Preeclampsia after the Seven Quantum Leap Prediction

Abstract

Preeclampsia is the disease of decades. During the 20th century there were seven quantum leaps or discoveries recorded. First, the discovery of the infl atable armband permitting to measure blood pressure in 1896. Second, the discovery that eclamptic (convulsions), and later “pre”eclamptic (proteinuria) women presented hypertension in 1897 and confi rmed in 1903, the discovery of the hypertensive disorders of pregnancy. Third, the eight major textbooks published all along the 20th century by delineating risk factors of preeclampsia with the concept of “preeclampsia, disease of primigravidae”. Fourth, the discovery in the 1970’s that human trophoblast implantation was far deeper than in other mammalian species. Fifth, and a major step forward, description at the end of the 1980’s that the maternal syndrome in preeclampsia (glomeruloendotheliosis, HELLP syndrome, eclampsia) could be unifi ed in a global endothelial cell infl ammation. Sixth, the epidemiological descriptions in the 1970–1990’s that indeed preeclampsia was a disease of fi rst pregnancies at the level of a couple (“primipaternity concept”), leading to an explosion in immunological research in the last decade, beginning in 1998. Seventh and fi nally, in the search for the “factor X” explaining the vascular infl ammation in preeclamptic women (inositol phospho glycans P-type were described in 2000, while soluble Flt-1 and S-endoglins have been clearly predicted since 1997). The majority of the seeds or fi ndings have been grounded or realized in the 20th century. Indeed, for preeclampsia, the 20th century has been le “Siècle des Lumières” (the Enlightenment).1