EARLY AND LATE PREECLAMPSIA: PATHOBIOLOGY PARADIGMS AND CLINICAL PRACTICE


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Preeclampsia (PE) remains a leading cause of maternal and perinatal mortality and morbidity. The currently existing classifications of PE are restricted in their ability to stratify women by the risk of poor maternal outcomes. In the past decades, knowledge of the pathogenesis of PE has undergone drastic changes in view of extended ideas on the heterogeneous nature of this syndrome. Patients with PE present with a wide range of clinical manifestations of the syndrome in both the mother and fetus, which vary from their degree (moderate, severe) to duration. PE may manifest less (early-onset) and more (late-onset) than 34 weeks, during childbirth and postpartum. It is shown that early- and late-onset PE may have different pathophysiology. The former, unlike the latter, is generally accompanied by placental ischemia and fetal growth restriction. Late-onset PE is associated with low-grade chronic inflammation, higher body mass index, and insulin resistance. Within the context of personalized medicine, future lines for investigations dealing with the prediction and prevention of PE should be based on the identification and refinement of the subtypes of PE with regard to the influence of maternal constitutional factors to stratify patents, by using specific biomarkers.

Full Text

Restricted Access

About the authors

Z. S KHODZHAEVA

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: z_khodzhaeva@oparina4.ru

A. M KHOLIN

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: a_kholin@oparina4.ru

E. M VIKHLYAEVA

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: vikhlyaevae23@mail.ru

References

  1. Sibai B., Dekker G., Kupferminc M. Pre-eclampsia. Lancet. 2005; 365(9461): 785-99.
  2. Tranquilli A.L. Introduction to ISSHP new classification of preeclampsia. Pregnancy Hypertens. 2013; 3: 57-61.
  3. Duley L. The global impact of pre-eclampsia and eclampsia. Semin. Perinatol. 2009; 33(3): 130-7.
  4. Trogstad L., Magnus P., Stoltenberg C. Pre-eclampsia: Risk factors and causal models. Best Pract. Res. Clin. Obstet. Gynaecol. 2011; 25(3): 329-42.
  5. Steegers E. A., von Dadelszen P., Duvekot J.J., Pijnenborg R. Pre-eclampsia. Lancet. 2010; 376(9741): 631-44.
  6. Roberts J.M., Bell M.J. If we know so much about preeclampsia. why haven’t we cured the disease? J. Reprod. Immunol. 2013; 99(1-2): 1-9.
  7. Romero R. Prenatal medicine: the child is the father of the man. 1996. J. Matern. Fetal Neonatal Med. 2009; 22(8): 636-9.
  8. Brosens I., Pijnenborg R., Vercruysse L., Romero R. The “Great Obstetrical Syndromes” are associated with disorders of deep placentation. Am. J. Obstet. Gynecol. 2011; 204(3): 193-201.
  9. Di Renzo G.C. The great obstetrical syndromes. J. Matern. Fetal Neonatal Med. 2009; 22(8): 633-5.
  10. Eastabrook G., Brown M., Sargent I. The origins and endorgan consequence of pre-eclampsia. Best Pract. Res. Clin. Obstet. Gynaecol. 2011; 25(4): 435-47.
  11. Maynard S.E., Karumanchi S.A. Angiogenic factors and preeclampsia. Semin. Nephrol. 2011; 31(1): 33-46.
  12. Shamshirsaz A.A., Paidas M., Krikun G. Preeclampsia, hypoxia, thrombosis, and inflammation. J. Pregnancy. 2012; 2012: 374047.
  13. Roberts J.M., Hubel C.A. The two stage model of preeclampsia: variations on the theme. Placenta. 2009; 30 (Suppl. A): S32-7.
  14. Redman C.W., Sargent I.L. Immunology of pre-eclampsia. Am. J. Reprod. Immunol. 2010; 63(6): 534-43.
  15. Oudejans C.B., van Dijk M. Placental gene expression and preeclampsia. Placenta. 2008; 29(Suppl. A): S78-82.
