From the Guidelines
Preeclampsia is a pregnancy complication characterized by new-onset hypertension and proteinuria, resulting from abnormal placentation, placental ischemia, and oxidative stress, which triggers the release of anti-angiogenic factors, leading to endothelial dysfunction and clinical manifestations such as hypertension, proteinuria, and potential complications like HELLP syndrome and eclampsia. The primary mechanism involves abnormal placentation, where trophoblast cells fail to adequately invade and remodel maternal spiral arteries, leading to placental ischemia and oxidative stress 1. This placental dysfunction triggers the release of anti-angiogenic factors like soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), which antagonize vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) 1. The resulting endothelial dysfunction affects multiple organ systems, causing widespread vasoconstriction, increased vascular permeability, and activation of inflammatory and coagulation cascades.
Some key points to consider in the mechanisms of preeclampsia include:
- Abnormal placentation and placental ischemia
- Release of anti-angiogenic factors such as sFlt-1 and sEng
- Endothelial dysfunction and its effects on multiple organ systems
- Increased risk due to genetic predisposition, immunological factors, and pre-existing maternal conditions like chronic hypertension, diabetes, obesity, and autoimmune disorders
- Potential complications like HELLP syndrome, eclampsia, and placental abruption
The only definitive treatment is delivery of the placenta, though antihypertensive medications like labetalol, nifedipine, or methyldopa may be used to manage blood pressure, and magnesium sulfate can prevent eclamptic seizures 1. It is essential to prioritize the management of preeclampsia to minimize morbidity, mortality, and improve quality of life for both the mother and the offspring.
From the Research
Mechanisms of Pre-eclampsia
- Pre-eclampsia is a complex condition involving multiple mechanisms, including vascular endothelial dysfunction, coagulation disorders, and oxidative stress 2, 3.
- The condition is characterized by high blood pressure and proteinuria, which can lead to serious complications for both the mother and the fetus 4, 5.
- The exact causes of pre-eclampsia are not fully understood, but it is thought to involve a combination of genetic, environmental, and hormonal factors 6.
Treatment of Pre-eclampsia
- Magnesium sulfate is commonly used to treat pre-eclampsia, particularly in severe cases 4, 6.
- Labetalol is also used to treat high blood pressure in pre-eclampsia, and may be combined with magnesium sulfate for improved efficacy 4, 5, 2.
- Low-molecular-weight heparin calcium (LMWH) may also be used in combination with magnesium sulfate and labetalol to improve coagulation and vascular endothelial function 3.
Effects of Treatment on Disease-Related Molecules
- Treatment with magnesium sulfate, labetalol, and LMWH can reduce the levels of disease-related molecules such as soluble fms-like tyrosine kinase-1 (sFlt-1) and endothelin (ET-1) 5, 2, 3.
- These treatments can also increase the levels of beneficial molecules such as placental growth factor (PlGF) and nitric oxide (NO) 5, 2, 3.
- The sFlt-1/PlGF ratio may be a useful predictor of treatment efficacy in pre-eclampsia 2.
Pregnancy Outcomes and Adverse Effects
- Treatment with magnesium sulfate, labetalol, and LMWH can improve pregnancy outcomes and reduce the incidence of adverse effects such as respiratory distress syndrome and hypoglycemia in neonates 4, 3.
- However, these treatments can also have adverse effects, such as tachycardia, bradycardia, and intracranial hemorrhage in pregnant women 4.