Pre‐eclampsia and the cardiovascular–placental axis

The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre‐eclampsia: A pragmatic guide for first‐trimester screening and prevention

“…In late‐onset disease, placentation is usually normal; however, feto‐placental demands exceed supply, resulting in a placental response that triggers the clinical phenotype. Whilst the placenta certainly plays an essential role in the development of PE, there is a growing body of evidence that the maternal cardiovascular system may have a significant contribution to the disorder …”

Placental Syncytiotrophoblast-Derived Extracellular Vesicles Carry Active NEP (Neprilysin) and Are Increased in Preeclampsia

“…In PE the cardiovascular burden associated with hypertension and increased peripheral resistance, imposes extra changes such that 50% of these women develop left ventricular diastolic dysfunction and a further 20% biventricular systolic dysfunction and severe left ventricular hypertrophy [7]. Some researchers believe that this cardiac dysfunction induces changes in the placenta resulting in the PE syndrome [25]. Our data convincingly show that NEP signalling via the placenta is upregulated in PE; we hypothesise that increased NEP might contribute to the cardiac remodelling seen in PE, as has been suggested by NEP inhibition outside pregnancy [15].…”

Reply

“…We thank Dr Gonser for his appreciation of our systematic review and his support of the hypothesis that the commonality between uterine artery and ophthalmic artery Doppler waveforms is attributed to the fact that both indices reflect maternal cardiovascular function. There are now considerable new data which support the cardiovascular origin of pre‐eclampsia,. Although we agree that ophthalmic artery Doppler assessment may prove superior to uterine artery waveform analysis in screening and diagnosis of pre‐eclampsia, data are currently lacking to support this assertion 3 .…”