From the Guidelines
Preeclampsia Causes
Preeclampsia is a complex condition and its exact cause is not fully understood, but it is believed to be related to abnormal placental development, leading to high blood pressure and damage to organs such as the kidneys and liver 1.
Key Factors
The following key factors are thought to contribute to the development of preeclampsia:
- Placental ischemia: poor remodeling of the spiral arteries, leading to reduced uteroplacental perfusion 1
- Abnormal immune system activation: autoimmune activation of the renin-angiotensin system, complement activation 1
- Angiogenic imbalance: elevated soluble fms-like tyrosine kinase 1 (sFlt-1), reduced placental growth factor (PlGF), and vascular endothelial growth factor 1
- Metabolic dysfunction: not mutually exclusive 1
Risk Factors
Risk factors that may contribute to the development of pre-eclampsia include:
- A history of high blood pressure, kidney disease, or autoimmune disorders, as well as certain genetic predispositions 1
- Women who are pregnant with multiple fetuses, have a history of pre-eclampsia in a previous pregnancy, or are over the age of 35 may also be at increased risk 1
Prevention and Management
In terms of prevention, low-dose aspirin, 81mg daily, starting at 12-28 weeks of gestation, may be recommended for women at high risk of developing pre-eclampsia 1. Close monitoring of blood pressure and urine protein levels is essential for early detection and management of pre-eclampsia. If pre-eclampsia is diagnosed, treatment may involve bed rest, medication to lower blood pressure, and in severe cases, hospitalization and delivery of the baby.
From the Research
Causes of Preeclampsia
Preeclampsia is a complex condition caused by various factors, processes, and pathways. The underlying causes of preeclampsia are not fully understood, but several studies have identified potential contributing factors, including:
- Reduced blood flow and oxygen to the uterus and placenta 2
- Heightened inflammatory reactions 2, 3
- Immune imbalances 2, 3, 4
- Altered genetic changes 2
- Imbalanced blood vessel growth factors 2, 5, 6
- Disrupted gut bacteria 2
- Vascular dysfunction, including impaired placentation, incomplete spiral artery remodeling, and endothelial damage 3, 5, 6
- Autoantibodies to type-1 angiotensin II receptor, platelet and thrombin activation, intravascular inflammation, and endothelial dysfunction 5
- An imbalance of angiogenesis, which can lead to an antiangiogenic state 5, 6
Pathogenesis of Preeclampsia
The pathogenesis of preeclampsia is still not clear, but it is believed to involve abnormal spiral artery remodeling, placental ischemia, and a resulting increase in the circulating levels of vascular endothelial growth factor receptor-1 (VEGFR-1) or soluble fms-like tyrosine kinase-1 (sFlt-1) 6. The increase in sFlt-1 may fulfill critical protective functions in preeclamptic pregnancies, but it also has pathogenic effects on the maternal vasculature 6.
Autoimmune Nature of Preeclampsia
Preeclampsia-eclampsia (PE-E) is characterized by many features typically seen in autoimmune diseases, or in association with autoimmune reactions 4. Although this does not mean that PE-E should be considered an autoimmune condition, it does suggest that abnormal autoimmune processes play an important part in the clinical presentation of PE-E 4.