Гіпертензивні розлади під час вагітності: сучасні аспекти патогенезу, скринінгу та профілактики

Hypertensive disorders of pregnancy, including preeclampsia (PE) and gestational hypertension, are among the most common complications of the gestational period and represent one of the leading causes of maternal and perinatal morbidity and mortality worldwide. They occur in approximately 10% of pregnancies and significantly influence outcomes for both the mother and the child. Women who have experienced these complications are at increased long-term risk of developing arterial hypertension, ischemic heart disease, heart failure, and other metabolic and vascular disorders.The article highlights current insights into the multifactorial pathogenesis of hypertensive disorders in pregnancy. Defective placentation, insufficient trophoblast invasion, impaired spiral artery remodeling, placental ischemia, angiogenic imbalance, oxidative stress, immunological alterations, and endothelial dysfunction have been identified as key mechanisms in these pathologies. Recent studies support the rationale for molecular subclassification of PE, which makes it possible to distinguish different clinical and pathogenetic phenotypes and to develop individualized preventive approaches.Particular attention is given to biomarkers, including placental growth factor, soluble fms-like tyrosine kinase 1 receptor, and soluble endoglin, which reflect angiogenic balance and can be used to predict adverse obstetric and perinatal outcomes. Uterine artery Doppler in the I trimester is emphasized as an important method for early screening of placental disorders.The review discusses prevention strategies supported by evidence-based medicine, recommendations of professional medical societies of various countries, including Ukraine. The most studied and safe interventions are the use of low-dose acetylsalicylic acid and calcium supplementation in women with insufficient dietary calcium intake. Promising directions of prevention and treatment, such as the use of L-arginine, vitamin D, low-molecular-weight heparins, progesterone, and statins, are also analyzed. At the same time, the absence of a universal test or a single preventive strategy able to avert all cases of PE is emphasized.In conclusion, the contemporary concept of screening is based on the integration of clinical risk factors with biochemical and biophysical markers, enabling the identification of high-risk groups and the timely implementation of preventive measures. Future research should aim to refine prediction algorithms, optimize preventive strategies, and evaluate their long-term effectiveness and safety for both mothers and children.