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Preeclampsia remains a leading cause of maternal and fetal morbidity and mortality in the United States and worldwide. Despite its significant prevalence (5% of all otherwise normal pregnancies may be affected), there is no early pregnancy screening test to recognize those at risk. Further, once diagnosed, there is no effective treatment beyond delivery. Emerging data are beginning to uncover the pathogenesis of this complex disease. In this review, the clinical presentation, current management, new evidence regarding pathogenesis, and future possibilities for screening and therapy will be discussed.