Curr Hypertens Rep (2014) 16:491 DOI 10.1007/s11906-014-0491-3
PREECLAMPSIA (VD GAROVIC, SECTION EDITOR)
Prediction of Preeclampsia-Bench to Bedside Anjali Acharya & Wunnie Brima & Shivakanth Burugu & Tanvi Rege
Published online: 21 September 2014 # Springer Science+Business Media New York 2014
Abstract Hypertensive disorders of pregnancy (HDP) constitute the most common medical condition seen during gestation, effecting 1 in 10 pregnancies in the USA. Traditionally, preeclampsia (PE) is defined as a new onset of hypertension and either proteinuria or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman. Preeclampsia is a potentially life-threatening condition with widespread underlying endothelial dysfunction, and accompanying inflammation, vasoconstriction, and platelet activation. Women with preeclampsia are at an increased risk for life-threatening complications and progression to eclampsia. Worldwide, 10 to 15 % of maternal deaths are from preeclampsia and related complications. Traditionally, diagnosis of preeclampsia is made based upon presence of risk factors and clinical criteria. Diagnosis is challenging in asymptomatic women early in pregnancy as well as in nulliparous women as they lack obstetric history; however, it is well known that women with previous preeclampsia have a 14.7 % risk of the condition in the second pregnancy. Prediction of those at risk and early diagnosis is crucial to enable close surveillance of high-risk women in order to improve maternal and fetal outcomes. There has been much advance in our understanding of the pathogenesis of PE and in the field of angiogenic markers. However, no one test meets the criteria for a good biomarker. A multiparametric approach appears to be optimal as we await
This article is part of the Topical Collection on Preeclampsia A. Acharya (*) : S. Burugu : T. Rege Nephrology Division, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA e-mail:
[email protected] W. Brima Albert Einstein College of Medicine, Bronx, NY 10461, USA
newer systems biology approaches to give us better insight into the pathogenesis of the disease. Keywords Preeclampsia . Early onset preeclampsia (EoPE) . Late onset preeclampsia (LoPE) . Systems biology . Multiparametric testing . Epigenetics
Introduction Hypertensive disorders of pregnancy (HDP) constitute the most common medical condition during gestation, impacting 1 in 10 pregnancies in the USA and a much higher number in the developing countries. The National High Blood Pressure Education Program of the NHLBI and the American College of Obstetricians and Gynecologists (ACOG) [1] classifies HDP into four major categories: preeclampsia/eclampsia, chronic hypertension, gestational hypertension, and preeclampsia superimposed upon chronic/preexisting hypertension. Hypertension in pregnancy is defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive woman [2]. Traditionally, preeclampsia (PE) is defined as a new onset of hypertension and either proteinuria or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman. Severe hypertension and signs/symptoms of end-organ injury are considered to be severe manifestations of the disease. In 2013, the American College of Obstetricians and Gynecologists (ACOG) removed proteinuria as an essential criterion for diagnosis of preeclampsia. Oliguria and fetal growth restriction were also removed as possible features of severe disease [1]. In patients with new onset hypertension without proteinuria, the new onset of any of the following is diagnostic of preeclampsia: platelet count 1.1 mg/dl or doubling of serum creatinine in the absence of other renal
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disease, liver transaminases at least twice the normal concentrations, pulmonary edema, and cerebral or visual symptoms [1]. Preeclampsia is a condition with widespread endothelial dysfunction, along with accompanying inflammation, vasoconstriction, and platelet activation. Women with preeclampsia are at an increased risk for life-threatening events, including placental abruption, acute kidney injury, cerebral hemorrhage, hepatic failure or rupture, pulmonary edema, disseminated intravascular coagulation, and progression to eclampsia. Worldwide, 10 to 15 % of maternal deaths are from preeclampsia and related complications [3]. In the USA, preeclampsia/ eclampsia is one of the four leading causes of maternal deaths [4]. PE can present as late onset (LoPE) after 34 weeks or early onset (EoPE) disease,
