Preeclampsia: Etiology, Pathophysiology, Risk Factors, Impact and Prevention: A Narrative Review
-
Musliha Mustary
,
Ansariadi .
,
Aminuddin Syam
,
Shanti Riskiyani
,
Kadek Ayu Erika
,
Apik Indarty Moedjiono
,
Mukhlis Lubis
Abstract
Background: Preeclampsia (PE) caused 30%-40% of maternal and newborn deaths worldwide. Despite unclear exact cause, strategies exist to mitigate less severe PE effects. This review explores PE etiology, pathophysiology, risk factors, impact, and prevention.
Methods: Searching Scopus, PubMed, ProQuest, Google Scholar, and Science Direct for “preeclampsia and pregnancy” and “prevention” yielded 2012–2022 articles.
Results: Preeclampsia features abnormal placental changes, altered immunity response, trophoblast apoptosis, and reduced uterine perfusion. Risk factors include hypertension history, nulliparity, age over 40, BMI over 35 kg/m², family history, amniotic pregnancy, and long pregnancy interval. This condition risks cardiovascular and neonatal morbidity, straining health resources. Prevention involves aspirin, vitamin D, exercise, folic acid, diet, early screening, and antenatal care.
Conclusion: Findings emphasize enhancing health literacy and preeclampsia education in prenatal care to mitigate PE risk among women. Further research, novel therapies, and assessing prevention strategies with accessible educational materials and multidisciplinary approaches are warranted to enhance pregnant women's health literacy and decrease PE risk.
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2. Mazloomi S, Khodadadi I, Alimohammadi S, et al (2021). Correlation of thioredoxin reductase (TrxR) and nitric oxide synthase (NOS) activities with serum trace elements in preeclampsia. Clin Exp Hypertens, 43(2): 120–4.
3. Rezai H, Ahmad S, Alzahrani FA, et al (2021). MZe786, a hydrogen sulfide-releasing aspirin prevents preeclampsia in heme oxygenase-1 haplodeficient pregnancy under high soluble flt-1 environment. Redox Biol, 38: 101768.
4. Chappell LC, Brocklehurst P, Green ME, et al (2019). Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. Lancet, 394 (10204): 1181–90.
5. Ortved D, Hawkins TLA, Johnson JA, et al (2019). Cost-effectiveness of first-trimester screening with early preventative use of aspirin in women at high risk of early-onset pre-eclampsia. Ultrasound Obstet Gynecol, 53(2) : 239–44.
6. Jhee JH, Lee S, Park Y, et al (2019). Prediction model development of late-onset preeclampsia using machine learning-based methods. PLoS One, 14 (8): e0221202.
7. MacDonald EJ, Lepine S, Pledger M, et al (2019). Pre‐eclampsia causing severe maternal morbidity – A national retrospective review of preventability and opportunities for improved care. Aust N Z J Obstet Gynaecol , 59(6): 825–30.
8. Tsigas EZ (2022). The Preeclampsia Foundation: the voice and views of the patient and her family. Am J Obstet Gynecol, 226 (2S): S1254-S1264.e1.
9. Osungbade KO, Ige OK (2011). Public Health Perspectives of Preeclampsia in Developing Countries: Implication for Health System Strengthening. J Pregnancy, 2011:481095.
10. Fox R, Kitt J, Leeson P, et al (2019). Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. J Clin Med, 8(10): 1625.
11. Stitterich N, Shepherd J, Koroma MM, et al (2021). Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study. BMC Pregnancy Childbirth, 21(1): 413.
12. Duhig KE, Myers J, Seed PT, et al (2019). Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial. Lancet, 393 (10183): 1807–18.
13. Inno R, Kikas T, Lillepea K, et al (2021). Coordinated Expressional Landscape of the Human Placental miRNome and Transcriptome. Front Cell Dev Biol, 9: 697947.
14. Wainstock T, Sergienko R, Sheiner E (2020). Who Is at Risk for Preeclampsia? Risk Factors for Developing Initial Preeclampsia in a Subsequent Pregnancy. J Clin Med, 9 (4): 1103.
15. Burton GJ, Redman CW, Roberts JM, et al (2019). Pre-eclampsia: pathophysiology and clinical implications. BMJ, 366:l2381.
16. Ghorbannejad S, MehdizadehTourzani Z, Kabir K, et al (2022). The effectiveness of Jacobson’s progressive muscle relaxation technique on maternal, fetal and neonatal outcomes in women with non-severe preeclampsia: a randomized clinical trial. Heliyon, 8 (6): e09709.
17. Rana S, Burke SD, Karumanchi SA (2022). Imbalances in circulating angiogenic factors in the pathophysiology of preeclampsia and related disorders. Am J Obstet Gynecol, 226 (2S): S1019–S1034.
18. Awamleh Z, Gloor GB, Han VKM (2019). Placental microRNAs in pregnancies with early onset intrauterine growth restriction and preeclampsia: Potential impact on gene expression and pathophysiology. BMC Med Genomics, 12 (1): 91.
19. Dugalic S, Petronijevic M, Stefanovic A, et al (2019). Comparison of 2 approaches in management of pregnant women with inherited trombophilias: Prospective analytical cohort study. Medicine (Baltimore), 98 (34): e16883.
