yuksel S, et al. Role of oxidative stress in preeclampsia and intrauterine growth restriction. J Obstet Gynaecol Res. 2012;38(4):658–64. https://doi.org/10.1111/j.1447-0756.2011.01771.x.

Toy H, Camuzcuoglu H, Camuzcuoglu A, Celik H, Aksoy N. Decreased serum prolidase activity and increased oxidative stress in early pregnancy loss. Gynecol Obstet Invest. 2010;69(2):122–7. https://doi.org/10.1159/000262608.

The heat and glare over summer in New Zealand can be really intense. This can make life uncomfortable in your home or office as the sun blasts through the windows during the day. Our UV window film protects you from the strength of the sun’s rays, decreasing heat and glare, while letting visible light through.

Mika F, Norikazu W, Keiko Y, Seiji T, Satoru N. The change of oxidative stress in maternal blood during pregnancy. Reprod Sci. 2022;29(9):2580–5. https://doi.org/10.1007/s43032-022-00848-8.

This systematic review incorporated four studies that met our eligibility criteria, focusing on OS markers in the context of GDM. In the first study, [79] assessed TAC and MDA, revealing a notably greater increase in these markers when compared to normal pregnant women [17]. In the second study, Lopez-Tinoco et al. [72].

Coughlan MT, Vervaart PP, Permezel M, Georgiou HM, Rice GE. Altered placental oxidative stress status in gestational diabetes mellitus. Placenta. 2004;25(1):78–84. https://doi.org/10.1016/S0143-4004(03)00183-8.

As this study is a systematic review, it does not involve direct participation of human or animal subjects and thus did not require ethical approval. However, all studies included in this review were conducted in accordance with ethical standards as stated in their respective publications.

Ryu HK, Moon JH, Heo HJ, Kim JW, Kim YH. Maternal c-reactive protein and oxidative stress markers as predictors of delivery latency in patients experiencing preterm premature rupture of membranes. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2017;136(2):145–50. https://doi.org/10.1002/ijgo.12024.

Longini M, Perrone S, Kenanidis A, et al. Isoprostanes in amniotic fluid: a predictive marker for fetal growth restriction in pregnancy. Free Radic Biol Med. 2005;38(11):1537–41. https://doi.org/10.1016/j.freeradbiomed.2005.02.017.

Jamilian M, Mirhosseini N, Eslahi M, et al. The effects of magnesium-zinc-calcium-vitamin D co-supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes. BMC Pregnancy Childbirth. 2019;19(1):107. https://doi.org/10.1186/s12884-019-2258-y.

Morris JM, Gopaul NK, Endresen MJ, et al. Circulating markers of oxidative stress are raised in normal pregnancy and pre-eclampsia. Br J Obstet Gynaecol. 1998;105(11):1195–9. https://doi.org/10.1111/j.1471-0528.1998.tb09974.x.

PROM is defined as the rupture of the amniotic membranes after 37 weeks of gestation. Five studies examining biomarkers of OS in pPROM and PROM were included in this analysis. In the first study, [39] analyzed 8-Isoprostane, TOS, and TAS, revealing an increase in TOS and 8-Isoprostane levels and a decrease in TAS within the case groups in comparison to the control groups [39]. In the second study, [35] evaluated TAC and TBARS, demonstrating a significant increase in these markers in PROM patients compared to normal pregnant women [35]. In the third study, [42] investigated Isoprostane and F2α IP, presenting significant increases in these markers in cases relative to the control group [42].

Rejc B, Karas-Kuželički N, Osredkar J, Geršak K. Correlation between markers of DNA and lipid oxidative damage in maternal and fetoplacental compartment in the mid-trimester of pregnancy. J Perinat Med. 2017;45(4):413–9. https://doi.org/10.1515/jpm-2015-0399.

In this section of our systematic review, we meticulously analysed nine studies that rigorously adhered to our stringent inclusion criteria. These investigations sought to elucidate the intricate landscape of OS markers within the context of IUGR.

