Preeclampsia is a heterogeneous disorder, and as with other diseases (e.g., type I and type II diabetes), progress in the understanding of this disorder would be assisted greatly if subtypes could be characterized. We suggest that a first step would be to subdivide preeclampsia into early‐onset disease ( 34 + 0 weeks').

Subclassification of Preeclampsia

Patients who develop pregnancy-induced hypertension exhibit a lesser increment in prostacyclin biosynthesis than healthy pregnant subjects. Whether this precedes the development of clinical disease and therefore may be important in the pathogenesis of pregnancy-induced hypertension or is a secondary event is unknown. We prospectively determined prostacyclin biosynthesis in pregnant subjects at risk of developing pregnancy-induced hypertension by use of noninvasive approach, measurement of the urinary metabolite 2,3-dinor-6-keto-prostaglandin F1 alpha. Patients were recruited at less than 20 weeks gestation. After delivery, patients were retrospectively allocated by use of preset criteria, to one of four groups: pregnancy-induced hypertension (n = 12), hypertension in labor (n = 22), chronic hypertension (n = 9), and normotension (n = 24). There was a significant increase in prostacyclin biosynthesis in all study groups during gestation. However, patients who developed pregnancy-induced hypertension exhibited a lesser increment and this difference persisted throughout gestation. These results are consistent with a pathophysiologic role for altered prostacyclin biosynthesis in women with pregnancy-induced hypertension. In addition, decreased prostacyclin formation identifies a population at risk of developing pregnancy-induced hypertension. Such information would assist the design of clinical trials of drugs, such as aspirin, that might prevent the development of this disease.

Decreased prostacyclin biosynthesis preceding the clinical manifestation of pregnancy-induced hypertension.

The discovery of the aquaporin-1 (AQP1) water channel by Agre and colleagues ([1][1],[2][2]), which led to the Nobel Prize in 2003, has revolutionized the understanding of body fluid water regulation by the kidney. Moreover, the identification of other water channels in the kidney, namely AQP2, 3,

Body Water Homeostasis: Clinical Disorders of Urinary Dilution and Concentration

Wilson S. Colucci, Michael A. Gimbrone, Jr., Margaret K. McLaughlin, William Halpern, and R. Wayne Alexander From the Cardiovascular Divison and the Vascular Pathophysiology Laboratory, Brigham and Women's Hospital, the Departments of Medicine and Pathology, Harvard Medical School, Boston, Massachusetts; and Departments of Obstetrics and Gynecology and of Physiology and Biophysics, University of Vermont Medical Center, Burlington, Vermont

Increased vascular catecholamine sensitivity and alpha-adrenergic receptor affinity in female and estrogen-treated male rats.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/lt.21572

MacGillivray I

Papers

Hypertension and pregnancy.