Opportunities for preeclampsia prevention: today and tomorrow

Authors

  • V. M. Guryeva State Budgetary Health Care Institution of the Moscow Region “Moscow Regional Research Institute of Obstetrics and Gynecology”, Moscow, Russian Federation
  • A. A. Travkina State Budgetary Health Care Institution of the Moscow Region “Moscow Regional Research Institute of Obstetrics and Gynecology”, Moscow, Russian Federation
  • M. O. Matveev State Budgetary Health Care Institution of the Moscow Region “Moscow Regional Research Institute of Obstetrics and Gynecology”, Moscow, Russian Federation
  • L. S. Morokhotova State Budgetary Health Care Institution of the Moscow Region “Moscow Regional Research Institute of Obstetrics and Gynecology”, Moscow, Russian Federation
  • Y. B. Kotov M.V. Keldysh Institute of Applied Mathematics of the Russian Academy of Sciences, Moscow, Russian Federation
  • T. A. Semenova National Research Nuclear University MEPhI, Moscow, Russian Federation

DOI:

https://doi.org/10.18370/2309-4117.2020.55.99-104

Keywords:

preeclampsia, placenta-associated complications, prevention of preeclampsia, antiplatelet agents, heparin

Abstract

Purpose of this review was to highlight the current and future possibilities of medicine in prevention of preeclampsia (PE) and placenta-associated complications (PAO). PE remains one of the most important causes of maternal and perinatal morbidity and mortality, and is responsible for the mass of premature births. The urgency of PE and PAO problem is primarily due to the lack of effective treatment for extensive clinical symptoms, as well as need to terminate pregnancy regardless of the gestational age and prognosis for fetus. In this regard, PE prevention is of great importance for clinical practice.

This review presents the modern concept of PE pathogenesis, highlights the key points of hemostatic system disorders, leading to the clinical symptoms and PE. It was also shown that the imbalance between thromboxane and endothelial prostacyclin as well as between pro- and anti-angiogenic factors in pregnant women with PE can be considered as a therapeutic target in PE prevention and treatment; prescription of antiplatelet agents and anticoagulants for PE prevention is justified.

Modern systematic reviews and meta-analysis have shown some effectiveness of antiplatelet agents and anticoagulants in PAO prevention. This review highlights the role of some nutrient deficiencies in the development of PAO and folate supplementation for their prevention. Presented data indicate that today there are methods for PAO prevention, which can significantly reduce their probability by 17–30% in pregnant women with a high risk of this obstetric pathology. However, a complete prevention and effective treatment of PAO at the stage of advanced clinical symptoms has not yet been developed, which leads to early termination of pregnancy, perinatal morbidity and mortality. Therefore, the development of new therapies that completely prevent or cure PE would be a major advance for practical obstetrics. This review presents the main scientific developments in this direction, in particular, clinical trials of drugs that can reduce sFlt-1 and soluble endoglin secretion, thus curing endothelial dysfunction in PE.

Author Biographies

V. M. Guryeva, State Budgetary Health Care Institution of the Moscow Region “Moscow Regional Research Institute of Obstetrics and Gynecology”, Moscow

MD, leading researcher, Obstetric Physiological Department

A. A. Travkina, State Budgetary Health Care Institution of the Moscow Region “Moscow Regional Research Institute of Obstetrics and Gynecology”, Moscow

PhD, senior researcher, Obstetric Physiological Department

M. O. Matveev, State Budgetary Health Care Institution of the Moscow Region “Moscow Regional Research Institute of Obstetrics and Gynecology”, Moscow

Clinical resident

L. S. Morokhotova, State Budgetary Health Care Institution of the Moscow Region “Moscow Regional Research Institute of Obstetrics and Gynecology”, Moscow

PhD, doctor of the Observational Department

Y. B. Kotov, M.V. Keldysh Institute of Applied Mathematics of the Russian Academy of Sciences, Moscow

Leading researcher

T. A. Semenova, National Research Nuclear University MEPhI, Moscow

PhD, associate professor

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Published

2020-11-30

How to Cite

Guryeva, V. M., Travkina, A. A., Matveev, M. O., Morokhotova, L. S., Kotov, Y. B., & Semenova, T. A. (2020). Opportunities for preeclampsia prevention: today and tomorrow. REPRODUCTIVE ENDOCRINOLOGY, (55), 99–104. https://doi.org/10.18370/2309-4117.2020.55.99-104

Issue

No. 55 (2020)

Section

Analytical review

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Copyright (c) 2020 V. M. Guryeva, A. A. Travkina, M. O. Matveev, L. S. Morokhotova, Y. B. Kotov, T. A. Semenova

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