Etiopathogenesis of hypertension in pregnant women
More details
Hide details
Katedra i Klinika Ginekologii Endokrynologicznej, Wydział Lekarski w Katowicach Śląskiego Uniwersytetu Medycznego w Katowicach
Marta Maksym   

Katedra i Klinika Ginekologii Endokrynologicznej, Wydział Lekarski w Katowicach Śląskiego Uniwersytetu Medycznego w Katowicach, ul. Medyków 14, 40-752 Katowice, tel. +48 32 789 40 00
Ann. Acad. Med. Siles. 2015;69:69–75
Hypertension during pregnancy is one of the most severe complications of pregnancy and can cause materno-foetal morbidity and mortality. Research on preventing pregnancy-induced hypertension, preeclampsia and eclampsia has been gaining interest in recent years. However, due to the unknown etiology of these diseases, their prevention is currently not possible. The aim of this article is to explore current data on the etiopathogenesis of the aforementioned afflictions, as well as on the possibilities for their early diagnosis in pregnant women.
Kawecka-Jaszcz K., Lubaszewski W. Nadciśnienie tętnicze w ciąży. Przew. Lek. 2003; 1: 120–124.
Widecka K., Grodzicki T., Narkiewicz K., Tykarski A., Dziwura J. Zasady postępowania w nadciśnieniu tętniczym – 2011 rok. Wytyczne Polskiego Towarzystwa Nadcisnienia Tętniczego. Nadciśn. Tętn. 2011; 15: 55–82.
Oleszczuk J., Leszczyńska-Gorzelak B., Poniedziałek-Czajkowska E. Nadciśnienie tętnicze. Rekomendacje postępowania w najczęstszych powikłaniach ciąży i porodu. BiFolium Lublin 2006, s. 46–60.
Sibai B.M., Stella C.L. Diagnosis and management of atypical preeclampsia-eclampsia. Am. J. Obstet. Gynecol. 2009; 200: 481.e1–481.e7.
Ramin K.D. The prevention and management of eclampsia. Obstet. Gynecol. Clin. N. Am. 1999; 26: 489–503.
Rampersad R., Nelson D.M. Trophoblast biology, responses to hypoxia and placental dysfunction in preeclampsia. Front. Biosci. 2007; 12: 2447–2456.
Myatt L. Role of placenta in preeclampsia. Endocrine 2002; 19: 103–111.
Wang A., Rana S., Karumanchi S. Preeclampsia: The Role of Angiogenic Factors in Its Pathogenesis. Physiology 2009; 24: 147–158.
Chesley L., Cooper D. Genetics of hypertension in pregnancy: possible single gene control of pre‐eclampsia and eclampsia in the descendants of eclamptic women. Br. J. Obstet. Gynaecol. 1986; 93: 898–908.
Arngrimsson R., Björnsson S., Geirsson R.T., Björnsson H., Walker J.J., Snaedal G. Genetic and familial predisposition to eclampsia and pre‐eclampsia in a defined population. Br. J. Obstet. Gynaecol. 1990; 97: 762–769.
Lie R.T., Rasmussen S., Brunborg H., Gjessing H.K., Lie-Nielsen E., Irgens L.M. Fetal and maternal contributions to risk of pre-eclampsia: population based study. BMJ, 1998; 316: 1343–1347.
Roberts J.M., Cooper D.W. Pathogenesis and genetics of pre-eclampsia. Lancet 2001; 357: 53–56.
Seremak-Mrozikiewicz A. Ocena częstości występowania oraz znaczenia wybranych polimorfizmów genetycznych w grupie kobiet z nadciśnieniem indukowanym ciążą z regionu Wielkopolski. Ośrodek Wydawnictw Naukowych. Instytut Chemii Bioorganicznej. Polska Akademia Nauk 2005.
Kuśmierska-Urban K., Rytlewski K., Reroń A. Wybrane polimorfizmy genów układu renina–angiotensyna w patogenezie nadciśnienia w przebiegu ciąży. Ginekol. Pol. 2013; 84: 214–218.
Kosmas I., Tatsioni A., Ioannidis J. Association of Leiden mutation in factor V gene with hypertension in pregnancy and pre-eclampsia: a meta-analysis. J. Hypertens. 2003; 21: 1221–1228.
Hubel C.A., McLaughlin M.K., Evans R.W., Hauth B.A., Sims C.J., Roberts J.M. Fasting serum triglycerides, free fatty acids, and malondialdehyde are increased in preeclampsia, are positively correlated, and decrease within 48 hours post partum. Am. J. Obstet. Gynecol. 1996; 174: 975–982.
