Preeclampsia as a Maternal-Fetal Conflict

Michel Odent, MD

In This Article


The association of preeclampsia with both high and low birth weight challenges the current belief that reduced uteroplacental perfusion is the unique pathophysiologic process in preeclampsia. Preeclampsia is thus presented from a new perspective, in the framework of maternal/fetal conflict.

Interspecies comparisons encourage us to raise new questions concerning the potential for conflict among humans. The spectacular brain growth spurt during the second half of fetal life is a specifically human trait. A conflict between the demands expressed by the fetus and what the mother can do without depleting her body leads us to consider first the needs of the developing brain.

There is a widespread belief that reduced uteroplacental perfusion is the central pathophysiologic process in preeclampsia. This belief is challenged by several puzzling aspects of the disease. For example, a study[1] looking at 97,270 births in 35 hospitals in Alberta, Canada, revealed that there is a significant association between preeclampsia and large-for-gestational-age infants, in addition to the well-known association with small-for-gestational age infants. Such findings are more easily interpreted if this multifactorial syndrome is presented as an expression of a maternal/fetal conflict. From this perspective, it is plausible that a large fetus's high demand for nutrients can be the root of conflict. Faulty placentation, inadequate maternal nutrition, and certain combinations of maternal and fetal genotypes are other factors that can independently increase the probability of conflict.

The common tendency to confuse gestational hypertension -- which is not associated with proteinuria -- and preeclampsia is an obstacle to understanding the nature of the disease. Several epidemiologic studies confirm that gestational hypertension is followed by good perinatal outcomes.[2,3,4,5] According to the most common definitions, preeclampsia implies the association of high blood pressure and the presence of more than 300 mg of protein in the urine per 24 hours (unrelated to urinary tract infection). There are usually other detectable metabolic imbalances.


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