The perplexing pregnancy disorder preeclampsia: what next?

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Immunology

Background:

• Preeclampsia is a leading cause of maternal and infant mortality worldwide, affecting 3-5% of pregnancies.
• Historically defined by hypertension and proteinuria, its complex pathophysiology has only recently begun to be understood.
• Despite advances in understanding inflammatory activation, endothelial dysfunction, and placental factors, prediction and prevention remain challenging.

Purpose of the Study:

• To discuss the complexity of preeclampsia and the potential existence of distinct subtypes.
• To highlight the limitations in current prediction and prevention strategies.
• To advocate for enhanced collaboration and data sharing in preeclampsia research.

Main Methods:

• Review of immunological origins, placental dysfunction (endoplasmic reticulum stress, oxidative stress), and maternal factors.
• Analysis of clinical, fundamental, epidemiological, and animal experimental findings.
• Discussion of collaborative approaches, exemplified by the Global Pregnancy Collaboration.

Main Results:

• Preeclampsia is a complex multisystemic syndrome with potential subtypes, complicating prediction and prevention.
• Advances in understanding pathophysiology have not yet translated into improved clinical outcomes.
• The need for collaborative efforts in data and sample sharing is critical.

Conclusions:

• The complexity and potential heterogeneity of preeclampsia necessitate a re-evaluation of current research approaches.
• Enhanced collaboration and resource sharing are essential to overcome challenges in prediction and prevention.
• The Global Pregnancy Collaboration serves as a model for future multi-institutional research efforts.