Role of arterial impairment in preeclampsia: should the paradigm shift?

Am J Physiol Heart Circ Physiol. 2021 Apr 2. doi: 10.1152/ajpheart.01005.2020. Online ahead of print.ABSTRACTPreeclampsia is a worldwide pregnancy complication with serious short and long-term maternal and neonatal consequences. Our understanding of preeclampsia pathophysiology has significantly evolved over the last decades with the recognition that impaired arterial function and structure may occur early in the course of pregnancy, preceding the clinic-humoral syndrome and driving long-term cardiovascular disease risk in the future of these patients. Although an early abnormal placentation may be the inciting event for a large proportion of cases, there is growing evidence that challenges the placental hypothesis in all affected women, since placental histopathology lesions thought to be characteristic are neither sensitive nor specific markers for the disorder. Recent hemodynamic investigations and studies on left ventricular function and structure in women with preeclampsia further challenge this universal paradigm and propose that placental dysfunction could be secondary to a maternal cardiovascular maladaptation to pregnancy in certain patients. Supporting this hypothesis, certain vascular features, which are characteristically enhanced in normal pregnancy allowing a healthy vascular adaptation are absent in preeclampsia and comparable to the non-pregnant population. However, arterial biomechanics in preeclampsia may only not cope with hemodynamic demands of pregnancy, ...
Source: American Journal of Physiology. Heart and Circulatory Physiology - Category: Physiology Authors: Source Type: research