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Review
. 2023 Jul;475(7):889-905.
doi: 10.1007/s00424-023-02810-2. Epub 2023 Apr 12.

Dietary supplements and vascular function in hypertensive disorders of pregnancy

Andy W C Man  1 , Yawen Zhou  1 , Ning Xia  1 , Huige Li  2
Affiliations
Review

Dietary supplements and vascular function in hypertensive disorders of pregnancy

Andy W C Man et al. Pflugers Arch. 2023 Jul.

Abstract

Hypertensive disorders of pregnancy are complications that can lead to maternal and infant mortality and morbidity. Hypertensive disorders of pregnancy are generally defined as hypertension and may be accompanied by other end organ damages including proteinuria, maternal organ disturbances including renal insufficiency, neurological complications, thrombocytopenia, impaired liver function, or uteroplacental dysfunction such as fetal growth restriction and stillbirth. Although the causes of these hypertensive disorders of pregnancy are multifactorial and elusive, they seem to share some common vascular-related mechanisms, including diseased spiral arteries, placental ischemia, and endothelial dysfunction. Recently, preeclampsia is being considered as a vascular disorder. Unfortunately, due to the complex etiology of preeclampsia and safety concerns on drug usage during pregnancy, there is still no effective pharmacological treatments available for preeclampsia yet. An emerging area of interest in this research field is the potential beneficial effects of dietary intervention on reducing the risk of preeclampsia. Recent studies have been focused on the association between deficiencies or excesses of some nutrients and complications during pregnancy, fetal growth and development, and later risk of cardiovascular and metabolic diseases in the offspring. In this review, we discuss the involvement of placental vascular dysfunction in preeclampsia. We summarize the current understanding of the association between abnormal placentation and preeclampsia in a vascular perspective. Finally, we evaluate several studied dietary supplementations to prevent and reduce the risk of preeclampsia, targeting placental vascular development and function, leading to improved pregnancy and postnatal outcomes.

Keywords: Cardiovascular diseases; Endothelium; Fetal reprogramming; Nitric oxide; Placenta.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Diagram showing different hypertensive disorders of pregnancy. Gestation hypertension is the increase in blood pressure during pregnancy. Preeclampsia patients have gestation hypertension and accompanied by the occurrence of at least one of the following complications at or after 20 weeks of gestation: proteinuria, maternal organ disturbances including renal insufficiency, neurological complications, thrombocytopenia, impaired liver function, or uteroplacental dysfunction such as fetal growth restriction and stillbirth. Women with chronic hypertension who develop symptoms of preeclampsia are diagnosed with superimposed preeclampsia. Eclampsia is the development of seizures in pre-existing preeclampsia and is a life-threatening emergency condition. Postpartum preeclampsia may also occur when the symptoms of preeclampsia persist in postpartum, which may increase the risk of chronic cardiovascular diseases.
Fig. 2
Fig. 2
Placental dysfunction in hypertensive disorders of pregnancy. The current understanding of the pathogenesis of placental dysfunction in hypertensive disorders of pregnancy. Placenta plays an important role in the development and severity of preeclampsia. It is proposed that the initiating step in the pathogenesis of preeclampsia is the abnormal placentation that characterized by defective trophoblast cell invasion and uterine vasculature remodeling. Placental dysfunction leads to further imbalance in angiogenic factors, increased placental oxidative stress, placental aging and increased endothelial activation markers in the pathogenesis of preeclampsia. These multiple factors can cause adverse effects in both mother and offspring. Endothelial dysfunction leads to end-organ damages in the mother and causes symptoms of preeclampsia. Placental insufficiency can lead to growth restriction and adverse birth outcomes in the offspring. Preeclampsia can also increase the risk of metabolic and cardiovascular diseases in the mother as well as in the later life of the offspring.
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