Maternal microvascular dysfunction during preeclamptic pregnancy

Author:

Stanhewicz Anna E.12,Nuckols Virginia R.1,Pierce Gary L.1234

Affiliation:

1. Department of Health and Human Physiology, University of Iowa, IA, U.S.A.

2. Fraternal Order of Eagles Diabetes Research Center, University of Iowa, IA, U.S.A.

3. Department of Internal Medicine, Division of Nephrology and Hypertension, University of Iowa, IA, U.S.A.

4. Abboud Cardiovascular Research Center, University of Iowa, IA, U.S.A.

Abstract

Abstract Preeclampsia is a hypertensive disorder of pregnancy effecting ∼5–8% of pregnancies in the United States, and ∼8 million pregnancies worldwide. Preeclampsia is clinically diagnosed after the 20th week of gestation and is characterized by new onset hypertension accompanied by proteinuria and/or thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. This broad definition emphasizes the heterogeneity of the clinical presentation of preeclampsia, but also underscores the role of the microvascular beds, specifically the renal, cerebral, and hepatic circulations, in the pathophysiology of the disease. While the diagnostic criteria for preeclampsia relies on the development of de novo hypertension and accompanying clinical symptoms after 20-week gestation, it is likely that subclinical dysfunction of the maternal microvascular beds occurs in parallel and may even precede the development of overt cardiovascular symptoms in these women. However, little is known about the physiology of the non-reproductive maternal microvascular beds during preeclampsia, and the mechanism(s) mediating microvascular dysfunction during preeclamptic pregnancy are largely unexplored in humans despite their integral role in the pathophysiology of the disease. Therefore, the purpose of this review is to provide a summary of the existing literature on maternal microvascular dysfunction during preeclamptic pregnancy by reviewing the functional evidence in humans, highlighting potential mechanisms, and providing recommendations for future work in this area.

Publisher

Portland Press Ltd.

Subject

General Medicine

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