Editorial: Preeclampsia-Eclampsia, Time to Act and Time to Deepen Research

Preeclampsia-eclampsia is one of the leading causes of maternal death in low and middle income countries (LMICs) accounting for more than seventy-five thousands maternal deaths every year. In high income countries, where treatment is more readily available, few women die of this disease, but complications- including rupture of liver, kidney failure, hemorrhage, and stroke - can cause lasting health problems. In addition, preeclampsia is among the most common causes of preterm births in high income countries. Preeclampsia-eclampsia is one of the pregnancy complications which has gained great attention in the research field and there are a number of international and national scientific societies as well as journals dealing exclusively with it. There are two major foci of research, those looking for the etiology of the disease and those looking for the prevention and treatment. Regardless that the disease has been observed for more than two thousand years still the etiology is unknown. Preeclampsia is known as the disease of theories and the history of research is prolific about big amounts of theories. Many years ago a researcher discovered a parasite in the placentas of women with preeclampsia, and the findings were published in a relevant journal, but a great disappointment came afterwards since the results showed that pieces of cotton swabs had become mixed in with the placentas; and under the microscope they looked like parasites. In contrast with this failure many relevant studies have provided clues that are approaching to solve this subject. In this issue a comprehensive and detailed review about the role that implantation and trophoblast invasion have in the genesis of preeclampsia was given by Ribeiro and coworkers. A promising area requiring more support is the role of angiogenic agents in the development of preeclampsia. Many ongoing studies are looking for modifications in maternal homeostasis previous to the development of preeclampsia that could contribute to better identify changes that can be associated with this disease. The possibility to perform genes studies could give information to assess the role of the genetic constitution of mother, the father and even the fetus on the genesis of preeclampsia. Studies about the etiology of preeclampsia will give a clue about approaches that could prevent this disease, but we are still far from obtaining such approaches and meanwhile many women in LMICs are dying as a consequence of this disease. Studies focused on the prevention and treatment of preeclampsia has given some relevant interventions and the challenge to make available such interventions to women living in LMICs. Antiplatelet agents, largely low-dose aspirin, have moderate benefits when used for prevention of pre-eclampsia and its consequences. There is a 17% reduction in the risk of pre-eclampsia associated with the use of antiplatelet agents (relative risk (RR) 0.83, 95% confidence interval (CI) 0.77 to 0.89), and 72 (CI 52 to 119) women need to receive such therapy to avoid one women with preeclampsia [1]. Disappointing results have been obtained with antioxidants since trials with supplements of vitamin C and E did not show any effects on preeclampsia prevention [2].