JS-HR-4: PREECLAMPSIA UP TO DATE; WHAT WE SHOULD KNOW FOR MOTHER AND CHILD.

Abstract

Preeclampsia (PE) is a systemic hypertensive disorder of pregnancy thought to arise from placental maladaptation and subsequent systemic inflammatory processes. PE is associated with significant maternal and fetal mortality with hypertensive disorder of pregnancy accounting for -14% of maternal deaths globally and also with increased maternal risks for chronic diseases in later life. In 2017, the American College of Cardiology/American Heart Association hypertension treatment guidelines identified hypertension as blood pressure (BP) 130/80 mmHg. The reference BP for hypertension during pregnancy as specified in international guidelines is still > 140/90 mmHg. Also, recommended target BP level differs between these guidelines. A large number of studies have been examining the incidence of PE and fetal outcomes according to BP levels to figure out the optimal level for pregnant women. Given only termination of pregnancy has been proved to initiate the resolution of PE once it has developed, prevention of PE is a health care priority. However, the predictive value of BP and other clinical characteristics for PE is relatively low, and therefore, improved method for the prediction of PE and associated adverse outcomes is required. Past history of PE is now widely known to link with major chronic diseases such as hypertension, type 2 diabetes mellitus, dyslipidemia, cardiovascular disease in later life. Since many cardiovascular risk factors are modifiable and related to lifestyle, all women with prior PE should be followed-up by physician even after resolution of PE (eg. hypertension, proteinuria). However, no long-term follow-up strategy for former-PE patient has yet been established. The 2019 Maternal Mortality update from the WHO report indicated the major contribution of PE and eclampsia to worldwide maternal deaths. Further investigation is needed to decrease PE related maternal and fetal deaths and also to reduce maternal risks for chronic diseases in later life. Participation of physicians is necessary to offer appropriate medical care to women with prior PE.