Progress in the understanding of the pathophysiology of immunologic maladaptation related to early-onset preeclampsia and metabolic syndrome related to late-onset preeclampsia

• DOI: 10.1016/j.ajog.2021.11.019
• Publication Date: 2022-01-05T12:57:20Z
• Authors: Pierre-Yves Robil...; Gustaaf Dekker; Marco Scioscia; Shigeru Saito
• Keywords: Maladaptation; Pathophysiology

Among mammalian species, human reproduction has 2 outstanding features. The hemochorial placentation is characterized by a very deep endovascular trophoblast invasion in the spiral arteries, reaching into myometrium. This requires an agonistic direct cell-cell interaction between maternal immune system and semiallogeneic trophoblast. second feature preeclampsia, heterogeneous syndrome, uniquely condition. female one of few mammals exposed to her partner's semen on multiple occasions before conception. Regulatory T cells, especially paternal antigen-specific regulatory play important role maintenance pregnancy. Sexual intercourse increases number dendritic cells uterus that induction cells. Paternal maintain pregnancy inducing tolerance. In decidua basalis preeclamptic cases, clonal are reduced; these would normally monoclonally expand recognize fetal or antigens. Programmed cell death-1 expressed regulate cytotoxic T-cell activity protect fetus against rejection. expression reduced preeclampsia early-onset making placenta vulnerable attack These phenomena can explain epidemiologic phenomenon more common couples using condom contraception, with shorter cohabitation periods, first pregnancies, pregnancies multiparous women when they change partner, after assisted donated gametes. contrast its importance shallow does not development is, maladaptation seem be involved. Late-onset (>34 weeks' gestation), representing 80% 90% most developed countries "Western lifestyle," strongly associated cardiometabolic variables (metabolic syndrome). Although underlying pathophysiology might quite different, syncytiotrophoblast stress final pathway leading syndrome among subtypes causing imbalance proangiogenic factors (placental growth factor vascular endothelial factor) antiangiogenic (soluble fms-like tyrosine kinase-1 soluble endoglin). Low-dose aspirin, started 16 week's gestation, will prevent up 60% but late-onset preeclampsia. Optimizing prepregnancy weight controlling gestational gain may effective ways