The Social Conditions in the Genesis of Preeclampsia


This article highlights the importance of preeclampsia as a global public health problem and the lack of a satisfactory model to explain its genesis. Scientific advances relevant to the placental pathophysiology, which have resulted in a deeper understanding of the immunological mechanisms associated to preeclampsia and have been translated into better treatment options, are also highlighted, although to date these approaches cannot explain the origin of the disease. From a theoretical approach underpinned by the concepts related to the social determinants of the health, and specifically from current psychosocial epidemiology, an alternative approach that gives account for the genesis of preeclampsia is proposed. The proposal is based in the scientific literature as well as in the work of the authors; it takes as references unfavorable socioeconomic and psychosocial conditions in pregnant women, linking these conditions to a series of failed adaptive biological processes closely related to an ineffective allostatic response by the body, which ultimately determines the occurrence of the disease.

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Salvador-Moysén, J. , Martínez-López, Y. , Ramírez-Aranda, J. , Aguilar-Durán, M. and Reyes-Romero, M. (2014) The Social Conditions in the Genesis of Preeclampsia. Open Journal of Epidemiology, 4, 115-121. doi: 10.4236/ojepi.2014.43016.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Duley, L. (2009) The Global Impact of Pre-Eclampsia and Eclampsia. Seminars in Perinatology, 33, 130-137.
[2] Mikat, B., Gellhaus, A., Wagner, N., Birdir, C., Kimmig, R. and Koninger, A. (2012) Early Detection of Maternal Risk for Preeclampsia. ISRN Obstetrics and Gynecology, 2012, Article ID: 172808, 7 pages.
[3] Lopez-Llera, M. (1995) Complexity and Complicity in Eclampsia: Barriers or Bridges? Medical Hypotheses, 45, 591-601.
[4] Dekker, G. and Sibai, B. (2001) Primary, Secondary and Tertiary Prevention of Preeclampsia. Lancet, 357, 209-215.
[5] Roberts, J.M. and Cooper, DW. (2001) Pathogenesis and Genetics of Preeclampsia. Lancet, 357, 53-56.
[6] Luft, F.C. (2003) Pieces of the Preeclampsia Puzzle. Nephrology Dialysis Transplantation, 18, 2209-2210.
[7] Podjarny, E., Losanczy, G. and Baylis, C. (2004) Animals Models of Preeclampsia. Seminars in Perinatology, 24, 596-606. S0146-0005(99)80055-X
[8] Furuya, M., Kurasawa, K., Nagahama, K., et al. (2011) Disrupted Balance of Angiogenic and Antiangiogenic Signaling in Preeclampsia. Journal of Pregnancy, 2011, Article ID: 123717, 10 pages.
[9] Maynard, S.E., Min, J.Y., Merchan, J., et al. (2003) Excess Placental Soluble Fms-Like Tyrosine Kinase 1 (sFlt1) May Contribute to Endothelial Dysfunction, Hypertension, and Proteinuria in Preeclampsia. Journal of Clinical Investigation, 111, 649-658.
[10] Cassel, J. (1976) The Contribution of the Social Environment to Host Resistance. American Journal of Epidemiology, 104, 107-123.
[11] Cassel, J. (1974) Psychosocial Processes and “Stress”: Theoretical Formulation. International Journal of Health Services, 4, 471-482.
[12] Cervantes, R. and Castro, F. (1985) Stress, Coping and Mexican American Mental Health: A Systematic Review. Hispanic Journal of Behavioral Science, 7, 1-73.
[13] Sheehan, J. (1998) Stress and Low Birth Weight: A Structural Modeling Approach Using Real Life Stressors. Social Science Medicine, 47, 1503-1512.
[14] Stone, A., Mezzacappa, E., Donatone, B. and Gonder, M. (1999) Psychosocial Stress and Social Support Are Associated with Prostate-Specific Antigen Levels in Men: Results from a Community Screening Program. Health Psychology, 18, 482-486.
