These factors are critical mediators of vascular function and impact the endothelium in distinctive

ways, including enhanced endothelial oxidative stress. The mechanisms of action and the consequences on the maternal vasculature will be discussed in this review. Preeclampsia is a multifaceted disorder of human pregnancy which affects millions of women worldwide (approximately 5% of all pregnancies) each year (reviewed in [131]). It is a leading cause of maternal morbidity and mortality, accounting LY294002 manufacturer for an estimated 50,000 deaths annually (reviewed in [40]). Preeclampsia is complex, affecting multiple systems, and is diagnosed after the 20th week of pregnancy by the onset of hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg) in the presence of proteinuria (300 mg or greater over 24 hours) [129]. Preeclampsia is also associated with a multitude of physiological changes which lead to vascular dysfunction and threaten maternal health. Aside from the vasculature, it affects the central nervous system, lungs, liver, kidneys, and the heart. Preeclampsia may increase the risk for eclampsia (seizures), and the development of HELLP syndrome. HELLP syndrome can lead to serious complications, including disseminated intravascular coagulation,

acute renal failure, and pulmonary edema, which may cause maternal illness Tolmetin and/or death (reviewed in [133]). Preeclampsia is resolved upon delivery of the placenta; which is, to date, the only available DZNeP mouse treatment. Depending on the stage of pregnancy, induced preterm delivery may jeopardize the life or health of the infant [130]. Impaired endothelial dysfunction is central to the risk associated with preeclampsia, and is believed to be instigated by circulating factors released as a result of placental ischemia/hypoxia [116, 117]. Among these, an imbalance in pro- and

antiangiogenic factors and activation of immune mediators contributing to excessive inflammation are of particular relevance. In addition, the generation of ROS within the endothelium plays an important role in vascular dysfunction. Maternal endothelial dysfunction leads to increased systemic resistance, which reduces perfusion to all organs including the placenta, further propagating placental ischemia and promoting a destructive cycle (Figure 1). This review will highlight the potential role and mechanisms for each of these elements in the development of preeclampsia. The circulatory demands of pregnancy are substantial and place significant stress on the maternal cardiovascular system. Blood volume increases by nearly 50% [108], cardiac output increases by 30–40% [71], and blood flow to the uterus increases by approximately eightfold [100].