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Prevention of preeclampsia

INTRODUCTION

Preeclampsia refers to a syndrome of new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman (table 1). The syndrome is called superimposed preeclampsia when accelerating hypertension and proteinuria develop after 20 weeks in a woman with preexisting 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 "Pathogenesis of preeclampsia".)

Several preexisting maternal characteristics increase the risk of preeclampsia, including hypertension, reduced renal function, obesity, insulin resistance, and diabetes. Maternal genetic or acquired thrombophilias are also risk factors for early, severe preeclampsia, although this literature is controversial. (See "Clinical features, diagnosis, and long-term prognosis of preeclampsia" and "Inherited thrombophilias in pregnancy" and "Obstetrical manifestations of the 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 "Management of preeclampsia".)

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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