From Epidemiology to Therapeutics: A Holistic Review of Preeclampsia’s Burden, Mechanisms, Risks, and Innovations

Abstract

Preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality worldwide, yet its complex pathophysiology and heterogeneous clinical presentation continue to challenge early diagnosis and effective management. Despite decades of research, significant gaps persist in translating mechanistic insights into universally effective therapies, particularly for high-risk populations in resource-limited settings. This review addresses the urgent need to consolidate recent advances in preeclampsia research, bridging fundamental science with clinical applications to improve outcomes. The review synthesizes critical insights into the multifactorial origins of preeclampsia, emphasizing the central role of placental dysfunction, angiogenic imbalance, and systemic inflammation. It evaluates current diagnostic tools, including the soluble Fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio, alongside evidence-based interventions such as lowdose aspirin, statins, and optimized antihypertensive regimens. Regional disparities in prevalence and outcomes are analyzed, highlighting the disproportionate burden in low- and middle-income countries. Emerging therapeutic strategies targeting oxidative stress, immune dysregulation, and genetic susceptibility are critically appraised. The review also explores innovative approaches like personalized risk assessment, while underscoring the limitations of existing treatments. Clinical studies comparing drug efficacy (e.g., nicardipine vs labetalol) and preventive measures (e.g., 150 mg aspirin) are systematically reviewed to guide practice. Finally, the interplay between preeclampsia and long-term maternal cardiovascular health is examined, reinforcing the need for postpartum surveillance. Future research must prioritize large-scale trials to validate novel biomarkers and therapies across diverse populations, with particular attention to implementation in resourceconstrained settings. Investigations into fetal microchimerism and epigenetic modifiers could unlock new preventive strategies, while artificial intelligence integration may revolutionize early-risk prediction models. Multidisciplinary collaborations are essential to develop standardized protocols for screening, management, and postpartum follow-up. By addressing these priorities, the field can mitigate the global burden of preeclampsia and its lifelong health consequences.