What do we know about redox status? A review in neonates of mothers with preeclampsia

BACKGROUND: Preeclampsia (PE) is a leading cause of maternal and perinatal morbimortality worldwide, driven by oxidative stress from an imbalance between reactive oxygen and nitrogen species and antioxidant defenses. Neonates born to mothers with PE face an oxidized intrauterine environment, yet their antioxidant response and potential therapeutic strategies remain insufficiently characterized. METHODS: A literature review was conducted searching PubMed, Redalyc, CORE, and Google Scholar for English-language papers using keywords including oxidative stress, preeclampsia, neonatal outcomes, antioxidant defence, NRF2, polysulfides, and antioxidant supplementation. RESULT: Neonates from mothers with PE exhibit elevated lipid peroxidation markers (conjugated dienes, lipohydroperoxides, malondialdehyde) yet show compensatory increases in total antioxidant capacity. The neonate's antioxidant defense system is summarized, including its enzymatic components superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT), and non-enzymatic factors, with a particular focus on novel reducing molecules known as polysulfides. Investigation into persulfides and polysulfides is not merely supplementary but essential, as these emerging redox species represent a promising and potentially superior therapeutic frontier for mitigating oxidative damage. The article also discusses contradictory findings on the impact of antioxidant interventions for PE, highlighting the inherent challenges of clinical trials in this population. We examine the potential therapeutic role of the transcription factor NRF2, alongside concerns about possible side effects. CONCLUSIONS: Current antioxidant supplementation for PE has proven largely ineffective or harmful. Persulfides and polysulfides emerge as a potentially superior antioxidant frontier for neonatal protection, warranting dedicated investigation. Well-designed clinical trials are urgently needed to evaluate the safety and efficacy of novel antioxidant strategies for improving neonatal outcomes in PE.