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The pathophysiology of pre-eclampsia
Annemarie Hennessy1, Jolene Ng2, Angela Makris2
1Faculty of Health and Medicine, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia. Annemarie.hennessy@sydney.edu.au.
Nature Reviews. Nephrology
|May 22, 2026
Summary
Pre-eclampsia, a severe pregnancy complication, involves maternal endothelial dysfunction and placental toxins like soluble fms-like tyrosine kinase-1 (sFLT1). Understanding these pathways aids in developing prevention and treatment strategies for this condition.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Nephrology
Background:
- Pre-eclampsia is a major cause of maternal and neonatal morbidity and mortality.
- It is characterized by hypertension and proteinuria, stemming from maternal endothelial dysfunction in key organs.
- The placenta plays a critical role, with dysfunction leading to toxin release that exacerbates maternal disease.
Purpose of the Study:
- To review the pathophysiology of pre-eclampsia, focusing on maternal endothelial dysfunction and placental factors.
- To explore the role of toxins, such as soluble fms-like tyrosine kinase-1 (sFLT1), as biomarkers.
- To identify risk factors and understand disease presentation variations.
Main Methods:
- Literature review and synthesis of current research on pre-eclampsia.
- Analysis of pathophysiological mechanisms including endothelial dysfunction, placental factors, and inflammation.
- Examination of risk factors and their contribution to disease presentation.
Main Results:
- Maternal endothelial dysfunction in renal, hepatic, and cerebral vasculature underlies pre-eclampsia symptoms.
- A dysfunctional placenta releases toxins, including sFLT1, contributing to disease progression and serving as biomarkers.
- Risk factors like obesity, diabetes, and chronic hypertension influence disease presentation and severity.
Conclusions:
- Pre-eclampsia involves complex interactions between placental dysfunction and maternal endothelial health.
- Identifying underlying pathways and risk factors is crucial for developing targeted prevention and treatment strategies.
- Early pre-eclampsia may indicate pre-existing chronic kidney disease, highlighting the need for comprehensive maternal health assessment.
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