Pathogenetic mechanisms of blood-brain barrier dysfunction in preeclampsia

Hypertensive disorders during pregnancy are the most difficult and unresolved problems of modern obstetrics. Today, their frequency ranges from 12 to 40 % and has no downward trend. About 60–70 % of maternal deaths in hypertensive disorders occur due to cerebral complications, due to the development of eclampsia, cerebral edema and stroke. Underestimating the severity of the condition, inadequate treatment and delayed delivery are the main causes of maternal morbidity and mortality. Despite significant advances in understanding the main stages of the pathogenesis of preeclampsia, the mechanisms of damage to cerebral vascular endothelial cells, as well as the features of local paracrine and autocrine regulation of cerebrovascular blood flow in proinflammatory and hypoxic conditions remain relevant for further study. This literature review is devoted to the study of the main mechanisms of disruption and/or damage to the blood-brain barrier in preeclampsia. A systematic analysis of modern Russian and foreign literature was carried out using the information databases eLibrary, Scopus, PubMed, MEDLINE and Cochrane Library for the period from January 2010 to December 2024. Information is provided on the role of vascular endothelial growth factor and its receptor system in increasing transcellular transport, as well as close contact proteins in enhancing the paracellular pathway. The mechanisms of impaired autoregulation of cerebral blood flow leading to the development of vasogenic cerebral edema in preeclampsia and eclampsia are described. Understanding the key links in the pathogenesis of damage to the blood-brain barrier in preeclampsia will allow us to further identify reliable and accessible early predictors of the development of cerebral dysfunction in this complication of pregnancy.

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