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A Critical Review of Early-Onset and Late-Onset Preeclampsia

Raymond, Dahlia BA, MBS*; Peterson, Erika MD

Obstetrical & Gynecological Survey: August 2011 - Volume 66 - Issue 8 - p 497-506
doi: 10.1097/OGX.0b013e3182331028

Preeclampsia is a leading cause of pregnancy-related morbidity and mortality in the United States. In the past 30 years, a large amount of research has been performed to investigate the pathogenesis and pathophysiology of preeclampsia, ways to treat preeclampsia, markers that can be used to predict preeclampsia, and associations with other factors, such as smoking, stroke, and cardiovascular disease. Preeclampsia has been characterized by some investigators into 2 different disease entities: early-onset preeclampsia and late-onset preeclampsia. Early-onset preeclampsia is usually defined as preeclampsia that develops before 34 weeks of gestation, whereas late-onset preeclampsia develops at or after 34 weeks of gestation. Although the presenting features overlap, they are associated with different maternal and fetal outcomes, biochemical markers, heritability, and clinical features. To date, no review has analyzed the data focusing on early- versus late-onset preeclampsia. This review summarizes the relevant research on the similarities and differences between early- and late-onset preeclampsia as it relates to pathogenesis and biomarkers, including differences in vascular endothelial growth factor, placental growth factor, vascular endothelial growth factor receptor-1, epidermal growth factor, transforming growth factor-β, vascular cell adhesion molecule, toll-like receptor, plasma pentraxin 3, soluble endoglin, and lipid peroxidation. Although many articles have been published regarding these 2 entities, more data regarding differences and similarities between the 2 are clearly needed. Such study should permit more effective diagnosis, treatment, and management of patients with preeclampsia.

Target Audience: Obstetricians & Gynecologists and Family Physicians

Learning Objectives: After the completing the CME activity, physicians should be better able to evaluate the role of abnormal placentation in preeclampsia. Develop a protocol for researching biomarkers relevant to early-onset and late-onset preeclampsia. To distinguish the biomarkers that are similar and different in early-onset and late-onset preeclampsia.

*Medical Student, University of Pittsburgh School of Medicine, Pittsburgh, PA; and †Division of Maternal Fetal Medicine, Department of OB/GYN, Medical College of Wisconsin, Milwaukee, WI

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credits™ can be earned in 2011. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors, faculty and staff in a position to control the content of this CME activity, and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Dahlia Raymond, BA, MBS, 5540 Fifth Ave, Apt 13, Pittsburgh, PA 15232. E-mail: or Erika Peterson, MD, Division of Maternal Fetal Medicine, Department of OB/GYN, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.