The Triadic Imbalance Syndrome of Pregnancy: A Conceptual Reframing of Preeclampsia and Related Obstetric Disorders Through the Demand–Supply–Variability (C-O-V) Framework

This essay proposes a conceptual reframing of preeclampsia and related obstetric disorders. The central proposition is that the maternal-placental dyad which has structured obstetric thinking since Redman articulated the two-stage model in 1991 should be extended into a triadic process in which the fetus is recognized as the third active biological agent. The framework is articulated through the operational shorthand C-O-V, where C stands for fetal demand (cerere), O for placental supply (ofertă), and V for the biological Variability of the maternal vertex — the integrated ensemble of inter-individual maternal biological variation that conditions both placental supply and maternal clinical response. The central claim is that pathology of the gestational interface arises when integrated demand C exceeds integrated supply O, and that the maternal biological variability V translates this imbalance into clinical phenotypes whose specific configuration depends on the spectral profile of each vertex. The framework is offered at three epistemic levels: as explanatory architecture (a vocabulary for situating existing mechanistic findings in a single coherent space), as predictive instrument (the central testable prediction is the existence of a clinically silent high-C, minimal-V phenotype that escapes current screening systematically), and as nomenclatural invitation (a tentative reorganization of obstetric nosology around the triadic process). The framework's articulation across fifteen empirically dissociable axes (six on V, five on O, four on C) and five spectral signaling channels is presented alongside — not against — the placental-pathology taxonomy of Romero/Redline, the PRECISE Network's hierarchical determinants framework, and the cardiovascular reassertion of Thilaganathan/Melchiorre. Version notes: This is the English version (v2.0) of the framework. The Romanian original (v1.0) was deposited on Zenodo in April 2026 (concept DOI 10.5281/zenodo.19885101). The framework's central intuition was first articulated by MBM in April 2015 as "A new theory of etiology of preeclampsia: hungry fetus versus placental insufficiency" (ResearchGate, public archive). This v2.0 EN expands the bibliography to 69 prospectively validated references (96% PMID-verified, 32 marked as pivotal), integrates three original figures (Triadic Process; Spectral Articulation; Temporal Architecture of FMF Screening Windows), and adds Part VIII (the predictive program) articulating five proposed prospective studies with operational pathways for empirical validation. The framework is offered as a conceptual contribution open to empirical validation, refinement, or refutation. It is not a peer-reviewed publication.