Introduction, history, controversies, and definitions

Marshall D. Lindheimer; Robert N. Taylor; James M. Roberts; F. Gary Cunningham; Leon Chesley

doi:10.1016/B978-0-12-407866-6.00001-8

Introduction, history, controversies, and definitions

Marshall D. Lindheimer, Robert N. Taylor, James M. Roberts, F. Gary Cunningham, Leon Chesley

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Abstract

This chapter contains Leon Chesley’s introduction from his sole-authored first edition, including an in-depth and scholarly review of our knowledge of preeclampsia through the ages. Also included is his lecture, "False steps in the history of preeclampsia," presented in September 1975 at an International Workshop; both meeting and lecture considered the impetus for renewed focus on this devastating disease. The chapter also contains an "EDITORS’ UPDATE" summarizing progress made since Chesley’s single-authored first edition, including the new classification schema in the American College of Obstetricians and Gynecologists’ Hypertension Task Force 2013 recommendations.

Original language	English (US)
Title of host publication	Chesley's Hypertensive Disorders in Pregnancy, Fourth Edition
Publisher	Elsevier Science
Pages	1-24
Number of pages	24
ISBN (Electronic)	9780124078666
DOIs	https://doi.org/10.1016/B978-0-12-407866-6.00001-8
State	Published - Jan 1 2014

Keywords

Classification schema
History of preeclampsia
Introduction

ASJC Scopus subject areas

General Medicine

Access to Document

10.1016/B978-0-12-407866-6.00001-8

Cite this

@inbook{34776e2778354c6d9258d7f343ccbf23,

title = "Introduction, history, controversies, and definitions",

abstract = "This chapter contains Leon Chesley{\textquoteright}s introduction from his sole-authored first edition, including an in-depth and scholarly review of our knowledge of preeclampsia through the ages. Also included is his lecture, {"}False steps in the history of preeclampsia,{"} presented in September 1975 at an International Workshop; both meeting and lecture considered the impetus for renewed focus on this devastating disease. The chapter also contains an {"}EDITORS{\textquoteright} UPDATE{"} summarizing progress made since Chesley{\textquoteright}s single-authored first edition, including the new classification schema in the American College of Obstetricians and Gynecologists{\textquoteright} Hypertension Task Force 2013 recommendations.",

keywords = "Classification schema, History of preeclampsia, Introduction",

author = "Lindheimer, {Marshall D.} and Taylor, {Robert N.} and Roberts, {James M.} and {Gary Cunningham}, F. and Leon Chesley",

