A 2025-update of “historical evolution of ideas on eclampsia/preeclampsia’’ (2017, workshop reunion 2016)

Abstract

This paper updates the 2017 article, “Historical Evolution of Ideas on clampsia/Preeclampsia: A Proposed Optimistic View of Preeclampsia”, published in the Journal of Reproductive Immunology, incorporating advances in preeclampsia research from 2017 to 2025. Eclampsia, documented for over 5000 years, remains a critical challenge in maternal-fetal medicine. We outline the historical progression of understanding preeclampsia, from early observations of proteinuria and hypertension to modern molecular insights. Key advancements include recognizing preeclampsia as a systemic endothelial disorder, the primipaternity concept, and distinguishing early-onset (EOP) and late-onset (LOP) preeclampsia. A 2024 study reaffirms primipaternity as a major risk factor, resolving a 22-year debate over birth intervals. We explore inositol phosphoglycans P-type (IPG-P) as a specific biomarker, antiangiogenic factors like sFlt-1, and proteomic subclassifications identifying four molecular subtypes. Additionally, 75 % of fetal growth restriction (FGR, i.e. known pathological ultrasound Doppler) cases occur without maternal preeclampsia, suggesting an evolutionary protective mechanism. Despite progress, affordable treatments remain elusive, particularly for low-income countries. Targeting IPG-P, pravastatin, or ergothioneine, and leveraging proteomic insights, could lead to breakthroughs in preeclampsia prevention and treatment, potentially resolving related conditions like FGR and preterm birth.