Dovepress factor, endoglin, and vascular endothelial growth factor during the f irst or second trimester. Increased vascular endothelial growth factor and endoglin levels, combined with increased sFlt-1 and decreased placental growth factor during the first trimester, is associated with a significantly increased risk of pre-eclampsia.20 Improved prediction of pre-eclampsia has been noticed when serum markers are combined with Doppler indices. In a recent nested case-control study, second trimester maternal serum cystatin C, C-reactive protein, and uterine artery mean resistance index were observed to be independent predictors of pre-eclampsia.45 Secondary prevention is based on antiplatelet aspirin therapy, which reduces the risk of pre-eclampsia by 10% in women who have at least one risk factor.46 No study currently allows determination of the exact dosage or the best time for initiation of aspirin. However, aspirin should be initiated as early as possible, ie, before 12–14 weeks, which corresponds to the beginning of the first phase of trophoblast invasion. The efficacy of aspirin has been shown only in women with previous pre-eclampsia asso- ciated with intrauterine growth retardation and without thrombophilia. Low molecular weight heparin is indicated only in cases of complicated thrombophilia (history of thromboembolic complications or of pre-eclampsia).47 Calcium supplementation at a dosage of 1.5 g/day, begin- ning at 15 weeks and continued throughout the pregnancy, is recommended for prevention of pre-eclampsia in women with a daily calcium intake ,600 mg/day.48 The statins, which stimulate HO-1 expression and inhibit sFlt-1 release, could have the potential to ameliorate early-onset pre-eclampsia.20 Other treatments, such as antioxidant treatment by vitamins C and E, oligoelements, and nitric oxide have no proven efficacy.6 Conclusion Pre-eclampsia is a rare pregnancy-related disease with an unpredictable course that can have serious consequences for both the mother and the fetus. The treatment is sim- ple, ie, delivery. Nonetheless, induced preterm delivery requires careful weighing of both maternal and fetal risk– benefit. Accordingly, identifying delivery criteria in case of pre-eclampsia is crucial to optimal management. Current research focuses on the prediction of onset of pre-eclampsia or even severe pre-eclampsia so as to allow early manage- ment and improve the morbidity and mortality associated with this disease. Specific tools for secondary prevention must also be developed for recurrent pre-eclampsia. Vascular Health and Risk Management 2011:7 Pre-eclampsia Disclosure The authors report no conflicts of interest in this work. References 1. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365: 785–799. 2. Pottecher T, Luton D. Prise en Charge Multidisciplinaire de la Prééclampsie. Issy Les Moulineaux, France: Elsevier Masson SAS; 2009. French. 3. Carty DM, Delles C, Dominiczak AF. Preeclampsia and future maternal health. J Hypertens. 2010;28:1349–1355. 4. Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33:130–137. 5. Zhang J, Zeisler J, Hatch MC, Berkowitz G. Epidemiology of pregnancy-induced hypertension. Epidemiol Rev. 1997;19:218–232. 6. Barton JR, Sibai BM. Prediction and prevention of preeclampsia. Obstet Gynecol. 2008;112(2 Pt 1):359–372. 7. Rijhsinghani A, Yankowitz J, Strauss AR, et al. Risk of preeclampsia in second-trimester triploid pregnancies. Obstet Gynecol. 1997;90: 884–888. 8. Julian CG. High altitude during pregnancy. Clin Chest Med. 2011;32: 21–31. 9. Meads CA, Cnossen JS, Meher S, et al. Methods of prediction and prevention of preeclampsia: systematic reviews of accuracy and effec- tiveness literature with economic modelling. Health Technol Assess. 2008;12:1–270. 10. Osmond C, Kajantie E, Forsén TJ, Eriksson JG, Barker DJ. Infant growth and stroke in adult life: the Helsinki Birth Cohort Study. Stroke. 2007;38:264–270. 11. Eriksson JG, Forsén T, Tuomilheto J, Osmond C, Barker DJ. Early growth and coronary heart disease in later life: longitudinal study. BMJ. 2001;322:949–953. 12. Barker DJ, Martyn CN, Osmond C, Hales CN, Fall CH. Growth in utero and serum cholesterol concentrations in adult life. BMJ. 1993; 307:1524–1527. 13. Fisher SJ, McMaster M, Roberts M. The placenta in normal pregnancy and preeclampsia. In: Chesley’s Hypertensive Disorders in Pregnancy. Amsterdam, the Netherlands: Academic Press, Elsevier; 2009. 14. Duran-Reyes G, Gomes-Melendez MR, Morali De La Brena G, Mrecado- Pichardo E, Medina-Navarro R, Hicks-Gomez JJ. Nitric oxide synthesis inhibition suppresses implantation and decreases CGMP concentration and protein peroxidation. Life Sci. 1999;65:2259–2268. 15. Roberts JM. Endothelial dysfunction in preeclampsia. Semin Reprod Endocrinol. 1998;16:5–15. 16. Mutze S, Rudnik-Schoneborn S, Zerres K, Rath W. Genes and the preeclampsia syndrome. J Perinat Med. 2008;36:38–58. 17. Genbacev O, Difederico E, McMaster M, Fisher SJ. Invasive cytotro- phoblast apoptosis in pre-eclampsia. Hum Reprod. 1999;14:59–66. 18. Colbern GT, Chiang MH, Main EK. Expression of the nonclassic histocompatibility antigen HLA-G by preeclamptic placenta. Am J Obstet Gynecol. 1994;170:1244–1250. 19. Nilsson E, Salonen Ros H, Cnattingius S, Lichtenstein P. The impor- tance of genetic and environmental effects for pre-eclampsia and gestational hypertension: a family study. BJOG. 2004;111:200–206. 20. Ahmed A. New insights into the etiology of preeclampsia: identification of key elusive factors for the vascular complications. Thromb Res. 2011;127(Suppl 3):S72–S75. 21. [No authors listed]. Report of the National High Blood Pressure Educa- tion Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol. 2000;133:S1–S22. 22. Multidisciplinary management of severe pre-eclampsia (PE). Experts’ guidelines 2008. Société française d’anesthésie et de réanimation. Collège national des gynécologues et obstétriciens français. Société française de médecine périnatale. Société française de néonatalogie. Ann Fr Anesth Reanim. 2009;28:275–281. submit your manuscript | www.dovepress.com Dovepress 473