Preeclampsia: a neurogenic conflict between mother and fetus

According to the results of annual monitoring by the Ministry of Health of the Russian Federation and the Federal State Statistics Service, maternal mortality from preeclampsia (PE) and eclampsia remains unstable and shows no consistent downward trend. Currently, there are no diagnostic tests that can reliably predict the development of PE in pregnant women, nor are there therapeutic targets that could prevent the development of this pathological condition long before the onset of pronounced clinical symptoms. The etiopathogenetic cause of preeclampsia remains unknown; a comprehensive, interdisciplinary, and global approach to addressing this problem is required. To understand the true nature of PE, it is necessary to consider the key role of the neurogenic component in the development of this complication: virtually all processes affecting the maternal-fetal relationship involve the brain and its damage. Objective. To present a new perspective on the etiopathogenesis of PE through maternal-fetal neurogenic conflict based on the hypothesis of the key role of the fetal brain and the study of neurocorticogenesis and neuron-specific proteins (NSPs). Conclusion. The presented data allow us to consider NSPs as markers of neurocorticogenesis, and the process of neurocorticogenesis as the formation of the substrate of the cerebral cortex, the structures and functions of higher nervous activity, and key human functions. This allows us to draw a unique conclusion, previously unknown to the scientific community: PE is a neurogenic conflict between mother and fetus during corticogenesis, when the main substrate of higher nervous activity—the neocortex—is formed, determining human life support and consciousness. This work lays the foundation for a broad range of fundamental research to identify innovative diagnostic and therapeutic targets, offering a real opportunity to halt the further and inevitable progression of PE, prevent severe complications for mother and fetus, reverse the unsustainable dynamics of maternal and perinatal morbidity and mortality, and the birth of children with neurological disorders, ensuring the country having healthy offspring.