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Clinical Review State of the Art Review

Pre-eclampsia: pathophysiology and clinical implications

BMJ 2019; 366 doi: (Published 15 July 2019) Cite this as: BMJ 2019;366:l2381
  1. Graham J Burton1 2,
  2. Christopher W Redman3,
  3. James M Roberts4,
  4. Ashley Moffett2 5
  1. 1Department of Physiology, Development & Neuroscience, University of Cambridge, UK
  2. 2Centre for Trophoblast Research, University of Cambridge, UK
  3. 3Nuffield Department of Obstetrics and Gynaecology, University of Oxford, UK
  4. 4Magee-Womens Research Institute, Depts. Obstetric Gynecology and Reproductive Sciences, Epidemiology, and Clinical and Translational Research, University of Pittsburgh, USA
  5. 5Dept of Pathology, University of Cambridge, UK.
  1. Correspondence to A Moffett am485{at}


Pre-eclampsia is a common disorder that particularly affects first pregnancies. The clinical presentation is highly variable but hypertension and proteinuria are usually seen. These systemic signs arise from soluble factors released from the placenta as a result of a response to stress of syncytiotrophoblast. There are two sub-types: early and late onset pre-eclampsia, with others almost certainly yet to be identified. Early onset pre-eclampsia arises owing to defective placentation, whilst late onset pre-eclampsia may center around interactions between normal senescence of the placenta and a maternal genetic predisposition to cardiovascular and metabolic disease. The causes, placental and maternal, vary among individuals. Recent research has focused on placental-uterine interactions in early pregnancy. The aim now is to translate these findings into new ways to predict, prevent, and treat pre-eclampsia.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors GJB and AM drafted the sections relating to the placenta and genetics; CWR the sections on definition and epidemiology; and JMR the sections on therapies and long-term implications. GJB and AM revised the final manuscript, which all authors approved.

  • Competing interests We have read and understood the BMJ policy on declaration of interests and declare the following interests: GJB, CR and AM, none. JMR is a consultant to Metabolomics Diagnostics Limited, a company attempting to develop a predictor of pre-eclampsia.

  • Provenance and peer review: commissioned; externally peer reviewed.

  • Patient involvement: no patients were involved in the creation of this article.

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