Impact of preventive therapy on regulating mechanisms of decidual macrophage polarization in pregnant women with high risk of preeclamplsia

Abstract

Despite the wealth of reports on the diagnosis and prevention of preeclampsia, the frequency of pregnancies and childbirths complicated with this pathology in Ukraine and throughout the world is ranging from 7 to 16%; moreover, no tendency to decrease is being observed. Pregnancies complicated with preeclampsia rank the third and fourth places in the structure of maternal mortality [1,2]. Perinatal mortality under severe uncorrected forms of preeclampsia makes up 53 – 100 ‰ [3,4]. To date, there have been proposed more than 30 theories of the development of preeclampsia [5,6]. This has led to the development of a large number of schemes for managing patients with the condition [7]. Unfortunately, the analysis of unsatisfactory results of preeclampsia therapy shows the lack of effective methods for prevention and successful management of the complex pathology [4,8,9]. Decidual macrophages (DMP) are involved in the formation of the “maternal-foetal” dialogue. The number of DMP increases in the first trimester of pregnancy, then remains unchanged through the second trimester, and goes up again during the labor [10,11]. The activation of placental and decidual macrophages can accelerate the production of various mediators, including those that contribute to the development of endothelial dysfunction and preeclampsia [9,14]. The role of macrophage polarization in the context of preeclampsia development is still insufficiently explored, therefore a detailed analysis of this issue as well as identifying factors, which can impact DMP differentiation in women with preeclampsia will be of great clinical importance for predicting the occurrence of this condition and its management.