Kolben M., Lopens A., Blaser J. et al. Measuring the concentration of various plasma and placenta extract proteolytic and vascular factors in pregnant patients with HELLP syndrome, pre-/eclampsia and highly pathologic Doppler flow values. Gynakol. Geburtshilfliche Rundsch. 1995; 35 Suppl 1: 126–131.
Davidge S.T. Oxidative stress and altered endothelial cell function in preeclampsia. Semin. Reprod. Endocrinol. 1998; 16: 65–73.
Kharfi A., Giguere Y., Sapin V., Masse J., Dastugue B., Forest J.C. Trophoblastic remodeling in normal and preeclamptic pregnancies: implication of cytokines. Clin. Biochem. 2003; 36: 323–331.
Buhimschi I.A., Saade G.R., Chwalisz K., Garfield R.E. The nitric oxide pathway in preeclampsia: pathophysiological implications. Hum. Reprod. Update 1998; 4: 25–42.
Cameron I.T., van Papendorp C.L., Palmer R.M.J., Smith S.K., Moncada S. Relationship between nitric oxide synthesis and increase in systolic blood pressure in women with hypertension in pregnancy. Hypertension in Pregnancy 1993; 12: 85–92.
Dekker G.A., Sibai B.M. Etiology and pathogenesis of preeclampsia: current concepts. Am. J. Obstet. Gynecol. 1998; 179: 1359-1375.
Granger J.P., Alexander B.T., Llinas M.T., Bennett W.A., Khalil R.A. Pathophysiology of hypertension during preeclampsia linking placental ischemia with endothelial dysfunction. Hypertension 2001; 38: 718–722.
Friedman S.A. Preeclampsia: a review of the role of prostoglandinas. Obstet. Gynecol. 1988; 71: 122–137.
Myatt L., Webster R. Vascular biology of preeclampsia. J. Thromb. Haemost. 2009; 7: 375–384.
Hubel C.A. Oxidative Stress in the Pathogenesis of Preeclampsia. Proc. Soc. Exp. Biol. Med. 1999 222: 222–235.
Wang Y., Walsh S.W. Placental mitochondria as a source of oxidative stress in pre-eclampsia. Placenta 1998; 19: 581–586.
Warren J.S., Johnson K.J., Ward P.A. Oxygen radicals in cell injury and cell death. Pathol. Immunopathol. Res. 1987; 6: 301–315.
Valko M., Leibfritz D., Moncol J., Cronin M.T., Mazur M., Telser J. Free radicals and antioxidants in normal physiological functions and human disease. Int. J. Biochem. Cell. Biol. 2007; 39: 44–84.
Soleymanlou N., Wu Y., Wang J.X. et al. A novel Mtd splice isoform is responsible for trophoblast cell death in pre-eclampsia. Cell. Death. Differ. 2005; 12: 441–452.
Gratacós E., Casals E., Deulofeu R., Cararach V., Alonso P.L., Fortuny A. Lipid peroxide and vitamin E patterns in pregnant women with different types of hypertension in pregnancy. Am. J. Obstet. Gynecol. 1998; 178: 1072–1076.
Yoneyama Y., Sawa R., Suzuki S. et al. Relationship between plasma malondialdehyde levels and adenosine deaminase activities in preeclampsia. Clin. Chim. Acta. 2002; 322: 169–173.
Atamer Y., Kocyigit Y., Yokus B., Atamer A., Erden A.C. Lipid peroxidation, antioxidant defense, status of trace metals and leptin levels in preeclampsia. Eur. J. Obstet. Gynecol. Reprod. Biol. 2005; 119: 60–66.
Gupta S., Aziz N., Sekhon L. et al. Lipid peroxidation and antioxidant status in preeclampsia: a systematic review. Obstet. Gynecol. Surv. 2009; 64: 750–759.
Powe C.E., Levine R.J., Karumanchi S.A. Preeclampsia, a disease of the maternal endothelium: the role of antiangiogenic factors and implications for later cardiovascular disease. Circulation 2011; 123: 2856–2869.
Maynard S., Min J., Merchan J. et al. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J. Clin. Inves. 2003; 111: 649–658.
Venkatesha S., Toporsian M., Lam C. et al. Soluble endoglin contributes to the pathogenesis of preeclampsia. Nat. Med. 2006; 12: 642–649.
Akolelar R., Syngelaki A., Sarquis R., Zvanca M., Nicolaides K.H. Prediction of early, intermediate and late preeclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat. Diagn. 2011; 31: 66–74.
Poon L., Kametas N., Maiz N., Akolekar R., Nicolaides K.H. First-trimester predictiona of hypertensive disorders in pregnancy. Hypertension 2009; 53: 812–818.
Zeisler H., Livingston J.C., Schatten C. Serum level of adhesion molecules in woman with pregnancy induced hypertension. Wien. Klin. Wochenschr. 2001; 113: 588–593.
