Preeclampsia: from epidemiological observations to molecular mechanisms

Preeclampsia is the main cause of maternal mortality and is associated with a five-fold increase in perinatal mortality in developing countries. In sp ite of this, the etiology of preeclampsia is unknown. The present article a nalyzes the contradictory results of the use of calcium supplementation in the prevention of preeclampsia, and tries to give an explanation of these r esults. The proposal of an integrative model to explain the clinical manife stations of preeclampsia is discussed. In this proposal we suggest that pre eclampsia is caused by nutritional, environmental and genetic factors that lead to the creation of an imbalance between the free radicals nitric oxide , superoxide and peroxynitrate in the vascular endothelium. The adequate in terpretation of this model would allow us to understand that the best way o f preventing preeclampsia is the establishment of an adequate prenatal cont rol system involving adequate antioxidant vitamin and mineral supplementati on, adequate diagnosis and early treatment of asymptomatic urinary and vagi nal infections. The role of infection in the genesis of preeclampsia needs to be studied in depth because it may involve a fundamental change in the p revention and treatment of precclampsia.