[15] Butler, L., Koopman, Ch., Classen, C. and Spiegel, D. (1999) Traumatic Stress, Life Events, and Emotional Support in women with Metastatic Breast Cancer: Cancer Related Traumatic Stress Symptoms Associated with Past and Current Stressors. Health Psychology, 18, 555-560.
[16] Wamala, S.P., Mittleman, M.A., Horsten, M., Schenck-Gustafsson, K. and Orth-Gomér, K. (2000) Job Stress and the Occupational Gradient in Coronary Heart Disease Risk in Women. The Stockholm Female Coronary Risk Study. Social Science & Medicine, 51, 481-489.
[17] Krieger, N. (2011) Epidemiology and The People’s Health. Oxford & New York: Oxford University Press.
[18] Richardson, D.M. and Nuru-Jeter, A.M. (2011) Neighborhood Contexts Experienced by Young Mexican-American Women: Enhancing Our Understanding of Risk for Early Childbearing. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 89, 59-73.
[19] Messer, L.C., Maxson, P. and Miranda, M.L. (2012) The Urban Built Environment and Associations with Women’s Psychosocial Health. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 90, 857-871.
[20] Roux, A.V.D. (2001) Investigating Neighborhood and Area Effects on Health. American Journal of Public Health, 91, 1783-1789.
[21] Kennedy, B., Kawachi, I. and Prothrow-Stih, D. (1996) Income Distribution and Mortality: Cross Sectional Ecology Study of the Robin Hood Index in the United States. BMJ, 312, 1004-1007.
[22] Branas, C., Rubin, D. and Guo, W. (2012) Vacant Properties and Violence in Neighborhoods. ISRN Public Health, 2012, Article ID: 246142.
[23] Berkman, L. and Clark, C. (2003) Neighborhoods and Networks: The Construction of Safe Places and Bridges. In: Kawachi, I. and Berkman, L., Eds, Neighborhoods and Health, Oxford University Press, Oxford & New York, 288-302.
[24] Marmot M. (2004) The Status Syndrome: How Social Standing Affects Our Health and Longevity. Henry Holt and Company, New York.
[25] Sterling, P. (2004) Principles of Allostasis: Optimal Design, Predictive Regulation, Pathophysiology, and Rational Therapeutics. In: Schulkin, J., Ed., Allostasis, Homeostasis, and the Costs of Physiological Adaptation, Cambridge University Press, Cambridge, 17-64.
[26] McEwen, B. (2007) Physiology and Neurobiology of Stress and Adaptation: Central Role of the Brain. Physiological Reviews, 87, 873-904.
[27] McEwen, B. (2007) Central Effects of Stress Hormones in Health and Disease: Understanding the Protective and Damaging Effects of Stress and Stress Mediators. European Journal of Pharmacology, 583, 174-185.
[28] McEwen, B. and Norton, E. (2004) The End of Stress as We Know It. DANA Press, Washington DC.
[29] Ganzel, B., Morris, P. and Wethington, E. (2010) Allostasis and the Human Brain: Integrating Models of Stress from the Social and Life Sciences. Physiological Reviews, 117, 134-174.
[30] Sibai, B., Dekker, G. and Kupferminc, M. (2005) Pre-Eclampsia. The Lancet, 365, 785-799.
[31] Nelissen, E.C., van Montfoort, A.P., Dumoulin, J.C. and Evers, J.L. (2011) Epigenetics and Placenta. Human Reproduction Update, 17, 397-417.
[32] Wilton, A.N., Cooper, D.W., Brennecke, S.P., Bishop, S.M. and Marshall, P. (1990) Absence of Close Linkage between Maternal Genes for Susceptibility to Pre-Eclampsia/Eclampsia and HLA DRβ. The Lancet, 336, 653-657.
[33] Humphrey, K.E., Harrison, G.A., Cooper, D.W., Wilton, A.N., Brennecke, S.P. and Trudinger, B.J. (1995) HLA-G Deletion Polymorphism and Pre-Eclampsia/Eclampsia. BJOG: An International Journal of Obstetrics & Gynaecology, 102, 707-710.
