Pathophysiology of preeclampsia: an angiogenic imbalance and long-lasting systemic vascular dysfunction

Abstract

Preeclampsia is a systemic vascular disorder characterized by new-onset hypertension and proteinuria after 20 weeks of gestation. This condition targets several organs, including the kidneys, liver and brain, and is the leading cause of maternal and perinatal morbidity and mortality. Furthermore, recent evidence has revealed preeclampsia as a significant risk factor for future cardiovascular diseases in these women. Over the past decade, increasing evidence has indicated that maternal angiogenic imbalances caused by placental antiangiogenic factors play a central role in the systemic vascular dysfunction underling preeclampsia. The severity of the maternal antiangiogenic state correlates closely with maternal and perinatal outcomes. Assessing angiogenic imbalance and several vascular function tests have also emerged as a way of detecting systemic vascular dysfunction during pregnancy. This review summarizes the current understanding of the pathophysiology of preeclampsia, its clinical applications and clinical evidence for future cardiovascular risks.

The prognostic role of serum uric acid levels in preeclampsia: A meta‐analysis

“…The pathophysiology of preeclampsia is complex and remains still under investigation. It is hypothesized that poor trophoblast invasion and deficient spiral artery remodeling lead to placental ischemia‐reperfusion injury 4 and the release of various angiogenic, 5 oxidative, 6 and inflammatory 7 mediators into maternal circulation, promoting generalized endothelial dysfunction, increased vascular reactivity, and activation of the coagulation cascade 8 . Risk stratification is essential in order to identify the subpopulation of pregnant women that would benefit from preventive measures early in the course of gestation, especially the administration of aspirin 9 .…”

Peripartum cardiomyopathy and hypertensive disorders of pregnancy and cardiovascular events among 1.6 million California pregnancies

“…Several lines of evidence suggest that a common pathology in many cases of preterm birth and IUGR, as well as subtypes of HDP and PPCM and HDP, is vascular dysfunction of varying chronicity and severity. (30-34) GDM is a risk factor for future diabetes and its attendant microvascular and macrovascular effects(35) which may explain the associations seen between GDM and stroke, as well as HF.…”

Factores de riesgo de preeclampsia, una actualización desde la medicina basada en evidencias

“…Una historia familiar de preeclampsia en un pariente de primer grado eleva el riesgo de preeclampsia (RR 2,90, IC del 95% 1,70 a 4,93) 15 lo que sugiere un mecanismo heredable en algunos casos sobre todo a partir de estudios de polimorfimos de genes claramente documentados como del Factor V de Leiden, el de los antígenos leucocitarios HLA, de las alteraciones NOS 3 del óxido nítrico endotelial, el angiotensinógeno y de la lipoproteinlipasa 18 . La aparición y la gravedad de la enfermedad parecen estar influenciadas principalmente por factores maternos, pero la contribución paterna a los genes fetales puede tener un papel en la placentación defectuosa y la preeclampsia posterior 19 .…”