430. Omics technologies and the future of preeclampsia research and clinical practice

Abstract

Despite the obvious success of human reproduction, pregnancy and childbirth pose significant risk to maternal and infant health. The great obstetrical syndromes have been a scourge for pregnant women and their care-givers continuing to the present day. Our understanding of the aetiology of these syndromes including preeclampsia is incomplete largely due to the fact that there are multiple pathways involved in their pathogenesis. For preeclampsia genetic, nutritional and other environmental factors have been implicated mostly those associated with inflammation, a skewed immune response to ’foreign’ fetal (paternal) antigens, control of blood pressure and plasma volume expansion, thrombosis, metabolic health, insulin resistance and placental trophoblast invasion and colonization of the uterine spiral arterioles. The challenge is to understand how all of these interact to cause disease. And to determine what to measure to predict risk not just for early onset preeclampsia but also for the much more common but still potentially life threatening preeclampsia at term. The cross talk between fetus, placenta and mother provides clues for new approaches for risk prediction, diagnosis and treatment. Integration of twenty first century omics interrogation of the placenta and maternal blood across gestation may provide tools with which to identify and monitor women and fetuses at risk and permit early intervention and treatments. Casting the net as broadly as possible enables unbiased identification of novel markers of impending disease. It will likely also inform subsequent diagnostics and treatments. But let’s not confine our thinking to one prognostic profile per pregnancy complication. Preeclampsia may be considered to be 2 or more disorders (early onset and term) with different molecular antecedent profiles and potentially different prevention strategies.