  16. Ferrazzi E., Rigano S., Padoan A., Boito S., Pennati G., Galan H.L. Uterine artery blood flow volume in pregnant women with an abnormal pulsatility index of the uterine arteries delivering normal or intrauterine growth restricted newborns. Placenta. 2011; 32(7): 487-92.
  17. Alfirevic Z., Stampalija T., Gyte G.M. Fetal and umbilical Doppler ultrasound in normal pregnancy. Cochrane Database Syst. Rev. 2010; (8): CD001450.
  18. Burton G.J., Woods A.W., Jauniaux E., Kingdom J.C. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta. 2009; 30(6): 473-82.
  19. Sohlberg S., Stephansson O., Cnattingius S., Wikstrom A.K. Maternal body mass index, height, and risks of preeclampsia. Am. J. Hypertens. 2012; 25(1): 120-5.
  20. Crispi F., Llurba E., Dominguez C., Martin-Gallan P., Cabero L., Gratacos E. Predictive value of angiogenic factors and uterine artery Doppler for early- versus late-onset preeclampsia and intrauterine growth restriction. Ultrasound Obstet. Gynecol. 2008; 31(3): 303-9.
  21. Khan K.S., Wojdyla D., Say L., Gülmezoglu A.M., Van Look P.F. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006; 367(9516): 1066-74.
  22. Mbah A. K., Kornosky J.L., Kristensen S., August E.M., Alio A.P., Marty P.J. et al. Super-obesity and risk for early and late pre-eclampsia. Br. J. Obstet. Gynaecol. 2010; 117(8): 997-1004.
  23. Brantsaeter A.L., Myhre R., Haugen M., Myking S., Sengpiel V., Magnus P. et al. Intake of probiotic food and risk of preeclampsia in primiparous women: the Norwegian Mother and Child Cohort Study. Am. J. Epidemiol. 2011; 174(7): 807-15.
  24. Wood L.E. Obesity, waist-hip ratio and hunter-gatherers. Br. J. Obstet. Gynaecol. 2006; 113(10): 1110-6.
  25. Valensise H., Vasapollo B., Gagliardi G., Novelli G.P. Early and late preeclampsia: two different maternal hemodynamic states in the latent phase of the disease. Hypertension. 2008; 52(5): 873-80.
  26. Wikstrom A.K., Nash P., Eriksson U.J., Olovsson M.H. Evidence of increased oxidative stress and a change in the plasminogen activator inhibitor (PAI)-1 to PAI-2 ratio in early-onset but not late-onset preeclampsia. Am. J. Obstet. Gynecol. 2009; 201(6): 597; e591-8.
  27. Gupta A.K., Gebhardt S., Hillermann R., Holzgreve W., Hahn S. Analysis of plasma elastase levels in early and late onset preeclampsia. Arch. Gynecol. Obstet. 2006; 273(4): 239-42.
  28. Vaisbuch E., Mazaki-Tovi S., Kusanovic J.P., Erez O., Than N.G., Kim S.K. et al. Retinol binding protein 4: an adipokine associated with intra-amniotic infection/inflammation. J. Matern. Fetal Neonatal Med. 2010; 23(2): 111-9.
  29. Masuyama H., Segawa T., Sumida Y., Masumoto A., Inoue S., Akahori Y., Hiramatsu Y. Different profiles of circulating angiogenic factors and adipocytokines between early- and late-onset pre-eclampsia. Br. J. Obstet. Gynaecol. 2010; 117(3): 314-20.
  30. Kusanovic J.P., Romero R., Chaiworapongsa T., Erez O., Mittal P., Vaisbuch E. et al. A prospective cohort study of the value of maternal plasma concentrations of angiogenic and anti-angiogenic factors in early pregnancy and midtrimester in the identification of patients destined to develop preeclampsia. J. Matern. Fetal Neonatal Med. 2009; 22(11): 1021-38.
  31. Odibo A.O., Zhong Y., Goetzinger K.R., Odibo L., Bick J.L., Bower C.R., Nelson D.M. First-trimester placental protein 13, PAPP-A ,uterine artery Doppler and maternal characteristics in the prediction of pre-eclampsia. Placenta. 2011; 32(8): 598-602.
