Why is the Exact Cause of Preeclampsia still Unclear?

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Main Question or Discussion Point

I've been reading about Preeclampsia, NOT because someone I know has it, but it's part of the risk factor of any pregnancy (anyone you know could be pregnant anytime), and I want to understand the exact cause of it. So far I have read that:

https://en.wikipedia.org/wiki/Pre-eclampsia

"While the exact cause of pre-eclampsia remains unclear, there is strong evidence that a major cause predisposing a susceptible woman to pre-eclampsia is an abnormally implanted placenta.[2][10] This abnormally implanted placenta may result in poor uterine and placental perfusion, yielding a state of hypoxia and increased oxidative stress and the release of anti-angiogenic proteins along with inflammatory mediators into the maternal plasma.[10] A major consequence of this sequence of events is generalized endothelial dysfunction.[1] The abnormal implantation may stem from the maternal immune system's response to the placenta, specifically a lack of established immunological tolerance in pregnancy. Endothelial dysfunction results in hypertension and many of the other symptoms and complications associated with pre-eclampsia."

And because the exact cause of it is not understood. There has been no medicine to cure it. It's strange that after all the development in medical science. It is still a mystery. Do you have any insight of the cause of it?

Any comments greatly appreciated. Thank you!
 

Answers and Replies

  • #2
jim mcnamara
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BTW: NIH (US National Institutes of Health) is an excellent source for up to date information.

You appear to think that winnowing out causation is easy and for some reason or another it has not happened.

Really there is no single reason why the condition occurs other than it appears to be a physiological, a maternal blood pressure response associated with incorrect fetal implantation in the placenta. So far. Association means that it does not always occur 100% of the time.

The other part of the why:
Testing with or experimenting on pregnant women with problems is not a great idea medically, nor is it ethical. As you would guess. Most of the research focus is in the context of working with other mammals like mice, and refining clinical protocols i.e., early diagnosis and treatment.

These are some examples, meant for non-medical folks ---

Mice:
https://www.nih.gov/news-events/news-releases/experimental-treatment-preeclampsia-effective-animals-nih-funded-researchers-show
Clinical:
https://www.nichd.nih.gov/health/topics/preeclampsia/researchinfo/activities

Short answer: Prevention means being able to coerce implantation of the new embryo into a "good spot" during the first few days of pregnancy. Failure to get a good spot means, as of now, it is a "crap shoot" how well things go.

We are discussing Human Biology. Which is fraught with exceptions, complications, and wildly different results. For what should all be the exact same thing. Like a disease.

Flu is a great example.

There are many diseases that have widely varying outcomes. Like the flu. During the last flu season about 80000 people died in the US from the flu. Some flu seasons have been much milder. Most of people who get the flu do not die from it, and predicting survival of the flu is never perfect. And many disease conditions arise - that were new, unknown, and unsuspected - after a bout of the flu. Flu has a reputation. It sort of "triggers" the onset of other medical problems. Again, not always.
 
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  • #3
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BTW: NIH (US National Institutes of Health) is an excellent source for up to date information.

You appear to think that winnowing out causation is easy and for some reason or another it has not happened.

Really there is no single reason why the condition occurs other than it appears to be a physiological, a maternal blood pressure response associated with incorrect fetal implantation in the placenta. So far. Association means that it does not always occur 100% of the time.
Preeclampsia is not just a blood pressure response. It affects all organs causing damages to them. End result is Clampsia or convulsion of the patient causing unconsciousness. See:

preeclam cartoons.JPG

https://medcomic.com/medcomic/preeclampsia-pathophysiology/

The only cure is delivery even if it's only the 5th month of pregnancy, meaning the baby can't survive. There are so many mortality worldwide because the mother was not diagnosed as having it. It comes suddenly and devastates.

Presently, there is no cure or medicine for it because the exact cause is still being debated. So frustrating, isn't it?



The other part of the why:
Testing with or experimenting on pregnant women with problems is not a great idea medically, nor is it ethical. As you would guess. Most of the research focus is in the context of working with other mammals like mice, and refining clinical protocols i.e., early diagnosis and treatment.

These are some examples, meant for non-medical folks ---

Mice:
https://www.nih.gov/news-events/news-releases/experimental-treatment-preeclampsia-effective-animals-nih-funded-researchers-show
Clinical:
https://www.nichd.nih.gov/health/topics/preeclampsia/researchinfo/activities

Short answer: Prevention means being able to coerce implantation of the new embryo into a "good spot" during the first few days of pregnancy. Failure to get a good spot means, as of now, it is a "crap shoot" how well things go.

We are discussing Human Biology. Which is fraught with exceptions, complications, and wildly different results. For what should all be the exact same thing. Like a disease.

Flu is a great example.

