Recognizing Subtypes of Preeclampsia and Its Clinical Usefulness
Preeclampsia May Not Look the Same for Every Patient
Our understanding of how preeclampsia develops and changes across pregnancy has grown, including the contributions of inflammation, oxidative stress, and blood vessel health. Yet, our ability to prevent and predict preeclampsia has made much less progress. Authors of this paper suggest that one reason for this may be that not all cases or outcomes of preeclampsia are the same and that preeclampsia is not just one disorder. There is increasing attention now on possible subtypes for preeclampsia, recognizing that 1) preeclampsia has different presentations and outcomes 2) there is a wide range in risk factors for preeclampsia, and 3) fetal effects like growth restriction/low birthweight are not present in all cases. For the field of preeclampsia to move forward, work should be done to define clear and useful subtypes with the following criteria: 1) each preeclampsia subtype should develop during pregnancy in a particular way, perhaps with maternal symptoms appearing in a predictable order when there is a risk factor, or should result in a specific maternal or fetal outcome (like delivery before 34 weeks), 2) each preeclampsia subtype should be something care providers and women can use for decision-making about care, so it shouldn’t be time-consuming to diagnose, and 3) the results should be reproducible, which means that these subtypes appear over and over in different pregnancies by different women. This is important so that different subtypes can be targeted with specific treatments (that is, providers could use more of a ‘precision medicine’ approach to individual pregnancies).
LINK: https://pubmed.ncbi.nlm.nih.gov/33775113/
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