Table 3.

Main etiologies and risk factors that favor or are associated with the onset of preeclampsia

Uteroplacental ischemia secondary to impairment of uterine artery remodeling Related to shallow trophoblast invasion Uteroplacental ischemia secondary to villitis of unknown etiology associated with fibrin deposition and maternal T cell infiltration. Related to a breakdown of maternal–fetal immune tolerance.

Uteroplacental ischemia secondary to maternal cardiovascular disorders Related to cardiovascular risk factors (diabetes, metabolic syndrome, obesity, hypertension, chronic renal disease…). Related to intravascular inflammation with maternal infection such as periodontal disease, urinary tract infection, SARS-CoV-2 infection, maternal intestinal dysbiosis.

Other etiologies Molar pregnancy (hydatidiform mole) Fetal disease: trisomy 13, Mirror syndrome, twin-to-twin transfusion syndrome Autoimmune disease such as antiphospholipid syndrome, antibodies against the angiotensin II receptor Placental aging (overcrowded villous contributing to intervillous hypoxia) Endocrine disorders such as hyperparathyroidism, secondary hypertension (Cushing syndrome, aldosteronism, pheochromocytoma, paraganglioma...) Nulliparity, longer interpregnancy interval (>5 y), assisted reproduction Previous intrauterine growth restriction, preeclampsia, placental abruption

Boulanger. Immunologic aspects of preeclampsia. Am J Obstet Gynecol Glob Rep 2024.