Clinical OpinionMapping the theories of preeclampsia: The need for systematic reviews of mechanisms of the disease
Section snippets
Conceptual framework: Systematic reviews to study mechanisms in preeclampsia
When faced with an extensive literature on disease mechanisms and their implications, assessment of causation is challenging.8 This is aggravated by the “citation bias” that exists in narrative reviews of investigators interested in supporting a given hypothesis. Often primary studies focus on a small part of a complex biologic chain of events. Some may provide information on the initial (etiologic) events; others evaluate the subsequent sequence of events (pathophysiology) that lead to
Generating hypotheses on the disease mechanisms in preeclampsia
In an exercise seeking evidence on the mechanisms proposed to explain the development of preeclampsia, we carried out an electronic search in MEDLINE (1980-2004) for the concept “preeclampsia” and “mechanisms of disease” combining appropriate MESH terms, text words, and word variants, without language restrictions. Citations on both primary research and reviews examining these mechanisms increased over recent years. Contrary to the case of systematic reviews of clinical trials, narrative
Implications for practice and research
A scientific strategy based on systematic literature review methodology can be developed to assess the hypothesized mechanisms in preeclampsia. They can help to understand current controversies and uncertainties and to identify gaps in the research evidence.4 However, with few exceptions,5, 13, 34, 35, 36 there is almost nothing published about how disease mechanisms could be assessed using systematic reviews. In Figure 3 we describe the main principles of reviews of mechanisms of disease. We
Acknowledgments
J.V., L.M., and K.S.K. conceptualized, developed, and applied systematic review methods to study mechanisms in preeclampsia. L.M. undertook the relevant reviews under supervision of K.S.K. and J.V.
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Hemodynamic pathways of gestational hypertension and preeclampsia
2022, American Journal of Obstetrics and GynecologyCitation Excerpt :Although human circulation is a closed-loop circuit with different components coupled in series, most studies on hemodynamic changes during pregnancy mainly focus on the heart and the arterial vascular tree, neglecting the microcirculation, venous system, and volume load.2 As such, many important aspects of gestational cardiovascular physiology are overlooked or remain unexplored, and this contributes to an incomplete understanding of the pathophysiological processes of gestational hypertensive disorders.3 The venous compartment is generally considered a rather passive organ, despite its active cooperation with the heart in the control of cardiac output.4
Vitamins supplementation affects the onset of preeclampsia
2018, Journal of the Formosan Medical AssociationCitation Excerpt :Begg's funnel plot seemed to be symmetrical (Fig. 4), which indicated that there was no significant publication bias. Abnormal placentation is regarded as underlying cause of preeclampsia, which is featured by invasion of trophoblast cells and remodeling of the uterine vasculature.40 It also results in reduced utero-placental perfusion that could activate the mechanisms regarding to promoting maternal vasoconstriction and damage or activation of endothelial cells.
Cytokine production by non-stimulated peripheral blood NK cells and lymphocytes in early-onset severe pre-eclampsia without HELLP
2013, Journal of Reproductive ImmunologyCitation Excerpt :Preeclampsia remains one of the major causes of maternal and neonatal morbidity worldwide, affecting up to 5–8% of pregnant women (Turner, 2010). Preeclampsia is considered a “disease of theories”, in which a wide spectrum of explanations has been put forward, proposing a range of molecular and environmental causes (Widmer et al., 2007; Mignini et al., 2006). It is characterized by an abnormal vascular response to placentation that is associated with endothelial cell dysfunction and systemic vascular resistance (Robillard et al., 2009).
Antenatal screening and predicting hypertension in pregnancy for midwives
2010, Women and BirthDietary supplements and vascular function in hypertensive disorders of pregnancy
2023, Pflugers Archiv European Journal of Physiology
Supported by a Research Training Grant from WHO/World Bank Special Programme of Research, Department of Reproductive health and Research, World Health Organization, Geneva, Switzerland (L.E.M).
Reprints not available from the authors.