20. Lane SL, Doyle AS, Bales ES, et al (2020). Increased uterine artery blood flow in hypoxic murine pregnancy is not sufficient to prevent fetal growth restriction. Biol Reprod, 102 (3): 660–70.
21. Kristensen JH, Basit S, Wohlfahrt J, et al (2019). Pre-eclampsia and risk of later kidney disease: Nationwide cohort study. BMJ, 365: l1516.
22. Than NG, Posta M, Györffy D, et al (2022). Early pathways, biomarkers, and four distinct molecular subclasses of preeclampsia: The intersection of clinical, pathological, and high-dimensional biology studies. Placenta, 125: 10–19.
23. Steinthorsdottir V, McGinnis R, Williams NO, et al (2020). Genetic predisposition to hypertension is associated with preeclampsia in European and Central Asian women. Nat Commun, 11 (1): 5976.
24. Hu XH, Li ZH, Muyayal KP (2022). A newly intervention strategy in preeclampsia: Targeting PD‐1/Tim‐3 signaling pathways to modulate the polarization of decidual macrophages. FASEB J, 36(1):e22073..
25. Aggarwal R, Jain AK, Mittal P, et al (2019). Association of pro- and anti-inflammatory cytokines in preeclampsia. J Clin Lab Anal, 33 (4): e22834.
26. Shraga Y, Pariente G, Rotem R, et al (2020). Changes in trends over time for the specific contribution of different risk factors for pre-eclampsia. Arch Gynecol Obstet, 302 (4): 977–82.
27. Lv LJ, Li SH, Li SC, et al (2019). Early-Onset Preeclampsia Is Associated With Gut Microbial Alterations in Antepartum and Postpartum Women. Front Cell Infect Microbiol, 9: 224.
28. Christoforaki V, Zafeiriou Z, Daskalakis G, et al (2020). First trimester neutrophil to lymphocyte ratio (NLR) and pregnancy outcome. J Obstet Gynaecol, 40 (1): 59–64.
29. Rana S, Lemoine E, Granger J, et al (2019). Preeclampsia: Pathophysiology, Challenges, and Perspectives. Circ Res, 124 (7): 1094–112.
30. Saif J, Ahmad S, Rezai H, Litvinova K, et al (2021). Hydrogen sulfide releasing molecule MZe786 inhibits soluble Flt-1 and prevents preeclampsia in a refined RUPP mouse model. Redox Biol, 38:101814.
31. Cerdeira AS, O’Sullivan J, Ohuma EO, et al (2019). Randomized Interventional Study on Prediction of Preeclampsia/Eclampsia in Women with Suspected Preeclampsia: INSPIRE. Hypertension, 74 (4): 983–90.
32. Brownfoot FC, Hannan NJ, Cannon P, et al (2019). Sulfasalazine reduces placental secretion of antiangiogenic factors, up-regulates the secretion of placental growth factor and rescues endothelial dysfunction. EBioMedicine, 41: 636–48.
33. Saleh L, Verdonk K, Visser W, et al (2016). The emerging role of endothelin-1 in the pathogenesis of pre-eclampsia., Ther Adv Cardiovasc Dis, 10 (5): 282–93.
34. Harris LK, Benagiano M, D’Elios MM, Brosens I, Benagiano G (2019). Placental bed research: II. Functional and immunological investigations of the placental bed. Am J Obstet Gynecol, 221(5):457–69.
35. Tamanna S, Clifton VL, Rae K, et al (2020). Angiotensin Converting Enzyme 2 (ACE2) in Pregnancy: Preeclampsia and Small for Gestational Age. Front Physiol, 11:590787.
36. Li JH, Wang LL, Liu H, et al (2019). Galectin-9 alleviates LPS-induced preeclampsia-like impairment in rats via switching decidual macrophage polarization to M2 subtype. Front Immunol, 9: 3142.
37. Negi M, Mulla MJ, Han CS, et al (2020). Allopurinol inhibits excess glucose-induced trophoblast IL-1β and ROS production. Reproduction, 159 (1): 73–80.
38. Chantanahom N, Phupong V (2021). Clinical risk factors for preeclampsia in twin pregnancies. Laganà AS, editor. PLoS One, 16 (4): e0249555.
39. Ngwenya S, Jones B, Mwembe D, et al (2021). Determinants of eclampsia in women with severe preeclampsia at Mpilo Central Hospital, Bulawayo, Zimbabwe. Pregnancy Hypertens, 25: 235–9.
40. Sharma S, Goyal M, Kumar PK, et al (2019). Association of raised blood lead levels in pregnant women with preeclampsia: A study at tertiary centre. Taiwan J Obstet Gynecol, 58 (1): 60–3.
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| Files | ||
| Issue | Vol 53 No 11 (2024) | |
| Section | Review Article(s) | |
| Keywords | ||
| Preeclampsia Etiology Risk factor Impact Prevention | ||
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How to Cite
1.
Mustary M, . A, Syam A, Riskiyani S, Ayu Erika K, Indarty Moedjiono A, Lubis M. Preeclampsia: Etiology, Pathophysiology, Risk Factors, Impact and Prevention: A Narrative Review. Iran J Public Health. 2024;53(11):2392-2403.