In the fourth study, Ryu et at. 2017 scrutinized MDA, revealing a significant increase in MDA levels in PROM patients when compared to normal pregnant women [38]. In the fifth study, [43] delved into TAS and TOS in pPROM cases, unveiling significantly higher TOS levels and lower TAS levels in pPROM patients compared to the normal health control group with healthy amniotic membranes [43].

Biri A, Bozkurt N, Turp A, Kavutcu M, Himmetoglu O, Durak I. Role of oxidative stress in intrauterine growth restriction. Gynecol Obstet Invest. 2007;64(4):187–92. https://doi.org/10.1159/000106488.

Aromataris E, Fernandez R, Godfrey C, Holly C, Kahlil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an Umberella review approach. Int J Evid Based Healthc. 2015;13(3):132–40.

In the third study, of [72] focusing on the second trimester, measured 8-Ip and 8-OHdG, uncovering an elevation in these markers [75]. In the fourth study, Restini et al. 2018 found out that pregnant women exhibited significantly higher levels of TAC and SOD compared to non-pregnant women, whose values remained within the normal range [66]. In the fifth study, Roger et al. 2007 concentrated on 8-isoPG F2α and 2,3 8-isoPG F2α, unveiling an increase in isoprostane levels among normotensive pregnant women [71]. In the sixth study [61] assessed TBARS levels, revealing a rise in this marker among normotensive pregnant women [62]. Finally, In the seventh study, Vakilan et al. 2009 examined TBARS levels at birth, indicating a significant increase in this marker [76] .

The review extends its focus to pathological pregnancy conditions, such as PE, IUGR, PROM, PBTs, GDM, and miscarriages. In these conditions, OS markers were significantly increased compared to normal pregnancies, indicating a potential contribution to the development and progression of these complication:

Joo EH, Kim YR, Kim N, Jung JE, Han SH, Cho HY. Effect of endogenic and exogenic oxidative stress triggers on adverse pregnancy outcomes: preeclampsia, fetal growth restriction, gestational diabetes mellitus and preterm birth. Int J Mol Sci. 2021;22(18):10122. https://doi.org/10.3390/ijms221810122.

Menon R, Boldogh I, Hawkins HK, et al. Histological evidence of oxidative stress and premature senescence in preterm premature rupture of the human fetal membranes recapitulated in vitro. Am J Pathol. 2014;184(6):1740–51. https://doi.org/10.1016/j.ajpath.2014.02.011.

Sıgnıfıcant levels of markers such as isoprostane, TBARS, and TOS have Increased compared to normal pregnancies. These findings suggest a potential association between OS and the onset of preterm labor and underscore the need for further investigation into specific markers [6, 38, 39, 42, 43, 48, 50, 75].

Ho E, Karimi Galougahi K, Liu CC, Bhindi R, Figtree GA. Biological markers of oxidative stress: applications to cardiovascular research and practice. Redox Biol. 2013;1(1):483–91. https://doi.org/10.1016/j.redox.2013.07.006.

Ahmad IM, Zimmerman MC, Moore TA. Oxidative Stress in Early Pregnancy and the Risk of Preeclampsia. Pregnancy Hypertens. 2019;18:99. https://doi.org/10.1016/j.preghy.2019.09.014.

Studies on miscarriages reveal significant increases in oxidative stress markers such as 8-OHdG, MDA, and TOS. These findings suggest a potential association between OS and pregnancy loss, highlighting the need for further investigation into specific markers [78, 79].

In the third study, [63] made a comprehensive evaluation encompassed 8-isoPGF2alpha, AOPP, PCO, GPx-3, and PON1. The findings underscored substantial elevations in these markers in GDM patients relative to normal pregnant women [72]. In the fourth study, [71] scrutinized 8-Isoprostane, 8-epiPGF2alpha, SOD, protein carbonyl, and GPx. The results indicated significant increases in all of these markers in cases compared to the control group, except for GPx, which exhibited no significant impact within the study [74].