[34] Tanaka, M., Jaamaa, G., Kaiser, M., Hills, E., Soim, A., Zhu, M., Shcherbatykh, I.Y., et al. (2007) Racial Disparity in Hypertensive Disorders of Pregnancy in New York State: A 10-Year Longitudinal Population-Based Study. American Journal of Public Health, 97, 163-170.
[35] Klebanoff, M., Shiono, P. and Rhoads, G. (1990) Outcomes of Pregnancy in a National Sample of Resident Physicians. The New England Journal of Medicine, 323, 1040-1045.
[36] Erickson, M. (1976) The Relationship between Psychological Variables and Specific Complications of Pregnancy, Labor and Delivery. Journal of Psychosomatic Research, 20, 207-210.
[37] Herrera, J.A., Ersheng, G., Shahabuddin, A.K.M., Lixia, D., Wei, Y., Faisal, M., et al. (2006) Evaluación periódica del riesgo biopsicosocial prenatal en la predicción de las complicaciones maternas y perinatales en Asia 2002-2003. Colombia Médica, 37, 6-14.
[38] Landsbergis, P. and Hatch, M. (1996) Psychosocial Work Stress and Pregnancy-Induced Hypertension. Epidemiology, 7, 346-351.
[39] Abeysena, C., Jayawardana, P. and Seneviratne, R. (2010) Effect of Psychosocial Stress on Maternal Complications during Pregnancy: A Cohort Study. International Journal of Collaborative Research on Internal Medicine & Public Health, 2, 436-448.
[40] Salvador, J., Martínez, Y., Lechuga, A., Terrones, A. and Ruiz, R. (2000) Situación psicosocial de las adolescentes y toxemias del embarazo. Salud Pública de México, 42, 99-105.
[41] Salvador-Moysén, J., Martínez-López, Y., Lechuga-Quinones, A.M. and Terrones-González, A. (2005) Hipertensión inducida por el embarazo enadolescentes: Un estudio multicéntrico. Ansiedad y Estrés, 11, 17-25.
[42] Landsbergis, P.A., Dobson, M., Koutsouras, G. and Schnall, P. (2013) Job Strain and Ambulatory Blood Pressure: A Meta-Analysis and Systematic Review. American Journal of Public Health, 103, e61-e71.
[43] Vianna, P., Bauer, M., Dornfeld, D. and Chies, J.A. (2011) Distress Conditions during Pregnancy May Lead to Pre-Eclampsia by Increasing Cortisol Levels and Altering Lymphocyte Sensitivity to Glucocorticoids. Medical Hypotheses, 77, 188-191.
[44] Hogg, K., Blair, J.D., McFadden, D.E., von Dadelszen, P. and Robinson, W.P. (2013) Early Onset Pre-Eclampsia Is Associates with Altered DNA Methylation of Cortisol-Signalling and Steroidogenic Genes in the Placenta. PLoS ONE, 8, e62969.
[45] Salvador-Moysén, J., Ramírez-Aranda, J.M., Martínez-López, Y. and Aguilar-Durán, M. (2012) Salivary Cortisol Levels as a Predictor of Preeclampsia in Adolescents. Colombia Médica, 43, 46-53.
[46] Aguilar-Durán, M. (2012) Estudio de los polimorfismos -800G/A, -509C/T y 869T/C del gen TGβ1 y del cortisol salivario en el desarrollo de preeclampsia en adolescentes embarazadas. Ph.D. Dissertation, Universidad Juárez del Estado de Durango, Durango.
[47] Viniegra, L. (2003) Hacia un concepto de salud colectiva. In: Viniegra, L., Ed., La crítica: Aptitud olvidada por la educación, 2nd Edition, Instituto Mexicano del Seguro Social, Ciudad de México, 89-107.
[48] Sampson, R.J. (2003) Neighborhood-Level Context and Health: Lessons from Sociology. In: Kawachi, I. and Berkman, L., Eds., Neighborhoods and Health, Oxford University Press, Oxford & New York, 132-146.
[49] Tejera, E., Bernardes, J. and Rebelo, I. (2012) Preeclampsia: A Bioinformatics Approach through Protein-Protein Interaction Networks Analysis. BMC Systems Biology, 6, 97.

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