Preeclampsia: Pathophysiology, Challenges, and Perspectives

Hypertensive disorders of pregnancy—chronic hypertension, gestational hypertension, and preeclampsia—are uniquely challenging as the pathology and its therapeutic management simultaneously affect mother and fetus, sometimes putting their well-being at odds with each other. Preeclampsia, in particula...

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Bibliographic Details
Published in:Circulation research 2019-03, Vol.124 (7), p.1094-1112
Main Authors: Rana, Sarosh, Lemoine, Elizabeth, Granger, Joey, Karumanchi, S Ananth
Format: Article
Language:English
Subjects:
Angiogenic Proteins - metabolism
Animals
Biomarkers - metabolism
Blood Pressure
Female
Humans
Intercellular Signaling Peptides and Proteins - metabolism
Oxidative Stress
Placenta - blood supply
Placenta - metabolism
Placentation
Pre-Eclampsia - metabolism
Pre-Eclampsia - mortality
Pre-Eclampsia - physiopathology
Pre-Eclampsia - therapy
Pregnancy
Pregnancy Outcome
Prognosis
Risk Factors
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Summary:Hypertensive disorders of pregnancy—chronic hypertension, gestational hypertension, and preeclampsia—are uniquely challenging as the pathology and its therapeutic management simultaneously affect mother and fetus, sometimes putting their well-being at odds with each other. Preeclampsia, in particular, is one of the most feared complications of pregnancy. Often presenting as new-onset hypertension and proteinuria during the third trimester, preeclampsia can progress rapidly to serious complications, including death of both mother and fetus. While the cause of preeclampsia is still debated, clinical and pathological studies suggest that the placenta is central to the pathogenesis of this syndrome. In this review, we will discuss the current evidence for the role of abnormal placentation and the role of placental factors such as the antiangiogenic factor, sFLT1 (soluble fms-like tyrosine kinase 1) in the pathogenesis of the maternal syndrome of preeclampsia. We will discuss angiogenic biomarker assays for disease-risk stratification and for the development of therapeutic strategies targeting the angiogenic pathway. Finally, we will review the substantial long-term cardiovascular and metabolic risks to mothers and children associated with gestational hypertensive disorders, in particular, preterm preeclampsia, and the need for an increased focus on interventional studies during the asymptomatic phase to delay the onset of cardiovascular disease in women.
ISSN:0009-7330
1524-4571
DOI:10.1161/CIRCRESAHA.118.313276