Burton GJ, Yung HW, Cindrova-Davies T, Charnock-Jones DS. Placental endoplasmic reticulum stress and oxidative stress in the pathophysiology of unexplained intrauterine growth restriction and early onset preeclampsia. Placenta. 2009;30(Suppl A(Suppl)):S43-48. https://doi.org/10.1016/j.placenta.2008.11.003.

Drejza MA, Rylewicz K, Majcherek E, et al. Markers of oxidative stress in obstetrics and gynaecology—a systematic literature review. Antioxidants. 2022;11(8). https://doi.org/10.3390/antiox11081477.

Kressig P, Beinder E, Schweer H, Zimmermann R, von Mandach U. Post-delivery oxidative stress in women with preeclampsia or IUGR. J Perinat Med. 2008;36(4):310–5. https://doi.org/10.1515/JPM.2008.053.

Li S, Yang H. Relationship between advanced glycation end products and gestational diabetes mellitus. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2019;32(17):2783–9. https://doi.org/10.1080/14767058.2018.1449201.

What is a biomarker

Kurlak LO, Scaife PJ, Briggs LV, Broughton Pipkin F, Gardner DS, Mistry HD. Alterations in antioxidant micronutrient concentrations in placental tissue, maternal blood and urine and the fetal circulation in pre-eclampsia. Int J Mol Sci. 2023;24(4):3579. https://doi.org/10.3390/ijms24043579.

While these conditions differ in their specific triggers and symptoms, they are all characterized by the shared risk of premature delivery. pPROM can result in PTBs. pPROM, which is defined as the rupture of the amniotic membranes before reaching 37 weeks of gestation, occurs in around 4% of pregnancies. It directly precedes approximately 40% to 50% of all cases of spontaneous PTBs [37]. Which is why we have included them in the same section. Within this section, we produced separate subsections, dedicated to explaining the biomarkers of OS that are related to one of these complications.

Hamzaoğlu Canbolat K, Öncül M, Özel A, et al. Oxidative stress and antioxidant status in threatened preterm labor. Arch Gynecol Obstet. Published online April 1, 2023. https://doi.org/10.1007/s00404-023-07023-7.

Myatt L, Kossenjans W, Sahay R, Eis A, Brockman D. Oxidative stress causes vascular dysfunction in the placenta. J Matern Fetal Med. 2000;9(1):79–82. https://doi.org/10.1002/(SICI)1520-6661(200001/02)9:1%3c79::AID-MFM16>3.0.CO;2-O.

Utilizing a systematic review approach, we conducted a comprehensive search across databases, including MEDLINE, CINAHL (EBSCOhost), ScienceDirect, Web of Science, and SCOPUS. Our search encompassed all publication years in English.

Poston L, Raijmakers MTM. Trophoblast oxidative stress, antioxidants and pregnancy outcome—a review. Placenta. 2004;25:S72–8. https://doi.org/10.1016/j.placenta.2004.01.003.

Kamath U, Rao G, Kamath SU, Rai L. Maternal and fetal indicators of oxidative stress during intrauterine growth retardation (IUGR). Indian J Clin Biochem IJCB. 2006;21(1):111–5. https://doi.org/10.1007/BF02913077.

Additionally, we included studies that measured OS biomarkers in various biological fluids (e.g., serum, urine, amniotic fluid) to capture a comprehensive range of data and avoid potential biases. These comprehensive inclusion criteria are essential to ensure that we do not miss relevant studies that could contribute significantly to our understanding of OS in pregnancy and its associated complications.

Not applicable. This manuscript does not include identifying images or other personal or clinical details of participants that compromise anonymity.

Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia

Lope-Tinoco et al. 2013 measured MDA, GSH, GST, and SOD, highlighting significant increases in these markers in cases compared to the control group [72].

