Preeclampsia 2.0: The urgent need for new thinking

Area of Science:

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

Background:

• Preeclampsia is a pregnancy-specific syndrome characterized by hypertension and organ dysfunction.
• The etiology of preeclampsia remains unclear, with existing hypotheses failing to explain its full spectrum.
• Current understanding lacks insight into the syndrome's early developmental stages.

Purpose of the Study:

• To review and synthesize data from before or during the first trimester of pregnancy in women who later develop preeclampsia.
• To investigate early alterations in placental cells and tissues preceding clinical symptoms.
• To identify potential insights into the syndrome's pathophysiology.

Main Methods:

• Literature review focusing on studies conducted prior to or within the first trimester.
• Analysis of data from pregnancies that subsequently developed preeclampsia.
• Synthesis of findings related to placental cell and tissue changes.

Main Results:

• Alterations in the villous trophoblast are observable during and by the end of the first trimester.
• These changes occur across all types of preeclampsia.
• Evidence suggests early placental modifications precede the onset of clinical symptoms.

Conclusions:

• Early first-trimester placental changes are a consistent feature in women who develop preeclampsia.
• These findings provide a foundation for developing novel hypotheses on preeclampsia etiology.
• Further research into early placental development may elucidate the syndrome's diverse manifestations.