Review consolidates biomarker evidence and management strategies for hypertensive disorders of pregnancy
This narrative review consolidates current evidence on the epidemiology, pathophysiology, and clinical management of hypertensive disorders of pregnancy, which affect approximately 5% to 10% of pregnancies worldwide. Investigators identify the sFlt-1/PlGF ratio as a validated diagnostic tool for short-term preeclampsia risk assessment, while noting that retinal microvascular imaging offers a potential non-invasive alternative. The authors report that targeting blood pressure below 140/90 mmHg in mild chronic hypertension reduces adverse maternal outcomes without compromising fetal growth, and highlight that long-term cardiovascular and offspring neurodevelopmental risks require further longitudinal study. For laboratory diagnostics, the review emphasises the routine integration of angiogenic biomarkers into clinical algorithms and suggests that machine learning applied to multi-omics data may soon support precision risk stratification.
The original study
Hypertensive disorders of pregnancy: epidemiology, pathophysiology, therapeutic strategies, and maternal-offspring outcomes.
- Authors
- Mu C, Xu S, Xu B, Wu D, Chang X, Yang D, et al.
- Journal
- Hypertension in pregnancy
- Type
- Journal Article, Review
- PMID
- 42867037
Original abstract
Hypertensive disorders of pregnancy (HDP) encompass chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension, affecting about 5% to 10% of pregnancies worldwide and remaining a major cause of maternal and perinatal morbidity and mortality. Their burden is increasing with rising obesity, advanced maternal age, evolving diagnostic criteria, and marked socioeconomic and racial-ethnic disparities. This review summarises current evidence on the epidemiology, pathophysiology, biomarkers, clinical management, and long-term outcomes of HDP, highlighting recent advances and unresolved questions. Mechanistically, HDP is characterised by systemic endothelial dysfunction and angiogenic imbalance, particularly involving soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng), together with immune maladaptation, oxidative stress, and genetic and environmental contributors such as endocrine-disrupting chemicals (EDCs) and sleep-disordered breathing (SDB). The sFlt-1/PlGF ratio is among the most validated tools for short-term risk assessment in suspected preeclampsia, while retinal microvascular imaging may provide a non-invasive marker of systemic microvascular dysfunction. Clinically, trial evidence supports treating mild chronic hypertension to below 140/90 mmHg to reduce adverse outcomes without compromising foetal growth. Long-term maternal cardiovascular and metabolic risks vary according to HDP phenotype, severity, gestational age at onset, and associated preterm delivery or foetal growth restriction, whereas offspring neurodevelopmental associations are largely observational and may be influenced by prematurity and shared familial or socioeconomic factors. Experimental strategies supported primarily by preclinical or early translational evidence include PPARγ agonists, placenta-targeted nanomedicine, and transcutaneous auricular vagus nerve stimulation. Machine learning combined with longitudinal multi-omics data may support precision risk stratification and individualised management.