Taravati A, Tohidi F. Comprehensive analysis of oxidative stress markers and antioxidants status in preeclampsia. Taiwan J Obstet Gynecol. 2018;57(6):779–90. https://doi.org/10.1016/j.tjog.2018.10.002.

A systematic review was conducted by synthesizing available studies, aiming to address the prevailing gaps and inconsistencies in the literature regarding OS markers in pregnancy. This comprehensive analysis was designed to shed light on areas requiring further investigation. The review adhered to established guidelines for conducting systematic reviews, including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [58] and the Cochrane Handbook for Systematic Reviews of Interventions [59]. By following these rigorous protocols, the study sought to ensure the highest standards of methodological rigor and transparency in the review process, thereby contributing to a more robust understanding of the role of OS markers in pregnancy.

In this review, we aimed to address gaps and inconsistencies in the existing literature regarding OS markers in pregnancy. The review encompassed data from a substantial number of studies, and we identified 45 of them as having a low risk of bias, which were included in the analysis. These selected studies delved deeply into OS markers. The comprehensive findings of these studies highlighted the significance of these markers in both normal and pathological pregnancy conditions. All the included studies are summarized in Table 3.

Musilova I, Tothova L, Menon R, et al. Umbilical cord blood markers of oxidative stress in pregnancies complicated by preterm prelabor rupture of membranes. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2016;29(12):1900–10. https://doi.org/10.3109/14767058.2015.1074997.

Simon-Szabo Z, Fogarasi E, Nemes-Nagy E, Denes L, Croitoru M, Szabo B. Oxidative stress and peripartum outcomes (Review). Exp Ther Med. 2021;22(1):771. https://doi.org/10.3892/etm.2021.10203.

Bogavac M, Jakovljevic A, Stajic Z, et al. Preeclampsia and level of oxidative stress in the first trimester of pregnancy. Vojnosanit Pregl. 2017;74(7):633–8. https://doi.org/10.2298/VSP150517251B.

Mannaerts D, Faes E, Cos P, et al. Oxidative stress in healthy pregnancy and preeclampsia is linked to chronic inflammation, iron status and vascular function. PLoS ONE. 2018;13(9). https://doi.org/10.1371/journal.pone.0202919.

Grzeszczak K, Łanocha-Arendarczyk N, Malinowski W, Ziętek P, Kosik-Bogacka D. Oxidative stress in pregnancy. Biomolecules. 2023;13(12):1768. https://doi.org/10.3390/biom13121768.

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Ozler S, Oztas E, Guler BG, et al. ADAMTS4 and Oxidative/Antioxidative Status in Preterm Premature Rupture of Membranes. Fetal Pediatr Pathol. 2016;35(4):239–50. https://doi.org/10.1080/15513815.2016.1175529.

Jain SK, Wise R. Relationship between elevated lipid peroxides, vitamin E deficiency and hypertension in preeclampsia. Mol Cell Biochem. 1995;151(1):33–8. https://doi.org/10.1007/BF01076893.

Numerous research studies have documented the presence of OS markers in pregnancy; however, these studies are conflicting. Furthermore, these studies tend to focus on the increase of specific OS markers in limited pregnancy conditions, such as pre-eclampsia [3, 7,8,9,10,11,12,13,14,15,16,17,18,19], intrauterine growth restriction [20,21,22,23,24,25,26], gestational diabetes mellitus [17, 25, 27,28,29,30,31,32,33,34], premature rupture of membranes [35,36,37,38,39,40,41,42,43], polycystic ovary syndrome [44], miscarriage [45, 46], and preterm labor [37, 35, 40, 47,48,49].

Restini LA de O, Dessordi R, Ferreira SMS, et al. Assessment of thyroid function, ioduria and oxidative stress in women in the first trimester of pregnancy. Nutr Hosp. 2018;35(6):1387–93. https://doi.org/10.20960/nh.1653.

