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Extracellular haemoglobin (Hb) and its metabolites heme and iron are highly toxic molecules and several defence mechanisms have evolved to protect the tissue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We will discuss the roles of free iron, heme, Hb, and the scavenger proteins haemopexin and alpha\u20101\u2010microglobulin in pregnancies complicated by PE and fetal growth restriction (FGR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In PE, oxidative stress causes syncytiotrophoblast (STB) stress and increased shedding of placental STB\u2010derived extracellular vesicles (STBEV). The level in maternal circulation correlates with the severity of hypertension and supports the involvement of STBEVs in causing maternal symptoms in PE. In PE and FGR, iron homeostasis is changed, and iron levels significantly correlate with the severity of the disease. The normal increase in plasma volume taking place during pregnancy is less for PE and FGR and therefore have a different impact on, for example, iron concentration, compared to normal pregnancy. Excess iron promotes ferroptosis is suggested to play a role in trophoblast stress and lipotoxicity. Non\u2010erythroid \u03b1\u2010globin regulates vasodilation through the endothelial nitric oxide synthase pathway, and hypoxia\u2010induced \u03b1\u2010globin expression in STBs in PE placentas is suggested to contribute to hypertension in PE. Underlying placental pathology in PE with and without FGR might be amplified by iron and heme overload causing oxidative stress and ferroptosis. As the placenta becomes stressed, the release of STBEVs increases and affects the maternal vasculature.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.13349","type":"journal-article","created":{"date-parts":[[2021,6,19]],"date-time":"2021-06-19T16:12:55Z","timestamp":1624119175000},"page":"952-968","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["The roles of free iron, heme, haemoglobin, and the scavenger proteins haemopexin and alpha\u20101\u2010microglobulin in preeclampsia and fetal growth restriction"],"prefix":"10.1111","volume":"290","author":[{"given":"Lena","family":"Erlandsson","sequence":"first","affiliation":[{"name":"Division of Obstetrics and Gynecology Department of Clinical Sciences Lund Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Masoumi","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Gynecology Department of Clinical Sciences Lund Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas R.","family":"Hansson","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Gynecology Department of Clinical Sciences Lund Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7838-9074","authenticated-orcid":false,"given":"Stefan R.","family":"Hansson","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Gynecology Department of Clinical Sciences Lund Lund University  Lund Sweden"},{"name":"Obstetrics and Gynecology Sk\u00e5ne University Hospital  Lund\/Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,6]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"WHO.The World Health Report 2005\u2013make every mother and child 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