Expert review: preeclampsia Type I and Type II

Area of Science:

• Reproductive biology and maternal-fetal medicine.
• Cardiovascular physiology and pathophysiology.
• Genomics and molecular biology.

Background:

• Preeclampsia pathogenesis involves complex interactions between maternal and fetal factors.
• The roles of the placenta and maternal cardiovascular system in preeclampsia are debated.
• Existing research highlights placental dysfunction and cardiovascular maladaptations.

Purpose of the Study:

• To propose an integrated model of preeclampsia development.
• To reconcile diverse preeclampsia phenotypes and their proposed origins.
• To define two distinct types of preeclampsia: Type I and Type II.

Main Methods:

• Development of an integrated cardiac-placental-fetal array model.
• Analysis of clinical phenotypes associated with each preeclampsia type.
• Single-cell transcriptomic survey of gene expression patterns.

Main Results:

• Type I preeclampsia: early onset, placental dysfunction, high vascular resistance, low cardiac output, often with fetal growth restriction.
• Type II preeclampsia: later onset, maternal cardiovascular intolerance, low vascular resistance, high cardiac output, potentially with fetal macrosomia.
• Molecular analysis revealed widespread gene dysregulation and imbalance in soluble fms-like tyrosine kinase-1 (sFLT1) and placental growth factor (PlGF), especially in Type I.

Conclusions:

• Preeclampsia can be classified into two distinct types based on pathophysiology and clinical presentation.
• This classification reconciles differing disease origins and phenotypes.
• Distinguishing between Type I and Type II preeclampsia can guide future research for targeted screening, prevention, and treatment.