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Preeclampsia: Prevention

Author
Phyllis August, MD, MPH
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

Preeclampsia refers to a syndrome of new onset of hypertension and either proteinuria or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman (table 1). The syndrome is called superimposed preeclampsia when accelerating hypertension and either proteinuria or end-organ dysfunction develop after 20 weeks in a woman with preexisting (chronic) hypertension.

The pathogenesis of preeclampsia is incompletely understood, but the disorder is clearly initiated by the presence of trophoblast. Impaired remodeling of uterine spiral arteries, reduced placental perfusion, increased inflammation, increased production of anti-angiogenic factors, and maternal endothelial cell damage are hallmarks of the disorder. (See "Preeclampsia: Pathogenesis".)

Several preexisting maternal characteristics increase the risk of preeclampsia, including hypertension, chronic kidney disease, obesity, insulin resistance, diabetes, assisted reproduction, and a history of preeclampsia in a previous pregnancy, particularly if it occurred preterm (prior to 34 weeks gestation). Maternal genetic or acquired thrombophilias may also be risk factors for early, severe preeclampsia, although this literature is controversial. (See "Preeclampsia: Clinical features and diagnosis" and "Inherited thrombophilias in pregnancy" and "Pregnancy in women with antiphospholipid syndrome".)

Preeclampsia is a common cause of maternal and perinatal morbidity and mortality in both developed and developing countries. Early delivery is the only effective treatment, but necessitates preterm birth in many cases. Thus, an intervention that could prevent preeclampsia would have a significant impact on maternal and infant health worldwide. (See "Preeclampsia: Management and prognosis".)

Many different strategies to prevent preeclampsia have been investigated in randomized controlled trials, but none have been found to be widely effective. It is not surprising that these simple approaches have been unsuccessful, given the complexities in pathogenesis and the likelihood that multiple etiologies cause the syndrome even though the clinical manifestations of elevated blood pressure and proteinuria are common to most cases.

                             

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Literature review current through: Nov 2016. | This topic last updated: Wed Dec 07 00:00:00 GMT+00:00 2016.
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