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Etiology of preeclampsia: an update
1Department of Obstetrics and Gynaecology, University of Adelaide, Lyell McEwin Health Service, Haydown Road, Elizabeth Vale 5112, SA.
Abstract:
Preeclampsia still ranks as one of obstetrics major problems. Clinicians typically encounter preeclampsia as maternal disease with variable degrees of fetal involvement. More and more the unique immunogenetic maternal - paternal relationship is appreciated, and as such also the specific 'genetic conflict' that is characteristic of haemochorial placentation. Factors influencing the unique maternal-fetal (paternal) interaction probably include the length and type of sexual relationship, the maternal (decidual natural killer cells) acceptation of the invading cytotrophoblast (paternal HLA-C), and seminal levels of transforming growth factor-b and probably other cytokines. The magnitude of the maternal response would be determined by factors including a maternal set of genes determining her characteristic inflammatory responsiveness, age, quality of her endothelium, obesity/insulin resistance and probably a whole series of susceptibility genes amongst which the thrombophilias received a lot of attention in recent years.
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