note = "Funding Information: Chesley{\textquoteright}s original introductory chapter, reproduced above, had been composed before 1976, while at about the same time, and with Leon{\textquoteright}s support and blessing, Drs. Lindheimer and Zuspan, at the University of Chicago, were organizing a National Institutes of Health supported International Workshop focusing on the Hypertensive Disorders of Pregnancy. The primary goal of the meeting, held 25–27 September 1975, as stated in the preface of its proceedings, 117 was that: “ Hypertension, especially preeclampsia, is a major complication of pregnancy causing significant morbidity and mortality in both fetus and mother. Nevertheless, research on the hypertensive complications of pregnancy has been sporadic, and scientists studying this and related fields have rarely communicated . ” The primary goal, further stated, was to “ stimulate investigative efforts in the field and to establish avenues of communication between clinical and laboratory scientists in various disciplines .” The workshop, composed of ~60 invitees with diverse research and clinical disciplines, shared views, data, argued profusely at times, and parted energized with new perspectives. The meeting achieved its immediate goals, communication between disciplines and stimulation of further research, and was also the impetus to the establishment of a new organization, the International Society for the Study of Hypertension in Pregnancy (ISSHP) that has held biennial meetings starting in 1978. More important, the workshop{\textquoteright}s long-term goals, implied as well in Leon{\textquoteright}s sole authored first edition, have been realized, namely, there are now more and more investigators focusing attention on a critical but neglected area of maternal and fetal health. Thus, as noted in this chapter{\textquoteright}s introduction, the 1980s and 1990s were characterized by an awakening of the need for focused research, producing at first new and important findings that affected both clinical and research approaches, followed by a logarithmic growth in investigative breakthroughs that have characterized the first decade of this millennium. Physicians now recognize preeclampsia as a systemic disease, more than just hypertension and proteinuria, 118 and investigators keep uncovering a panoply of pathophysiological changes associated with preeclampsia. In addition we are now witnessing initial probes into specific therapies based on findings that relate to uncovered mechanisms.(e.g., ref. 119 ). One should note that this renewed emphasis on reversing the morbidity and mortality associated with hypertension and pregnancy has not gone by unnoticed. National and international agencies including the World Health Organization, the National Institutes of Health in the United States (e.g., their Heart Lung and Blood, as well as Child and Health Development Institutes), and the Royal College of Obstetrics and Gynaecology (London), among them, have all either convened study groups that summarized needs, or formulated policy statements underscoring the status of knowledge in the field, or the enormous underfunding that exists in this important area of reproductive medicine that must be addressed. Still it is fair to say that as of 2014 research support especially in regard to preeclampsia remains near the bottom in terms of Disability Adjusted Lost Years (DALYs), despite the fact this disease remains a leading cause of maternal and fetal death. The chapters that follow include, among other topics, attention to new findings regarding normal and abnormal placentation, roles of circulating molecules that include altered hormone levels and proteins and/or other substances of placental origin, autocoids, as well as the physiology and pathophysiology of the cardiovascular system (especially the endothelium). New, also, is a rapidly expanding interest in the contribution of the maternal constitution, both genetic and environmental, and a better understanding of the normal and abnormal cerebral circulation. Also highlighted is exciting new work relating to immunology, epigenetics, the systemic inflammatory and antioxidant states, as well as potential mechanisms behind the occurrence of eclampsia. A topic of special interest, virtually unstudied until 2003, is the exciting role of antiangiogenic factors in the production of preeclampsia phenotypes, and its emerging role in triage of women with early preeclampsia. Finally, we note that Leon Chesley{\textquoteright}s landmark study 120 of the remote prognosis of eclampsia in which he personally investigated each individual{\textquoteright}s outcome for as long as 40 years after their the index pregnancy has spurred newer and larger epidemiological surveys that have established preeclampsia as a risk marker for future cardiac and metabolic disease. We now know women who have manifested de novo hypertension in pregnancy, including preeclampsia, require closer scrutiny throughout life and interventions such as early life-style changes may alter their remote outcomes. All of the accomplishments alluded to above and more will be amply cited in the chapters that follow. This optimistic introduction, however, must be tempered a bit, as unsolved problems and controversies remain. For example, the exact etiologies of both preeclampsia and eclampsia are still unclear (and such clarification is a key step if definitive preventative and therapeutic strategies are to be achieved). The remainder of this Editors{\textquoteright} Update focuses on two of the controversies, measurement of blood pressure during gestation, this controversy now resolved, and progress toward agreement on classification schemas. Publisher Copyright: {\textcopyright} 2015 Elsevier Inc. All rights reserved.",

year = "2014",

month = jan,

day = "1",

doi = "10.1016/B978-0-12-407866-6.00001-8",

language = "English (US)",

pages = "1--24",

booktitle = "Chesley's Hypertensive Disorders in Pregnancy, Fourth Edition",

publisher = "Elsevier Science",

address = "United Kingdom",

}

TY - CHAP

T1 - Introduction, history, controversies, and definitions

AU - Lindheimer, Marshall D.

AU - Taylor, Robert N.

AU - Roberts, James M.

AU - Gary Cunningham, F.

