The “Great Obstetrical Syndromes”

Abstract

The Great Obstetrical Syndromes, namely, preterm labor, preterm prelabor rupture of membranes (pPROM), fetal demise, preeclampsia, and intrauterine growth restriction (IUGR), affect more than 15% of pregnancies, posing the mother and the fetus at high risk for adverse pregnancy outcomes. These pregnancy complications may be responsible for both short- and long-term health outcomes.Many pathways leading to their development have been suggested. Inflammation is the factor under higher evaluation from a clinical and academic point of view, offering a number of aspects to be assessed, due to the complexity of this process as well as of the immune system and its physiologic and pathologic changes during pregnancy. This process has been described in sterile conditions, in the presence of infection from pathogens, as well as in other conditions such as obesity, another extremely actual challenge for health systems.Indeed, from implantation to parturition, inflammation in conjunction with the immune system function plays a significant role during normal pregnancy. Moreover, inflammation has to be tightly controlled since an exacerbation of this process can negatively affect tissue function, leading to the development of pregnancy complications, as suggested in obese women or those with gestational diabetes mellitus.Due to the importance of the topic, the need for preventive strategies to reduce the incidence of the Great Obstetrical Syndromes is of extreme importance. Unfortunately, while we have available tools to perform an adequate secondary prevention of women at high risk for these syndromes, there is still a lack of effective screening tools for primary prevention.KeywordsGestational diabetes mellitusImmune systemInflammationMetabolomicsMicrobiomeObesityPregnancy complicationsPreterm laborToll-like receptor