Peixoto Alberto Borges, Rolo Liliam Cristine, Nardozza Luciano Marcondes Machado, Araujo Júnior Edward
Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo-SP, CEP 05089-030, Brazil.
Mario Palmério University Hospital - University of Uberaba (UNIUBE), Uberaba-MG, Brazil.
Methods Mol Biol. 2018;1710:73-83. doi: 10.1007/978-1-4939-7498-6_6.
Pregnancy is known to induce rapid, progressive, and substantial changes to the cardiovascular system, ultimately facilitating successful pregnancy outcomes. Women who develop hypertensive disorders during pregnancy are considered to have "failed" the cardiovascular stress test of pregnancy and likely represent a subpopulation with inadequate cardiovascular accommodation. Preeclampsia is a serious complication with a myriad of manifestations in both mother and offspring. This pregnancy syndrome is a polygenic disease and has now been linked to a greater incidence of cardiovascular disease. Moreover, offsprings born to preeclamptic mothers exhibit an elevated risk of cardiovascular disease, stroke, and mental disorders during adulthood. This suggests that preeclampsia not only exposes the mother and the fetus to complications during pregnancy but also programs chronic diseases during adulthood in the offspring. The etiology of preeclampsia remains unknown, with various theories being suggested to explain its origin. It is primarily thought to be associated with poor placentation and entails excessive maternal inflammation and endothelial dysfunction. It is well established now that the maternal immune system and the placenta are involved in a highly choreographed cross talk that underlies adequate spiral artery remodeling required for uteroplacental perfusion and free flow of nutrients to the fetus. Although it is not clear whether immunological alterations occur early during pregnancy, studies have proposed that dysregulated systemic and placental immunity contribute to impaired angiogenesis and the onset of preeclampsia. Recently emerged strong evidence suggests a potential link among epigenetics, microRNAs (miRNAs), and pregnancy complications. This chapter will focus on important aspects of epigenetics, immunological aspects, and cardiovascular and vascular remodeling of preeclampsia.
众所周知，怀孕会引起心血管系统迅速、渐进且显著的变化，最终促成成功的妊娠结局。孕期发生高血压疾病的女性被认为“未能通过”孕期的心血管压力测试，可能代表了心血管调节不足的亚人群。子痫前期是一种严重的并发症，在母亲和子代中均有多种表现。这种妊娠综合征是一种多基因疾病，现已与心血管疾病的更高发病率相关联。此外，子痫前期母亲所生的后代在成年期患心血管疾病、中风和精神障碍的风险升高。这表明子痫前期不仅使母亲和胎儿在孕期面临并发症，还会使后代在成年期患上慢性疾病。子痫前期的病因仍然不明，人们提出了各种理论来解释其起源。主要认为它与胎盘形成不良有关，涉及母体过度炎症和内皮功能障碍。现在已经明确，母体免疫系统和胎盘参与了一场精心编排的相互作用，这是子宫胎盘灌注和营养物质向胎儿自由流动所需的足够螺旋动脉重塑的基础。虽然尚不清楚免疫改变是否在孕期早期发生，但研究表明，全身和胎盘免疫失调会导致血管生成受损和子痫前期的发生。最近出现的有力证据表明表观遗传学、微小RNA（miRNA）与妊娠并发症之间存在潜在联系。本章将重点关注子痫前期的表观遗传学重要方面、免疫学方面以及心血管和血管重塑。