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This comprehensive review systematically explores OS markers in pregnancy, shedding light on their significance in both normal physiological conditions and various pathological states. In normal pregnancies, OS markers such as MDA, 8-OHdG and TBARS exhibit elevated levels, indicating an essential increase in oxidative load to support physiological processes [16, 50, 61, 63,64,65,66].

López-Tinoco C, Roca M, García-Valero A, et al. Oxidative stress and antioxidant status in patients with late-onset gestational diabetes mellitus. Acta Diabetol. 2013;50(2):201–8. https://doi.org/10.1007/s00592-011-0264-2.

In the fifth study, [62] focused on 8-OHdG and dROM. Both markers demonstrated significant rises in IUGR compared to normal pregnancy conditions [64]. In the sixth study, [71] assessed F2α-Isoprostavne, unveiled a significant increase in cases compared to controls [82]. In the seventh study, [26] measured MDA, The results emphasize its significant increase in IUGR compared to normal pregnancy conditions [26]. In the eighth study, Zhang et al. 2023 measured 8-OHdG, revealing a significant elevation, particularly in cases of IUGR [52]. Finally, In the ninth study, [21] assessed MDA and XO. Both markers demonstrated significant increases in cases of IUGR [21], underscoring the pervasive influence of oxidative stress in the context of IUGR.

Schneider D, Hernández C, Farías M, Uauy R, Krause BJ, Casanello P. Oxidative stress as common trait of endothelial dysfunction in chorionic arteries from fetuses with IUGR and LGA. Placenta. 2015;36(5):552–8. https://doi.org/10.1016/j.placenta.2015.02.003.

Saroyo YB, Wibowo N, Irwinda R, et al. Oxidative stress induced damage and early senescence in preterm placenta. J Pregnancy. 2021;2021:9923761. https://doi.org/10.1155/2021/9923761.

Cakina S, Pek E, Ozkavak O, Kocyigit D, Beyazıt F. The role of paraoxonase and myeloperoxidase as oxidative stress markers in pregnant women with hypothyroidism. Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol. 2022;38(10):840–3. https://doi.org/10.1080/09513590.2022.2114449.

A comprehensive systematic search was undertaken by three independent reviewers across various medical and scientific databases, including MEDLINE, CINAHL (EBSCOhost), ScienceDirect, Web of Science, and SCOPUS, without limitations on publication year. The search strategy involved utilizing a combination of search terms and MeSH terms to comprehensively cover the topic of OS biomarkers in pregnancy. The combined terms used are: ((Pregnancy OR gestation OR “pregnant toxemia” OR obstetrics OR gynecology OR “gyn(a)ecology”) AND (“oxidative stress” OR biomarkers OR “total oxidative status” OR “total antioxidant capacity” OR “lipid peroxidation” OR peroxides OR “hydrogen peroxide”) AND (“malondialdehyde” OR malonaldehyde OR “thiobarbituric acid reactive substances” OR “protein carbonyls” OR “nitric oxide” OR “advanced oxidation protein products” OR “advanced glycation end products” OR “carboxymethyl-lysine”)) NOT ANIMALS NOT “genetic studies and several other related terms. The primary objective of this systematic search was to identify research papers that not only presented the parameters used to characterize OS and its markers but also explored the association between OS and pregnancy, along with pregnancy-related complications.

Ferreira RC, Fragoso MBT, Bueno NB, Goulart MOF, de Oliveira ACM. Oxidative stress markers in preeclamptic placentas: a systematic review with meta-analysis. Placenta. 2020;99:89–100. https://doi.org/10.1016/j.placenta.2020.07.023.

Menon R, Richardson LS. Preterm prelabor rupture of the membranes: a disease of the fetal membranes. Semin Perinatol. 2017;41(7):409–19. https://doi.org/10.1053/j.semperi.2017.07.012.