  32. Van der Merwe J.L., Hall D.R., Wright C., Schubert P., Grove D. Are early and late preeclampsia distinct subclasses of the disease--what does the placenta reveal? Hypertens. Pregnancy. 2010; 29(4): 457-67.
  33. Vasapollo B., Novelli G.P., Gagliardi G., Tiralongo G.M., Pisani I., Manfellotto D. et al. Medical treatment of early-onset mild gestational hypertension reduces total peripheral vascular resistance and influences maternal and fetal complications. Ultrasound Obstet. Gynecol. 2012; 40(3): 325-31.
  34. Савельева Г.М. Эклампсия в современном акушерстве. Акушерство и гинекология. 2010; 6: 4-9.
  35. Tranquilli A.L., Landi B., Giannubilo S.R., Sibai B. Preeclampsia: No longer solely a pregnancy disease. Pregnancy Hypertens. 2012; 2: 350-7.
  36. Davis E.F., Lazdam M., Lewandowski A.J., Worton S.A., Kelly B., Kenworthy Y. et al. Cardiovascular risk factors in children and young adults born to preeclamptic pregnancies: a systematic review. Pediatrics. 2012; 129(6): e1552-61.
  37. Пальцев М.А. Молекулярная медицина: достижения и перспективы. Актовая речь. М.: Медицина; 2009.
  38. Бодрова Т.А., Костюшев Д.С., Антонова Е.Н., Гнатенко Д.А., Бочарова М.О., Лопухин Ю.М., Пальцев М.А., Сучков С.В. Введение в предиктивно-превентивную медицину: опыт прошлого и реалии дня завтрашнего. Вестник Российской академии медицинских наук. 2013; 1: 58-64.
  39. Lambers M.J., Groeneveld E., Hoozemans D.A., Schats R., Homburg R., Lambalk C.B., Hompes P.G. Lower incidence of hypertensive complications during pregnancy in patients treated with low-dose aspirin during in vitro fertilization and early pregnancy. Hum. Reprod. 2009; 24(10): 2447-50
  40. Hossain N., Schatz F., Paidas M.J. Heparin and maternal fetal interface: why should it work to prevent pregnancy complications? Thromb. Res. 2009; 124(6): 653-5.
  41. Krause B., Sobrevia L., Casanello P. Epigenetics: new concepts of old phenomena in vascular physiology. Curr. Vasc. Pharmacol. 2009; 7(4): 513-20.
  42. Wu C.S., Nohr E.A., Bech B.H., Vestergaard M., Catov J.M., Olsen J. Health of children born to mothers who had preeclampsia: a population-based cohort study. Am. J. Obstet. Gynecol. 2009; 201(3): 269; e210.
  43. Oglaend B., Forman M.R., Romundstad P.R., Nilsen S.T., Vatten L.J. Blood pressure in early adolescence in the offspring of preeclamptic and normotensive pregnancies. J. Hypertens. 2009; 27(10): 2051-4.
  44. Nicholson J.K., Holmes E., Kinross J., Burcelin R., Gibson G., Jia W., Pettersson S. Host-gut microbiota metabolic interactions. Science. 2012; 336(6086): 1262-7.
  45. Maynard C.L., Elson C.O., Hatton R.D., Weaver C.T. Reciprocal interactions of the intestinal microbiota and immune system. Nature. 2012; 489(7415): 231-41.
  46. Bergen N.E., Jaddoe V.W., Timmermans S., Hofman A., Lindemans J., Russcher H. et al. Homocysteine and folate concentrations in early pregnancy and the risk of adverse pregnancy outcomes: the Generation R Study. Br. J. Obstet. Gynaecol. 2012; 119(6): 739-51.
  47. Lamkanfi M., Walle L.V., Kanneganti T.D. Deregulated inflammasome signaling in disease. Immunol. Rev. 2011; 243(1): 163-73.
  48. Sep S.J., Smits L.J., Prins M.H., Spaanderman M.E., Peeters L.L. Simple prepregnant prediction rule for recurrent early-onset hypertensive disease in pregnancy. Reprod. Sci. 2009; 16(1): 80-7.
  49. Blankley R.T., Gaskell S.J., Whetton A.D., Dive C., Baker P.N., Myers J.E. A proof-of-principle gel-free proteomics strategy for the identification of predictive biomarkers for the onset of preeclampsia. Br. J. Obstet. Gynaecol. 2009; 116(11): 1473-80.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2013 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies