Abstract
Relevance: Preeclampsia is a major pregnancy complication and a leading global cause of maternal and perinatal morbidity and mortality. Despite extensive research, its pathogenesis remains complex and multifactorial. Recent perspectives define preeclampsia as a heterogeneous disorder involving immunological and genetic factors, abnormal placentation, and endothelial dysfunction. The introduction of angiogenic biomarkers and integrated first-trimester risk models has significantly improved early prediction and prevention; however, challenges remain in their standardized clinical application. The study aimed to synthesize recent evidence on the pathophysiology, risk factors, early prediction, diagnosis, and prevention of preeclampsia. Materials and Methods: A literature review of studies published between 2015 and 2025 was conducted, including original articles, cohort studies, meta-analyses, and reviews. The analysis focused on etiology, clinical risk factors, angiogenic biomarkers, first-trimester screening, and preventive strategies. A qualitative thematic synthesis was conducted to address placental remodeling, angiogenic imbalance, immune-inflammatory mechanisms, epigenetics, and personalized approaches. Results: Impaired spiral artery remodeling and placental ischemia are central to preeclampsia pathogenesis, leading to angiogenic imbalance (increased sFlt-1, decreased PlGF) and systemic endothelial dysfunction. Genetic, metabolic, and clinical risk factors further contribute to disease development. Integrated first-trimester screening combining biochemical markers, ultrasound, and clinical data provides the most effective early risk assessment. PlGF levels and the sFlt-1/PlGF ratio are valuable tools for diagnosis and monitoring. Emerging approaches, including microRNA profiling, cfDNA methylation, and polygenic risk models, show promising potential. Conclusion: Preeclampsia is a multifactorial disorder with diverse clinicopathogenetic phenotypes. Integration of first-trimester screening and angiogenic biomarkers improves predictive accuracy and enables personalized management. Molecular prediction methods are перспективны, but require standardization and validation. A history of preeclampsia is associated with increased long-term cardiovascular risk, necessitating prolonged follow-up.