There are many diseases that have widely varying outcomes. Like the flu. During the last flu season about 80000 people died in the US from the flu. Some flu seasons have been much milder. Most of people who get the flu do not die from it, and predicting survival of the flu is never perfect. And many disease conditions arise - that were new, unknown, and unsuspected - after a bout of the flu. Flu has a reputation. It sort of "triggers" the onset of other medical problems. Again, not always.
 
  • #4
jim mcnamara
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Let me explain something that bears on what you see reported about disease, medical research, and practice.

I was talking with the triage nurse and the head of medicine at Sage Memorial Hospital in Ganado AZ, on the Navajo reservation. Long ago. An older Grandma came in with some younger kids in tow. The doc looked up, said 'Oh.' Then he asked the nurse to get one of the kids from the entourage into an exam room. Next day I asked what that was all about. The answer was - the boy looked like he had polio. Turns out he did. The doc spent years in East Africa where polio was endemic. He had seen many cases. It is no longer endemic there thanks to WHO effort largely.

This ability to see things like this is really a gift, so us non-physician types just let it go. The downside to this is sometimes physicians see things that probably are not there, and other docs respond with 'I don't know what she saw'. Some internet content is this kind of content. The problem is that you and I are not competent to judge.

Go with white papers and press releases from NIH.

And yes, pre-eclampsia and eclampsia (seizures) are also related to the placenta and some plumbing being in a bad place.

One odd confounding fact: pre-eclampsia is more common in first-time pregnancies.

Factors commonly cited as risk:

  • Previous history of preeclampsia. (2.2% increased risk in second pregnancy)
  • Multiple gestation (i.e., pregnant with more than one baby)
  • History of chronic high blood pressure, diabetes, kidney disease or organ transplant.
  • First pregnancy (higher risk than any subsequent pregnancy)
  • Obesity, particularly with Body Mass Index (BMI) of 30 or greater.
  • Nulliparity
 
  • #5
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Didn't studies suggest a link to magnesium deficiency / wonky magnesium metabolism ? Given magnesium salt infusions are used to relieve some cases, I'm surprised there's no mention...
 
  • #6
jim mcnamara
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@Nik_2213 Yes, here is one paper that suggests magnesium serum levels for early identification of patients at risk. In a very limited population.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955494/

However, almost everything cited everywhere including the one above is clinical - associated causes, risk factors, etc. There are lots of them that are currently used. However - think carefully. Why would all of these additional factors exist? Is dietary magnesium deficiency the problem? Then why does the risk change for patients with nulliparity or second pregnancy?

Until there is an explanatory mechanism for hypomagnesemia caused by in utero problems, it remains clinical. -- it has many antecedents
Currently hypomagnesemia is listed as being caused by renal problems, diarrhea, and dietary issues.

The causes of magnesium depletion and hypomagnesemia are decreased gastrointestinal (GI) absorption and increased renal loss. Decreased GI absorption is frequently due to diarrhea, absorption, and inadequate dietary intake.
--www.dodge.com gastroenterology
 
  • #7
Although I have ABSOLUTELY NO CREDENTIALS, - I believe there is a possible link to muscle overuse syndrome - of which there are many locations ( named types - locations ). In RSI the problem is manifest when a muscle is in hyper tonus ( as in muscle cramp ) in a 24/7 status. This was recognized in the translation of 1900's German research translated by David Simons, - of Simon and Travell trigger points.

This 1970's paper has been ignored, - but is still quite important for the German research physicians' insight.

The male/female muscle overuse problem is NAMED Restless Leg Syndrome, and has been the subject of a number of papers. The RLS sufferer suffers "muscle cramping" that disturbs sleep, - often requiring calf stretch a number of times during the night.

These muscle overuse problems are amenable to high pressure - deep tissue massage, of gradual increasing force over 1 to 5 weeks. This is best done over the entire muscle and tendon unit - through a layer of cotton, using a hard ( brass ) shaft with a somewhat rounded end. In the German literature a wooden dowel was used in what was termed Gelotripse ( Traumatic massage ) of maximum force at the very start. When the muscle was no longer sensitive to pressure - the muscle was termed back to normal - recent scientific literature references the remediation of pain neurons in the muscle SPINDLE CELLS.

In theory ( MINE) the chronic activation of calf muscle spindle cells - ( and thus 24/7 hyper tonus ) results in a renal neural plexus sensor to increase blood pressure, - and the cascade of symptoms results. I realize this seems simplistic, - but women who have had Pre-E have a higher RLS risk.

In addition this hyper tonus effectively cancels calf muscle "compliance" - and transfers much more peak muscle load to the TENDON - resulting in the mechanical breakdown of Collagen, ( TENDINOSIS ) and risking Achilles tendon rupture - as reflected in the below article citing the requirement for collagen repair.

Overuse tendinosis, not tendinitis part 1: a new paradigm for a difficult clinical problem.
(Physician and Sports Medicine 2000 )

I would be happy to correspond if interested.

[Personal contact information deleted by the Mentors]
 
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