Pre-eclampsia--still a disease of theories

Pre-eclampsia is still one of the leading causes of maternal and fetal morbidity and mortality. Despite active research for many decades, the etiology of this disorder exclusive to human pregnancy is an enigma. Recent evidence suggests there may be several underlying causes or predispositions leading to endothelial dysfunction and causing the signs of hypertension, proteinuria, and edema--findings that allow us to make the diagnosis of the "syndrome" of pre-eclampsia. It is obvious that a single mechanism responsible for the syndrome pre-eclampsia does not exist. Instead, several mechanisms can act together and even multiply each other. The search for the underlying cause of this disorder and for a clinical marker to predict which women will develop pre-eclampsia is ongoing, with its prevention being the ultimate goal.