Endothelial Dysfunction in Preeclampsia: Focus on the Uteroplacental Circulation

Preeclampsia is a pregnancy disorder characterized by de novo maternal hypertension, end-organ damage, and fetal complications. It is also associated with increased long-term cardiovascular risk for both the mother and offspring. A general lack of understanding of this disease prevents effective treatment and prevention, with delivery of the fetoplacental unit being the current standard of care for severe cases. A hallmark characteristic of the maternal syndrome is endothelial dysfunction in both reproductive and nonreproductive vascular beds. As the uterine vascular bed serves as the interface between the maternal and fetal circulation, it is pivotal in the cardiovascular function of both mother and fetus. In this review, we highlight uterine artery endothelial maladaptation as a central feature of preeclampsia and discuss its anatomic, cellular, and circulating correlates.