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Title: | Preeclampsia has two phenotypes which require different treatment strategies | Authors: | Masini, Giulia Foo, Lin F. Tay, Jasmine Wilkinson, Ian B. Valensise, Herbert GYSELAERS, Wilfried Lees, Christoph C. |
Issue Date: | 2022 | Publisher: | MOSBY-ELSEVIER | Source: | AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 226 (2) , p. S1006 -S1018 | Abstract: | The opinion on the mechanisms underlying the pathogenesis of preeclampsia still divides scientists and clinicians. This common complication of pregnancy has long been viewed as a disorder linked primarily to placental dysfunction, which is caused by abnormal trophoblast invasion, however, evidence from the previous two decades has triggered and supported a major shift in viewing preeclampsia as a condition that is caused by inherent maternal cardiovascular dysfunction, perhaps entirely independent of the placenta. In fact, abnormalities in the arterial and cardiac functions are evident from the early subclinical stages of preeclampsia and even before conception. Moving away from simply observing the peripheral blood pressure changes, studies on the central hemodynamics reveal two different mechanisms of cardiovascular dysfunction thought to be reflective of the early-onset and late-onset phenotypes of preeclampsia. More recent evidence identified that the underlying cardiovascular dysfunction in these phenotypes can be categorized according to the presence of coexisting fetal growth restriction instead of according to the gestational period at onset, the former being far more common at early gestational ages. The purpose of this review is to summarize the hemodynamic research observations for the two phenotypes of preeclampsia. We delineate the physiological hemodynamic changes that occur in normal pregnancy and those that are observed with the pathologic processes associated with preeclampsia. From this, we propose how the two phenotypes of preeclampsia could be managed to mitigate or redress the hemodynamic dysfunction, and we consider the implications for future research based on the current evidence. Maternal hemodynamic modifications throughout pregnancy can be recorded with simple-to-use, noninvasive devices in obstetrical settings, which require only basic training. This review includes a brief overview of the methodologies and techniques used to study hemodynamics and arterial function, specifically the noninvasive techniques that have been utilized in preeclampsia research. | Notes: | Lees, CC (corresponding author), Imperial Coll Healthcare, Queen Charlottes & Chelsea Hosp, Ctr Fetal Care, London, England.; Lees, CC (corresponding author), Imperial Coll London, Inst Reprod & Dev Biol, Dept Metab Digest & Reprod, London, England.; Lees, CC (corresponding author), Katholieke Univ Leuven, Dept Dev Regenerat, Leuven, Belgium. c.lees@imperial.ac.uk |
Keywords: | arterial function;blood pressure;cardiac output;cardiovascular function;fetal growth restriction;hemodynamics;hypertensive disease of pregnancy;preeclampsia;vascular resistance | Document URI: | http://hdl.handle.net/1942/37096 | ISSN: | 0002-9378 | e-ISSN: | 1097-6868 | DOI: | 10.1016/j.ajog.2020.10.052 | ISI #: | WOS:000759636700017 | Rights: | 2020 Elsevier Inc. All rights reserved. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2023 |
Appears in Collections: | Research publications |
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Preeclampsia has two phenotypes which require different treatment strategies.pdf Restricted Access | Published version | 1.68 MB | Adobe PDF | View/Open Request a copy |
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