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Diferencias Clínicas y Moleculares de los Trastornos Hipertensivos del Embarazo

Mariko Horii^1,2,3, Robert Morey^1,2,3, Jennifer N Chousal^1,2,3

¹Department of Pathology, University of California San Diego, La Jolla(M.H., R.M., J.N.C., M.M., O.A.).

Arteriosclerosis, thrombosis, and vascular biology

|December 30, 2025

Resumen

Los trastornos hipertensivos del embarazo, incluida la preeclampsia, son afecciones distintas de la hipertensión gestacional, no simplemente etapas de gravedad. La malperfusión vascular materna diferencia los subtipos de preeclampsia, lo que sugiere una divergencia temprana en el embarazo.

Área de la Ciencia:

Obstetricia y Ginecología
Medicina Perinatal
Biología Reproductiva

Sus antecedentes:

Los trastornos hipertensivos del embarazo (HDP) incluyen la hipertensión crónica (cHTN), la hipertensión gestacional (gHTN), la preeclampsia y la preeclampsia sobreimpuesta (siPE).
Existen estudios comparativos limitados sobre las características clínicas y moleculares detalladas que diferencian los subtipos de HDP.
Este estudio evalúa los subtipos de HDP utilizando datos clínicos, histopatológicos placentarios y moleculares.

Objetivo del estudio:

Comparar las características clínicas, histopatológicas placentarias y moleculares de los diferentes subtipos de trastornos hipertensivos del embarazo.
Investigar las posibles distinciones y relaciones moleculares entre los subtipos de HDP.
Determinar si la preeclampsia representa una etapa avanzada de otros trastornos hipertensivos o una condición distinta.

Principales métodos:

Se utilizó una cohorte de embarazo de 10 años con datos clínicos, patología placentaria y secuenciación de ARN de tejido placentario.
Se empleó un diseño anidado de casos y controles para el análisis comparativo.
Se aplicaron los criterios actuales del ACOG para el diagnóstico clínico y la declaración de consenso de Ámsterdam para el examen placentario.

Principales resultados:

La hipertensión crónica y la hipertensión gestacional mostraron una patología placentaria normal, a diferencia de la preeclampsia y la siPE, que se enriquecieron en malperfusión vascular materna.
La secuenciación de ARN reveló distintas firmas de expresión génica y activaciones de vías en todos los subgrupos de HDP.
No hubo evidencia molecular que respaldara la preeclampsia como una etapa avanzada de otros trastornos hipertensivos; en cambio, se identificaron condiciones fisiopatológicas distintas.
La preeclampsia y la siPE compartieron perfiles de expresión génica cuando estuvo presente la malperfusión vascular materna.

Conclusiones:

La malperfusión vascular materna es un diferenciador clave para los embarazos que progresan a preeclampsia y siPE.
La cascada hacia la preeclampsia/siPE puede divergir tempranamente en el embarazo de la gHTN/cHTN, potencialmente vinculada a eventos de la gestación temprana.
La evaluación histopatológica placentaria es crucial para comprender la etiología de la HDP.

Palabras clave:

presión arterial obesidad placenta proteinuria transcriptoma

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