Pathophysiology of Pre-Eclampsia-Two Theories of the Development of the Disease

Abstract

Pre-eclampsia (PE) continues to be a leading cause of maternal and fetal mortality and morbidity. While substantial progress has been made in understanding the pathomechanisms of PE, the pathophysiology of the disease is still not fully understood. While the "two-stage model" of the development of PE is the most widely accepted theory, stating that the placenta is the main source of the disease, there are some other pathophysiological models of PE. Among these other theories, the one considering heart dysfunction as serving as the primary cause of PE seems to be gaining increasing prominence. In this review, we aim to elucidate these two divergent concepts concerning the development of PE. Despite some differences in their proposed pathomechanisms, both theories share vital pathophysiological elements in common. A central and critical component in both models is impaired placental perfusion, which appears to be a crucial phenomenon in PE. A comprehensive understanding of the different pathomechanisms involved in PE may be helpful in clinical practice, prompting a more individual approach to care of patients with PE.

Keywords: anti-angiogenic factors; cardiovascular impairment; echocardiography; placenta; placental growth factor; pre-eclampsia.

Figure 1

The physiological process of trophoblast invasion and remodeling of spiral arteries. Own authorship, created with Biorender.com (accessed on 23 November 2023).

Figure 2

Abnormal placentation as a result of impaired trophoblast invasion. Own authorship, created with Biorender.com (accessed on 23 November 2023).

Figure 3

The second stage of pre-eclampsia—mechanisms of endothelial injury. Abbreviations: ROS—reactive oxygen species, sEng—soluble endoglin, sFlt-1—soluble fms-like tyrosine kinase 1, STMB—syncytiotrophoblast microparticles, VEGF—vascular endothelial growth factor. Own authorship, created with Biorender.com (accessed on 23 November 2023).

Figure 4

Pre-eclampsia as a result of maladaptation of the maternal cardiovascular system. Abbreviations: ApoA1—apolipoprotein A1, ApoB—apolipoprotein B, ApoE—apolipoprotein E, HDL—high-density lipoprotein, MRI—magnetic resonance imaging, PE—pre-eclampsia, TGs—triglycerides. Own authorship, created with Biorender.com (accessed on 18 December 2023).