Preeclampsia epidemiology(ies) and pathophysiology(ies)

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Cardiovascular and Neurological Health

Background:

• Preeclampsia/eclampsia has been recognized for 2000 years, with evolving diagnostic and pathophysiologic concepts.
• Historically viewed as a seizure disorder, it is now understood as a multisystemic inflammatory syndrome specific to pregnancy.
• Despite resolution of acute symptoms post-delivery, preeclampsia increases long-term cardiovascular and neurological disease risks in affected women.

Purpose of the Study:

• To review the historical evolution of preeclampsia concepts.
• To highlight the extended impact of preeclampsia beyond pregnancy.
• To propose a framework for future research based on the syndrome's heterogeneity.

Main Methods:

• Literature review and synthesis of historical and current understanding of preeclampsia.
• Analysis of diagnostic criteria and pathophysiological concepts over time.
• Examination of the long-term health consequences of preeclampsia.

Main Results:

• Preeclampsia concepts have shifted from a seizure disorder to a complex, multisystemic inflammatory syndrome.
• Delivery resolves acute findings, but long-term risks for cardiovascular and neurological diseases persist.
• Emerging data suggest multiple pathophysiological pathways, indicating preeclampsia is a syndrome with potential subtypes.

Conclusions:

• Understanding preeclampsia as a syndrome with diverse underlying pathways is critical.
• The heterogeneity of preeclampsia likely explains the limited success in prediction and prevention.
• Future research should focus on identifying and characterizing distinct preeclampsia subtypes to guide targeted interventions.