Preeclampsia has two phenotypes which require different treatment strategies

Area of Science:

• Obstetrics and Gynecology
• Cardiovascular Physiology
• Reproductive Medicine

Background:

• Preeclampsia pathogenesis is debated, with a historical focus on placental dysfunction versus emerging evidence implicating inherent maternal cardiovascular dysfunction.
• Cardiovascular and arterial abnormalities in preeclampsia are detectable early, even before conception, suggesting a primary maternal etiology.
• Central hemodynamic studies reveal distinct cardiovascular dysfunction patterns, differentiating early-onset and late-onset preeclampsia phenotypes.

Purpose of the Study:

• To review hemodynamic research findings for the two identified preeclampsia phenotypes.
• To delineate normal pregnancy hemodynamic changes versus those in preeclampsia.
• To propose management strategies targeting hemodynamic dysfunction and discuss future research directions.

Main Methods:

• Review of existing hemodynamic research in preeclampsia.
• Focus on noninvasive techniques for assessing maternal hemodynamics and arterial function.
• Description of methodologies used in obstetrical settings with basic training requirements.

Main Results:

• Two distinct hemodynamic phenotypes of preeclampsia are identified, potentially linked to fetal growth restriction rather than gestational onset.
• Abnormalities in central hemodynamics characterize these phenotypes.
• Physiological hemodynamic changes in normal pregnancy contrast with pathological changes in preeclampsia.

Conclusions:

• Maternal cardiovascular dysfunction is a key factor in preeclampsia, with distinct hemodynamic profiles for different phenotypes.
• Noninvasive hemodynamic monitoring can be utilized in clinical obstetrics for preeclampsia assessment.
• Understanding these hemodynamic differences is crucial for targeted management and future research in preeclampsia.