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Historical evolution of ideas on eclampsia/preeclampsia: A proposed optimistic view of preeclampsia
Pierre-Yves Robillard1, Gustaaf Dekker2, Gérard Chaouat3
1Service de Néonatologie. Centre Hospitalier Universitaire Sud Réunion, BP 350, 97448 Saint-Pierre Cedex, La Réunion, France; Centre d'Etudes Périnatales Océan Indien (CEPOI), Centre Hospitalier Universitaire Sud Réunion, BP 350, 97448 Saint-Pierre cedex, La Réunion, France.
Insights
Pre-eclampsia understanding has evolved from early descriptions of proteinuria and hypertension to recognizing it as a global endothelial disease. Distinguishing early-onset and late-onset forms highlights different underlying causes and risk factors.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Pathophysiology
Background:
- Pre-eclampsia, historically documented, has seen significant advancements in comprehension over centuries.
- Early observations focused on proteinuria and gestational hypertension in eclamptic women.
- Modern understanding includes trophoblastic invasion, immunological factors, and endothelial dysfunction.
Observation:
- The 1970s revealed the unique 'double' trophoblastic invasion in humans and proposed pre-eclampsia as a 'couple disease' involving immunological aspects.
- By the late 1980s, pre-eclampsia was identified as a systemic endothelial cell disease, encompassing conditions like HELLP syndrome and eclampsia.
- The late 1990s established a distinction between early-onset pre-eclampsia (EOP) and late-onset pre-eclampsia (LOP) based on gestational age.
Findings:
- EOP is primarily linked to implantation issues, while LOP is associated with pre-existing maternal conditions such as obesity, diabetes, and coagulopathies.
- LOP constitutes 90% of cases globally, predominantly in developed countries.
- Early-onset pre-eclampsia (EOP) presents a higher fatality rate, exceeding 30% in regions with young first-time mothers.
Implications:
- Understanding the distinct etiologies of EOP and LOP is crucial for targeted prevention and management strategies.
- Further research into potential common factors, such as inositol phospho glycans (P type), may elucidate the mechanisms of maternal endotheliosis in both forms.
- This evolving comprehension of pre-eclampsia necessitates a nuanced approach to patient care, considering diverse risk profiles and pathophysiological pathways.
Abstract:
Eclampsia (together with epilepsy) being the first disease ever written down since the beginning of writings in mankind 5000 years ago, we will make a brief presentation of the different major steps in comprehension of Pre-eclampsia. 1) 1840. Rayer, description of proteinuria in eclampsia, 2) 1897 Vaquez, discovery of gestational hypertension in eclamptic women, 3) In the 1970's, description of the "double" trophoblastic invasion existing only in humans (Brosens & Pijnenborg,), 4) between the 1970's and the 1990's, description of preeclampsia being a couple disease. The "paternity problem" (and therefore irruption of immunology), 5) at the end of the 1980's, a major step forward: Preeclampsia being a global endothelial cell disease (glomeruloendotheliosis, hepatic or cerebral endotheliosis, HELLP, eclampsia), inflammation (J.Roberts.C Redman, R Taylor), 6) End of the 1990's: Consensus for a distinction between early onset preeclampsia EOP and late onset LOP (34 weeks gestation), EOP being rather a problem of implantation of the trophoblast (and the placenta), LOP being rather a pre-existing maternal problem (obesity, diabetes, coagulopathies etc…). LOP is predominant everywhere on this planet, but enormously predominant in developed countries: 90% of cases. This feature is very different in countries where women have their first child very young (88% of world births), where the fatal EOP (early onset) occurs in more than 30% of cases. 7) What could be the common factor which could explain the maternal global endotheliosis in EOP and LOP? Discussion about the inositol phospho glycans P type.
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