Preeclampsia, one of the hypertensive disorders of pregnancy, remains a leading cause of
maternal death worldwide, with the majority of deaths occurring in developing countries.
Preeclampsia is a multi-organ syndrome of pregnancy that manifests after 20 weeks' gestation
with new-onset hypertension alongside maternal end-organ dysfunction and/or fetal growth
restriction. Importantly, preeclampsia poses serious health risks for the baby, implicated in
12% of cases of fetal growth restriction, and is a known antecedent in up to 19% of preterm
births. There is currently no effective treatment for preeclampsia except delivery of the
baby, and as such, it remains a significant burden of disease for both mothers and their
babies worldwide. Screening for women at risk of preeclampsia is an important part of
antenatal care. Once women are identified as high risk, they can be targeted for more
intensive antenatal surveillance and prophylactic interventions. Most current strategies for
risk assessment are based on obstetric and medical history and clinical examination. However,
there is surprisingly little reliable evidence on the actual risk associated with individual
factors and how they might interact. Risk factors with a particularly high association with
preeclampsia (more than one in ten risks) include maternal diabetes, chronic hypertension,
and renal disease. Thrombophilia and autoimmune disease have a strong association with severe
early-onset preeclampsia. Obstetric factors associated with high risk are multiple
pregnancies, history of preeclampsia in a previous pregnancy especially if severe or early
onset, and a current hydropic pregnancy. Other factors linked with preeclampsia but
associated with a somewhat lower risk include first pregnancies, age less than 20 or more
than 35 years, a family history of preeclampsia, and obesity. Proton pump inhibitors such as
esomeprazole have long-term safety data about the treatment of gastric reflux in pregnancy.
In vitro studies show proton pump inhibitors decrease soluble fems like tyrosine kinase -1
(sFlt-1) and soluble endoglin and improve markers of endothelial dysfunction . while
esomeprazole reduces blood pressure in a preeclampsia transgenic mouse model that
overexpresses sFlt-1.