Prevention of Hypertensive Disorders in Pregnancy

Abstract

For unknown reasons some women fail to exhibit or maintain proper adaptational circulatory responses to the presence of trophoblast, which may lead to circulatory maladaptation disease (“MAD-disease”). Pregnancy-induced hypertension (PIH) and preeclampsia (PE), and also fetal growth retardation, abruptio placentae, and premature labor may represent clinical expressions of MAD-disease. So far, primary prevention of PIH-PE appears to be not possible, except by means of avoiding pregnancy altogether. However, secondary prevention may be feasible by manipulation of the eicosanoid (prostaglandin) system, a disturbance of which has emerged as an important secondary mechanism in the development of PIH-PE. Results of small controlled studies on secondary prevention of PIH-PE and of other expressions of MAD-disease using low-dose aspirin look promising, but application in clinical practice should await the outcome of larger properly designed clinical trials.