Stressmarkers in blood

Ibrahim, A., Khoo, M.I., Ismail, E.H.E. et al. Oxidative stress biomarkers in pregnancy: a systematic review. Reprod Biol Endocrinol 22, 93 (2024). https://doi.org/10.1186/s12958-024-01259-x

Eick SM, Ferguson KK, Milne GL, et al. Repeated measures of urinary oxidative stress biomarkers and preterm birth in Puerto Rico. Free Radic Biol Med. 2020;146:299–305. https://doi.org/10.1016/j.freeradbiomed.2019.11.003.

Biberoglu E, Biberoglu K, Kirbas A, et al. Circulating and myometrial markers of oxidative stress in pregnant women with fetal growth restriction. J Obstet Gynaecol Res. 2016;42(1):29–35. https://doi.org/10.1111/jog.12857.

Woods JR. Reactive oxygen species and preterm premature rupture of membranes-a review. Placenta. 2001;22(Suppl A):S38-44. https://doi.org/10.1053/plac.2001.0638.

Ferguson KK, McElrath TF, Chen YH, Loch-Caruso R, Mukherjee B, Meeker JD. Repeated measures of urinary oxidative stress biomarkers during pregnancy and preterm birth. Am J Obstet Gynecol. 2015;212(2):208.e1. https://doi.org/10.1016/j.ajog.2014.08.007.

Hung TH, Lo LM, Chiu TH, et al. Research findings indicate that various indicators of oxidative stress were observed to be elevated during the third trimester, including markers such as urinary 8-hydroxydeoxyguanosine (8-OHdG), plasma 8-isoprostane, total antioxidant capacity (TAC), and the activities of erythrocyte glutathione peroxidase (GPX) and superoxide dismutase (SOD). Subsequently, following. Reprod Sci Thousand Oaks Calif. 2010;17(4):401–9. https://doi.org/10.1177/1933719109359704.

After evaluating 54,173 records, 45 studies with a low risk of bias were selected for inclusion. This systematic review has underscored the importance of these markers in both physiological and pathological pregnancy states such as preeclampsia, intrauterine growth restrictions, preterm premature rupture of membranes, preterm labour, gestational diabetes mellitus and miscarriages.

Cuffe JS, Xu ZC, Perkins AV. Biomarkers of oxidative stress in pregnancy complications. Biomark Med. 2017;11(3):295–306. https://doi.org/10.2217/bmm-2016-0250.

Orhan H, Onderoglu L, Yücel A, Sahin G. Circulating biomarkers of oxidative stress in complicated pregnancies. Arch Gynecol Obstet. 2003;267(4):189–95. https://doi.org/10.1007/s00404-002-0319-2.

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In the seventh study Ahmed et al. 2019, focusing on SOD, GSH, and GSG, indicated significant increases in PE cases [69]. In the eighth study, Ferguson et al. 2015 analysed 8-isoprostane, which exhibited a notable increase in PE [78]. In the ninth study, Sikkema et al. 2001 homed in on SOD, showing a significant elevation in PE [8]. In the tenth study, Shigemitsu et al. 2016 investigated MDA and TBARS in the second and third trimesters of PE subjects, with a substantial increase, particularly in the third trimester [79]. And lastly. In the eleventh study, Godhamgaonkar and Joshi 2023 assessed MDA, and the results showed significant increase in the marker in PE patient as compared control group [80].

Ilhan N, Celik E, Kumbak B. Maternal plasma levels of interleukin-6, C-reactive protein, vitamins C, E and A, 8-isoprostane and oxidative status in women with preterm premature rupture of membranes. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2015;28(3):316–9. https://doi.org/10.3109/14767058.2014.916674.

Additionally, some studies only address the elevation of these markers during certain trimesters of pregnancy [46, 50,51,52,53] or postpartum [6, 54,55,56,57]. To address this existing research gap comprehensively, our systematic review aims to provide a comprehensive and detailed analysis of OS markers throughout pregnancy, thus offering a comprehensive overview of the subject.

