Adolescent Preeclampsia: Pathological Drivers and Clinical Prevention

Abstract

Preeclampsia is an important cause of maternal and perinatal morbidity, especially in first-time pregnant adolescent women. Although prevention of preeclampsia has been attempted for many decades, effective intervention can only be achieved upon the full elucidation of the risk factors and mechanisms of disease. As the pathogenesis of preeclampsia during adolescence may differ from that in older women, preventive interventions should be tailored accordingly. During adolescence, 4 putative drivers of preeclampsia can be identified. First, uterine immaturity in very young teenagers is likely a major cause of defective deep placentation and adverse reproductive outcome, underscoring the importance of educational programs and public health initiatives focused on teen pregnancy prevention. Second, the association between adolescent obesity and preeclampsia merits further studies on the benefits of weight loss and dietary interventions to improve pregnancy outcome. Third, there is a need for greater awareness of the link between cardiovascular risk factors in young women and early-onset preeclampsia associated with atherosclerosis of the uteroplacental arteries. Finally, infrequent menstruations may prolong uterine immaturity because of lack of "menstrual preconditioning." This risk factor may be amenable to pharmacological/hormonal preconditioning prior to conception.

Placental bed research: II. Functional and immunological investigations of the placental bed

“…In their definition, Alnaes-Katjavivi et al 18 applied the criterion of !140 mm for identifying uteroplacental spiral arteries; this agrees with the findings in hysterectomy studies. 14 Placental bed biopsies: from myometrium till basal plate Half a century ago, 2 groups, in Jamaica and in Belgium, started taking placental bed biopsies using different techniques: the first group obtained the biopsies at the time of caesarean delivery and used a cervical biopsy forceps, 4 while the second group obtained biopsies transvaginally as well, at the time of manual removal of the placenta after vaginal delivery; they used a sharpened ovum forceps for obtaining a large biopsy from the placental bed area. 16 Because of the blind technique in obtaining the biopsy, confirmation of the origin through the identification of the decidua basalis of the placental bed is of…”

“…12,13 A new, very important finding is that these clinical disorders can have for the newborn long-term consequences going into adulthood, causing cardiovascular disease, obesity and diabetes in the offspring as well as an increased risk of premature death in the mother. 14…”

Long-Term Consequences of Placental Vascular Pathology on the Maternal and Offspring Cardiovascular Systems

“…Indeed, immunopathological involutions have been demonstrated across the arterial tree, including carotid arteries, iliac, and popliteal arteries [ 27 ] and it seems plausible that these complex abnormalities may occur also in the myometrial spiral arteries during postpartum [ 60 , 61 ].…”

Preeclampsia—a disorder of uterine “stretch?”

“…Finally, recent epidemiological studies have clearly demonstrated that the risk of preeclampsia is significantly higher in young adolescent than in adult women. 6 It is unlikely that this is regulated by any activation of uterorenal nerves and increase in renal cortical ischemia.…”

“…5 The optimal management of pregnant women with COVID-19 poses multiple challenges, ranging from screening for the virus on admission to labor and delivery, to management of the acutely ill parturient, anesthesia, and protection of healthcare personnel. 6 Although it was originally thought that pregnant women with COVID-19 were no more likely to develop severe morbidity or die, recent reports suggest that a subset may develop multiorgan failure and even die. Given that healthy pregnant women have evidence of increased generation of thrombin and a prothrombotic state, as well as increased intravascular inflammation that is exaggerated in the context of infection, such patients may be at an increased risk for thrombosis when affected by COVID-19.…”