1
IRUS Total
Downloads

Preeclampsia has two phenotypes which require different treatment strategies

File Description SizeFormat 
Expert Review on Preeclampsia 27102020 submitted.docxAccepted version1.94 MBMicrosoft WordView/Open
Title: Preeclampsia has two phenotypes which require different treatment strategies
Authors: Masini, G
Foo, LF
Tay, J
Wilkinson, IB
Valensise, H
Gyselaers, W
Lees, CC
Item Type: Journal Article
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.
Issue Date: 1-Feb-2022
Date of Acceptance: 31-Oct-2020
URI: http://hdl.handle.net/10044/1/97036
DOI: 10.1016/j.ajog.2020.10.052
ISSN: 0002-9378
Publisher: Elsevier BV
Start Page: S1006
End Page: S1018
Journal / Book Title: American Journal of Obstetrics and Gynecology
Volume: 226
Issue: 2, Suppl.
Copyright Statement: © 2020 Elsevier Inc. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Science & Technology
Life Sciences & Biomedicine
Obstetrics & Gynecology
arterial function
blood pressure
cardiac output
cardiovascular function
fetal growth restriction
hemodynamics
hypertensive disease of pregnancy
preeclampsia
vascular resistance
MATERNAL CARDIAC-FUNCTION
BASAL METABOLIC-RATE
GESTATIONAL HYPERTENSION
BLOOD-PRESSURE
CARDIOVASCULAR FUNCTION
VASCULAR-RESISTANCE
ARTERIAL STIFFNESS
GROWTH RESTRICTION
WORKING GROUP
BIRTH-WEIGHT
arterial function
blood pressure
cardiac output
cardiovascular function
fetal growth restriction
hemodynamics
hypertensive disease of pregnancy
preeclampsia
vascular resistance
Antihypertensive Agents
Blood Pressure
Cardiac Output
Endothelium, Vascular
Female
Fetal Growth Retardation
Heart Rate
Hemodynamics
Humans
Phenotype
Pre-Eclampsia
Pregnancy
Pulse Wave Analysis
Vascular Resistance
Endothelium, Vascular
Humans
Fetal Growth Retardation
Pre-Eclampsia
Antihypertensive Agents
Cardiac Output
Pregnancy
Blood Pressure
Heart Rate
Vascular Resistance
Phenotype
Female
Hemodynamics
Pulse Wave Analysis
Obstetrics & Reproductive Medicine
1114 Paediatrics and Reproductive Medicine
Publication Status: Published
Online Publication Date: 2021-06-10
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Faculty of Medicine



This item is licensed under a Creative Commons License Creative Commons