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Shigemitsu A, Naruse K, Akasaka J, et al. Lipid oxidative stress and deposition markers for feto-maternal interaction in pregnancy. J Reprod Immunol. 2016;115:81. https://doi.org/10.1016/j.jri.2016.04.254.

In the context of GDM, research demonstrates significant increases in markers such as MDA, TAC, 8-isoPGF2alpha and advanced glycation end products (AGEs) compared to normal pregnancies. These findings suggest a potential role of oxidative stress in the pathogenesis of GDM and highlight the need for further exploration of specific markers [66, 71, 76, 86, 87].

The eligibility criteria for our systematic review were established to ensure a comprehensive and focused analysis of OS markers in pregnancy and pregnancy-related complications. Pregnant women were the target population of interest, and studies investigating OS markers in pregnancy and their association with pregnancy-related complications were included. A comparison between healthy pregnancies and high-risk pregnancies was considered where applicable. The primary outcomes of interest were levels of OS biomarkers, and included studies were required to present measures of central tendency (mean, median) and variability (standard deviation, interquartile range) for these biomarkers. Both interventional and observational studies were included to provide a comprehensive understanding of the topic, and studies conducted at healthcare institutions were included to ensure clinical relevance and applicability. Only full-text articles published in English were considered for inclusion. Animal experiments, studies with incomplete data on OS markers, genetic studies of antioxidant enzymes, and grey literature, including case series/reports, conference papers, proceedings, abstract-only articles, editorial reviews, letters of communication, and commentaries, were excluded to uphold the quality and reliability standards of included studies.

Rogers MS, Wang CCR, Tam WH, Li CY, Chu KO, Chu CY. Oxidative stress in midpregnancy as a predictor of gestational hypertension and pre-eclampsia. BJOG Int J Obstet Gynaecol. 2006;113(9):1053–9. https://doi.org/10.1111/j.1471-0528.2006.01026.x.

Women’s Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia

Conception and design: Nik Ahmad Zuky Nik Lah, Abu Bakar Ibrahim and Nik Hazlina Nik Hussain. Resource acquisition:  Abu Bakar Ibrahim, Martina Irwan Khoo and Engku Husna Engku Ismail. Manusript review:  Anani Aila Mat Zin, Liza Noordin, Sarimah Abdullah, and Zaleha Abdullah Mahdy providing critical feedback for intellectual enrichment. Final approval - Nik Ahmad Zuky Nik Lah, Nik Hazlina Nik Hussain anD Zaleha Abdullah Mahdy.

Hempstock J, Jauniaux E, Greenwold N, Burton GJ. The contribution of placental oxidative stress to early pregnancy failure. Hum Pathol. 2003;34(12):1265–75. https://doi.org/10.1016/j.humpath.2003.08.006.

Oxıdatıve stress (OS) biomarkers can be categorized into two groups: molecules that undergo modifications due to interactions with reactive oxygen species (ROS) within their surroundings, and molecules within the antioxidant system that alter in response to heightened redox stress [1]. OS markers in pregnancy refer to specific biological indicators or measurements that are used to assess the presence and extent of OS in pregnant individuals [2]. OS occurs when there is an imbalance between the production of reactive oxygen and nitrogen species (ROS and RNS) and the body’s ability to counteract their harmful effects through antioxidant defenses [3].

Jamilian M, Mansury S, Bahmani F, Heidar Z, Amirani E, Asemi Z. The effects of probiotic and selenium co-supplementation on parameters of mental health, hormonal profiles, and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome. J Ovarian Res. 2018;11(1):80. https://doi.org/10.1186/s13048-018-0457-1.

We retrieved all studies published in these databases from their beginning until October 22, 2023, to evaluate their suitability for inclusion in this research. Our search encompassed full-text articles in English language. To uncover more potentially suitable studies, we also examined the reference lists of the included citations. The detailed search terms used are listed in Table 1.

Zygula A, Kosinski P, Wroczynski P, et al. Oxidative stress markers differ in two placental dysfunction pathologies: pregnancy-induced hypertension and intrauterine growth restriction. Oxid Med Cell Longev. 2020;2020:1323891. https://doi.org/10.1155/2020/1323891.

Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia

Wang DP, Niu YY, Wang XQ, Jin ZA. Expression and role of anti-oxidative damage factors in the placenta of preterm infants with premature rupture of membranes. Zhongguo Dang Dai Er Ke Za Zhi Chin J Contemp Pediatr. 2022;24(1):71–7. https://doi.org/10.7499/j.issn.1008-8830.2108190.

Draganovic D, Lucic N, Jojic D. Oxidative stress marker and pregnancy induced hypertension. Med Arch Sarajevo Bosnia Herzeg. 2016;70(6):437–40. https://doi.org/10.5455/medarh.2016.70.437-440.

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Burton GJ, Watson AL, Hempstock J, Skepper JN, Jauniaux E. Uterine glands provide histiotrophic nutrition for the human fetus during the first trimester of pregnancy. J Clin Endocrinol Metab. 2002;87(6):2954–9. https://doi.org/10.1210/jcem.87.6.8563.

Vakilian K, Ranjbar A, Zarganjfard A, et al. On the relation of oxidative stress in delivery mode in pregnant women; a toxicological concern. Toxicol Mech Methods. 2009;19(2):94–9. https://doi.org/10.1080/15376510802232134.

Toy H, Camuzcuoglu H, Arioz DT, Kurt S, Celik H, Aksoy N. Serum prolidase activity and oxidative stress markers in pregnancies with intrauterine growth restricted infants. J Obstet Gynaecol Res. 2009;35(6):1047–53. https://doi.org/10.1111/j.1447-0756.2009.01063.x.

In the first study [68] conducted a comprehensive assessment of TOS, -SH, and TAC. The results unveiled a conspicuous upsurge in these markers [70]. The second study [20] focused on TOC and TAC. Its findings showcase a significant increase in these markers in cases compared to controls [20]. In the third study, [66] assessed MDA, a prominent marker within the OS realm, exhibiting a marked increase in IUGR cases [81]. In the fourth study, [66] measured MDA, CAT, XO, and SOD. Strikingly, these markers demonstrated substantial elevations within the context of IUGR [68].

Toescu V, Nuttall SL, Martin U, et al. Changes in plasma lipids and markers of oxidative stress in normal pregnancy and pregnancies complicated by diabetes. Clin Sci Lond Engl 1979. 2004;106(1):93–8. https://doi.org/10.1042/CS20030175.

Ferguson KK, Kamai EM, Cantonwine DE, Mukherjee B, Meeker JD, McElrath TF. Associations between repeated ultrasound measures of fetal growth and biomarkers of maternal oxidative stress and inflammation in pregnancy. Am J Reprod Immunol N Y N 1989. 2018;80(4):e13017. https://doi.org/10.1111/aji.13017.

For future researchers, a deeper exploration is warranted to identify the specific OS markers associated with these complications. Furthermore, unraveling the root causes that trigger heightened OS in these conditions is imperative. Such investigations will provide invaluable insights into the etiology and potential therapeutic interventions for these pregnancy-related diseases.

Burton GJ, Jauniaux E. Oxidative stress. Best Pract Res Clin Obstet Gynaecol. 2011;25(3):287–99. https://doi.org/10.1016/j.bpobgyn.2010.10.016.

A comprehensive electronic search using diverse search terms resulted in the retrieval of 54, 173 articles. Following the evaluation of their titles and abstracts, 53, 322 articles were eliminated. Subsequently, 851 articles were assessed for eligibility, with 146 of them undergoing further evaluation. In the end, 45 papers met the criteria and were included in the final review. This screening process for inclusion and eligibility was carried out by three independent reviewers. This systematic review encompassed various study designs, comprising 16 cross-sectional studies, 18 case-control studies and 11 cohort studies. The PRISMA flow chart (Fig. 1) illustrates the search process.