Matsubara K., Abe E., Ochi H., Kusanagi Y., Ito M. Changes in serum concentrations of tumor necrosis factor alpha and adhesion molecules in normal pregnant women and those with pregnancy-induced hypertension. J. Obstet. Gynaecol. Res. 2003; 29: 422–426.
Shah D.M. The role of RAS in the pathogenesis of preeclampsia. Curr. Hypertens. Rep. 2006; 8: 144–152.1.
AbdAlla S., Lother H., el Massiery A., Quitterer U. Increased AT(1) receptor heterodimers in preeclampsia mediate enhanced angiotensin II responsiveness. Nat. Med. 2001; 7: 1003–1009.
Gant N., Daley G., Chand S., Whalley P.J., MacDonald P.C. A study of angiotensin II pressor response throughout primigravid pregnancy. J. Clin. Invest. 1973; 52: 2682–2689.
Wallukat G., Homuth V., Fischer T. et al. Patients with preeclampsia develop agonistic autoantibodies against the angiotensin AT1 receptor. J. Clin. Invest. 1999; 103: 945–952.
Xia Y., Susan M.R., Kellems R.E. Potential roles of angiotensin receptor-activating autoantibody in the pathophysiology of preeclampsia. Hypertension 2007; 50: 269–275.
Evans K.N., Nguyen L., Chan J. et al. Effects of 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 on cytokine production by human decidual cells. Biol. Reprod. 2006; 75: 816–822.
Evans K.N., Bulmer J.N., Kilby M.D., Hewison M. Vitamin D and placental-decidual function. J. Soc. Gynecol. Investig. 2004; 11: 263–271.
Baker A.M., Haeri S., Camargo C.A. Jr, Espinola J.A., Stuebe A.M. A nested case-control study of midgestation vitamin D deficiency and risk of severe preeclampsia. J. Clin. Endocrinol. Metab. 2010; 95: 5105–5109.
Bodnar L.M., Catov J.M., Simhan H.N., Holick M.F., Powers R.W., Roberts J.M. Maternal vitamin D deficiency increases the risk of preeclampsia. J. Clin. Endocrinol. Metab. 2007; 92: 3517–3522.
Weinert L.S., Reichelt A.J., Schmitt L.R. et al. Serum Vitamin D Insufficiency Is Related to Blood Pressure in Diabetic Pregnancy. Am. J. Hypertens. 2014; 27: 1316–1320.
Burris H.H., Rifas-Shiman S.L., Huh S.Y. et al. Vitamin D status and hypertensive disorders in pregnancy. Ann. Epidemiol. 2014; 24: 399–403.
Estemberg D., Kowalska-Koprek U., Brzozowska M., Karowicz-Bilińska A. Przyrost masy ciała a zagrożenie wystąpieniem nadciśnienia w ciąży. Ginekol. Pol. 2008; 79: 616–620.
Poon L.C., Kametas N.A., Pandeva I., Valencia C., Nicolaides K.H. Mean arterial pressure at 11(_0) to 13(_6) weeks in the prediction of preeclampsia. Hypertension 2008; 51: 1027–1033.
Poon L., Karagiannis G., Leal A., Romero X.C., Nicolaides K.H. Hypertensive disorders in pregnancy: screening by uterine artery Doppler imaging and blood pressure at 11-13 weeks. Ultrasound Obstet. Gynecol. 2009; 34: 497–502.
Jašović-Siveska E., Jašović V. Prediction of mild and severe preeclampsia with blood pressure measurements in first and second trimester of pregnancy. Ginekol. Pol. 2011, 82, 845–850.
Kazimierak W., Kowalska-Koprek U., Karowicz-Bilińska A., Berner-Trąbska M., Lenczowska-Wężyk M., Brzozowska M. Ocena przydatności 24-godzinnego monitorowania ciśnienia tętniczego u ciężarnych metodą Holtera, dla poprawy efektów leczenia nadciśnienia tętniczego. Ginekol. Pol. 2008; 79: 174–176.
Plasencia W., Maiz N., Bonino S., Kaihura C., Nicolaides K.H. Uterine artery Doppler at 11_0 to 13_6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet. Gynecol. 2007; 30: 742–749.
Akolekar R., Syngelaki A., Poon L., Wright D., Nicolaides K.H. Competing risks model in early screening for preeclampsia by biophysical and biochemical markers. Fetal Diagn. Ther. 2012; 33: 8–15.
Kuc S., Wortelboer E.J., van Rijn B.B., Franx A., Visser G.H., Schielen P.C. Evaluation of 7 serum biomarkers and uterine artery Doppler ultrasound for first-trimester prediction of preeclampsia: a systematic review. Obstet. Gynecol. Surv. 2011; 66: 225–239.