Preeclampsia

  • Allison L. Cohen
  • S. Ananth Karumanchi
Chapter
First Online:
Part of the Contemporary Diabetes book series (CDI)

Abstract

Preeclampsia is a syndrome of new-onset hypertension and proteinuria after 20-weeks gestation in a previously normotensive woman. Preeclampsia is a leading cause of maternal, fetal, and neonatal morbidity and mortality throughout the world. There are multiple risk factors for preeclampsia, including pregestational diabetes and obesity. Women with preeclampsia have an increased risk of recurrence in subsequent pregnancies and have an increased long-term risk of cardiovascular disease.

Although the etiology of preeclampsia is still unclear, recent studies have elucidated the pathophysiology underlying the disease. All of the clinical features of preeclampsia can be explained as a maternal response to placental-derived toxic factors that lead to generalized endothelial dysfunction. Recent evidence has shown alterations in angiogenic factors, including an increase in soluble fms-like tyrosine kinase 1 (sFlt-1), a naturally occurring circulating vascular endothelial growth factor (VEGF) antagonist, in women with preeclampsia. Soluble endoglin (sEng), a novel placenta-derived soluble anti-angiogenic protein appears to be another mediator of preeclampsia. Abnormalities in these circulating angiogenic proteins are not only present during clinical preeclampsia, but also antedate clinical symptoms by several weeks. There are also immunologic changes and changes in the renin-angiotensin system that may lead to the development of preeclampsia.

Women with pregestational diabetes have an increased risk of preeclampsia, especially those with underlying renal disease. It is especially difficult to diagnose preeclampsia in these women with underlying hypertension and proteinuria. In this chapter, we will discuss the epidemiology and the recent developments in the pathogenesis of preeclampsia. We will also highlight the contribution of pregestational diabetes in preeclampsia and discuss the long term of implications for maternal health in women with a history of preeclampsia.

Key words

Preeclampsia Vascular endothelial growth factor Soluble fms-like tyrosine kinase 1 receptor Placental like growth factor Endoglin Diabetes Proteinuria Angiogenesis Gestational hypertension 
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Notes

Acknowledgments

A.L.C. is funded by the Clinical Investigator Training Program: Beth Israel Deaconess Medical Center - Harvard/MIT Health Sciences and Technology, in collaboration with Pfizer Inc., and Merck & Co. S.A.K. is funded by R01 grants from the National Institute of Diabetes, Digestive and Kidney Diseases (DK 065997) and the National Heart, Lung, and Blood Institute (HL079594).

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Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Allison L. Cohen
    • 1
  • S. Ananth Karumanchi
  1. 1.Joslin Diabetes Center, One Joslin PlaceBostonUSA

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