AU - Chesley, Leon

N1 - Funding Information: Chesley’s original introductory chapter, reproduced above, had been composed before 1976, while at about the same time, and with Leon’s support and blessing, Drs. Lindheimer and Zuspan, at the University of Chicago, were organizing a National Institutes of Health supported International Workshop focusing on the Hypertensive Disorders of Pregnancy. The primary goal of the meeting, held 25–27 September 1975, as stated in the preface of its proceedings, 117 was that: “ Hypertension, especially preeclampsia, is a major complication of pregnancy causing significant morbidity and mortality in both fetus and mother. Nevertheless, research on the hypertensive complications of pregnancy has been sporadic, and scientists studying this and related fields have rarely communicated . ” The primary goal, further stated, was to “ stimulate investigative efforts in the field and to establish avenues of communication between clinical and laboratory scientists in various disciplines .” The workshop, composed of ~60 invitees with diverse research and clinical disciplines, shared views, data, argued profusely at times, and parted energized with new perspectives. The meeting achieved its immediate goals, communication between disciplines and stimulation of further research, and was also the impetus to the establishment of a new organization, the International Society for the Study of Hypertension in Pregnancy (ISSHP) that has held biennial meetings starting in 1978. More important, the workshop’s long-term goals, implied as well in Leon’s sole authored first edition, have been realized, namely, there are now more and more investigators focusing attention on a critical but neglected area of maternal and fetal health. Thus, as noted in this chapter’s introduction, the 1980s and 1990s were characterized by an awakening of the need for focused research, producing at first new and important findings that affected both clinical and research approaches, followed by a logarithmic growth in investigative breakthroughs that have characterized the first decade of this millennium. Physicians now recognize preeclampsia as a systemic disease, more than just hypertension and proteinuria, 118 and investigators keep uncovering a panoply of pathophysiological changes associated with preeclampsia. In addition we are now witnessing initial probes into specific therapies based on findings that relate to uncovered mechanisms.(e.g., ref. 119 ). One should note that this renewed emphasis on reversing the morbidity and mortality associated with hypertension and pregnancy has not gone by unnoticed. National and international agencies including the World Health Organization, the National Institutes of Health in the United States (e.g., their Heart Lung and Blood, as well as Child and Health Development Institutes), and the Royal College of Obstetrics and Gynaecology (London), among them, have all either convened study groups that summarized needs, or formulated policy statements underscoring the status of knowledge in the field, or the enormous underfunding that exists in this important area of reproductive medicine that must be addressed. Still it is fair to say that as of 2014 research support especially in regard to preeclampsia remains near the bottom in terms of Disability Adjusted Lost Years (DALYs), despite the fact this disease remains a leading cause of maternal and fetal death. The chapters that follow include, among other topics, attention to new findings regarding normal and abnormal placentation, roles of circulating molecules that include altered hormone levels and proteins and/or other substances of placental origin, autocoids, as well as the physiology and pathophysiology of the cardiovascular system (especially the endothelium). New, also, is a rapidly expanding interest in the contribution of the maternal constitution, both genetic and environmental, and a better understanding of the normal and abnormal cerebral circulation. Also highlighted is exciting new work relating to immunology, epigenetics, the systemic inflammatory and antioxidant states, as well as potential mechanisms behind the occurrence of eclampsia. A topic of special interest, virtually unstudied until 2003, is the exciting role of antiangiogenic factors in the production of preeclampsia phenotypes, and its emerging role in triage of women with early preeclampsia. Finally, we note that Leon Chesley’s landmark study 120 of the remote prognosis of eclampsia in which he personally investigated each individual’s outcome for as long as 40 years after their the index pregnancy has spurred newer and larger epidemiological surveys that have established preeclampsia as a risk marker for future cardiac and metabolic disease. We now know women who have manifested de novo hypertension in pregnancy, including preeclampsia, require closer scrutiny throughout life and interventions such as early life-style changes may alter their remote outcomes. All of the accomplishments alluded to above and more will be amply cited in the chapters that follow. This optimistic introduction, however, must be tempered a bit, as unsolved problems and controversies remain. For example, the exact etiologies of both preeclampsia and eclampsia are still unclear (and such clarification is a key step if definitive preventative and therapeutic strategies are to be achieved). The remainder of this Editors’ Update focuses on two of the controversies, measurement of blood pressure during gestation, this controversy now resolved, and progress toward agreement on classification schemas. Publisher Copyright: © 2015 Elsevier Inc. All rights reserved.

PY - 2014/1/1

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N2 - This chapter contains Leon Chesley’s introduction from his sole-authored first edition, including an in-depth and scholarly review of our knowledge of preeclampsia through the ages. Also included is his lecture, "False steps in the history of preeclampsia," presented in September 1975 at an International Workshop; both meeting and lecture considered the impetus for renewed focus on this devastating disease. The chapter also contains an "EDITORS’ UPDATE" summarizing progress made since Chesley’s single-authored first edition, including the new classification schema in the American College of Obstetricians and Gynecologists’ Hypertension Task Force 2013 recommendations.

AB - This chapter contains Leon Chesley’s introduction from his sole-authored first edition, including an in-depth and scholarly review of our knowledge of preeclampsia through the ages. Also included is his lecture, "False steps in the history of preeclampsia," presented in September 1975 at an International Workshop; both meeting and lecture considered the impetus for renewed focus on this devastating disease. The chapter also contains an "EDITORS’ UPDATE" summarizing progress made since Chesley’s single-authored first edition, including the new classification schema in the American College of Obstetricians and Gynecologists’ Hypertension Task Force 2013 recommendations.

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KW - History of preeclampsia

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PB - Elsevier Science

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Introduction, history, controversies, and definitions

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