Pré-eclâmpsia-síndrome hipertensiva gestacional-uma revisão

Abstract

The identification of the exact etiology of pre-eclampsia (PE), one of the gestational hypertensive syndromes (GHS) remains unknown, making it necessary to understand its pathogenesis to guide the prophylactic control of long-term risk factors for both mother and fetus. PE is a complication of pregnancy characterized by hypertension (HTN-preg) and most often accompanied by proteinuria. In addition, it can lead to intrauterine growth restriction (IUCR) and prematurity at birth. PE is a disorder that affects 2-10% of pregnancies and plays a predominant role in mortality, perinatal and maternal morbidity, and its incidence suffers wide variability, a result of differences in the many different risk factors and predictors of pregnancy disorder around the world. The most significant risk factors from an epidemiological point of view are demographic, genetic, dietary, and environmental factors. They include moderate to high severity risk factors and shared risk factors; as well as diagnostic parameter analysis of maternal active circulating biomarkers. Demographic factors include maternal and paternal ethnicity and race, socioeconomic conditions, and education; dietary factors include diet based on macronutrients such as fats, proteins, and carbohydrates and micronutrients such as calcium and vitamins. Body weight- is a risk factor for morbid obesity. Genetic factors include variants in fetal genes from maternal and paternal genes, the maternal single nucleotide genetic polymorphisms (SNPs). Environmental factors are related to climate change, environmental pollutants such as air pollution, and also sedentary lifestyle (the lack of regular exercise). Moderate to high severity risk factors for the occurrence of PE include nulliparity, multifetal pregnancy or gestational interval longer than 10 years. And finally, shared risk factors, include maternal parity, history of PE, twin birth or twin pregnancy, chronic hypertension, maternal age, personal and family history, and obstetric history of the mother. Circulating biomarkers include antiangiogenic and angiogenic factors, cytokines, angiotensin, antibody receptors, and reactive oxygen species (ROS). In this sense, the purpose of this work was to describe the main mechanisms of dysregulation that accompany PE, such as abnormal trophoblast invasion of the placenta, antiangiogenic responses, oxidative stress, and inflammation. This included those of diagnoses, demographic factors, dietary factors genetic factors, environmental factors, moderate to high severity risk factors, shared risk factors, and maternal circulating biomarkers were included.