{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:19:35Z","timestamp":1792804775965,"version":"4.5.0"},"reference-count":141,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T00:00:00Z","timestamp":1720569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Instituto Nacional de Perinatolog\u00eda \u201cIsidro Espinosa de los Reyes\u201d","id":[{"id":"https:\/\/ror.org\/00ctdh943","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Preeclampsia (PE) is a multifactorial pregnancy disorder characterized by hypertension and proteinuria, posing significant risks to both maternal and fetal health. Despite extensive research, its complex pathophysiology remains incompletely understood. This narrative review aims to elucidate the intricate mechanisms contributing to PE, focusing on abnormal placentation, maternal systemic response, oxidative stress, inflammation, and genetic and epigenetic factors. This review synthesizes findings from recent studies, clinical trials, and meta-analyses, highlighting key molecular and cellular pathways involved in PE. The review integrates data on oxidative stress biomarkers, angiogenic factors, immune interactions, and mitochondrial dysfunction. PE is initiated by poor placentation due to inadequate trophoblast invasion and improper spiral artery remodeling, leading to placental hypoxia. This triggers the release of anti-angiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), causing widespread endothelial dysfunction and systemic inflammation. Oxidative stress, mitochondrial abnormalities, and immune dysregulation further exacerbate the condition. Genetic and epigenetic modifications, including polymorphisms in the Fms-like tyrosine kinase 1 (FLT1) gene and altered microRNA (miRNA) expression, play critical roles. Emerging therapeutic strategies targeting oxidative stress, inflammation, angiogenesis, and specific molecular pathways like the heme oxygenase-1\/carbon monoxide (HO-1\/CO) and cystathionine gamma-lyase\/hydrogen sulfide (CSE\/H2S) pathways show promise in mitigating preeclampsia\u2019s effects. PE is a complex disorder with multifactorial origins involving abnormal placentation, endothelial dysfunction, systemic inflammation, and oxidative stress. Despite advances in understanding its pathophysiology, effective prevention and treatment strategies remain limited. Continued research is essential to develop targeted therapies that can improve outcomes for both mothers and their babies.<\/jats:p>","DOI":"10.3390\/ijms25147569","type":"journal-article","created":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T08:16:57Z","timestamp":1720772217000},"page":"7569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":190,"title":["A Narrative Review on the Pathophysiology of Preeclampsia"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9524-4133","authenticated-orcid":false,"given":"Johnatan","family":"Torres-Torres","sequence":"first","affiliation":[{"name":"Clinical Research Branch, Instituto Nacional de Perinatolog\u00eda Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"},{"name":"Obstetric and Gynecology Department, Hospital General de M\u00e9xico Dr. Eduardo Liceaga, Mexico City 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7276-8463","authenticated-orcid":false,"given":"Salvador","family":"Espino-y-Sosa","sequence":"additional","affiliation":[{"name":"Clinical Research Branch, Instituto Nacional de Perinatolog\u00eda Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-3857","authenticated-orcid":false,"given":"Raigam","family":"Martinez-Portilla","sequence":"additional","affiliation":[{"name":"Clinical Research Branch, Instituto Nacional de Perinatolog\u00eda Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7701-9621","authenticated-orcid":false,"given":"Hector","family":"Borboa-Olivares","sequence":"additional","affiliation":[{"name":"Clinical Research Branch, Instituto Nacional de Perinatolog\u00eda Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9551-9021","authenticated-orcid":false,"given":"Guadalupe","family":"Estrada-Gutierrez","sequence":"additional","affiliation":[{"name":"Clinical Research Branch, Instituto Nacional de Perinatolog\u00eda Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Acevedo-Gallegos","sequence":"additional","affiliation":[{"name":"Clinical Research Branch, Instituto Nacional de Perinatolog\u00eda Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Ruiz-Ramirez","sequence":"additional","affiliation":[{"name":"Obstetric and Gynecology Department, Hospital General de M\u00e9xico Dr. Eduardo Liceaga, Mexico City 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Velasco-Espin","sequence":"additional","affiliation":[{"name":"Obstetric and Gynecology Department, Hospital General de M\u00e9xico Dr. Eduardo Liceaga, Mexico City 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Cerda-Flores","sequence":"additional","affiliation":[{"name":"Obstetric and Gynecology Department, Hospital General de M\u00e9xico Dr. Eduardo Liceaga, Mexico City 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ramirez-Gonzalez","sequence":"additional","affiliation":[{"name":"Obstetric and Gynecology Department, Hospital General de M\u00e9xico Dr. Eduardo Liceaga, Mexico City 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lourdes","family":"Rojas-Zepeda","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Department, Instituto Materno Infantil del Estado de Mexico, Toluca 50170, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1002\/uog.27510","article-title":"Performance of machine-learning approach for prediction of pre-eclampsia in a middle-income country","volume":"63","year":"2024","journal-title":"Ultrasound Obstet. 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