Сучасний погляд на етіологію та патогенез прееклампсії як основної причини перинатальних втрат

Abstract

Preeclampsia (PE) is one of the most important problems of modern obstetrics. There is an opinion that the nature of PE is different when it starts before or after 34 weeks of pregnancy. Early onset of PE correlates with high neonatal morbidity and mortality and maternal complications. Being a multifactorial disease, PE has a number of candidate genes that are involved in the complex regulation of various endothelial functions. The article provides an overview of modern medical literature on the etiology and pathogenesis of PE. For a more detailed understanding of the pathogenesis, each angiogenesis factor is considered separately, as well as variations in the genes encoding them and the influence of these factors on the development of PE. Purpose - to clarify the causes of PE development, the role of timely diagnosis of genetic polymorphisms and angiogenesis markers for constructing an algorithm for diagnosing and predicting the development of PE. It has been established that the main pathogenetic moment in the development of PE is the lack of reconstruction of the junction of the spiral arteries and the trophoblast, which reflects a defect in deep placentation. This contributes to increased production of vasoconstrictor mediators from the very beginning of pregnancy and their progressive increase with gestational age. This does not allow the formation of adequate uteroplacental bleeding, which leads to relative hypoxia in the trophoblastic tissue, thereby causing oxidative stress of the entire placenta. This phenomenon further compromises placental villous angiogenesis and leads to an imbalance in the production of angiogenic and antiangiogenic growth factors. It has been proven that the presence of polymorphism in the angiogenesis genes worsens the pathomorphological conditions caused by PE. This is due to a genetically programmed decrease in the production of angiogenic factors, which further exacerbates the aforementioned imbalance. That is why a comprehensive genetic examination of a woman at the stage of preconception preparation will make it possible to predict the risks of developing PE. This prognosis will provide the possibility of earlier administration of drugs that can improve the effects of primary placentation and reduce rates of gestational complications and perinatal losses. No conflict of interests was declared by the authors.