Immunology, Contraception, and Preeclampsia

At the beginning of this century, it was suggested that the etiology of preeclampsia/eclampsia had an immunologic component. The hypothesis advanced was that preeclampsia/ eclampsia reflected either a partial breakdown of the mechanisms responsible for the normal exemption of the fetoplacental unit from rejection as an allograft or an immunologic response directed against tissue- or organ-specific antigens associated with the placenta.¹ Since then, increasingly sophisticated investigations that have paralleled new developments in immunobiology have furthered our understanding of the immunobiology of the maternal-fetal relationship and thereby this condition.

There are cogent immunologic explanations for the basic observations regarding preeclampsia/eclampsia.² The immunologic factors contributing to the pathogenesis of preeclampsia/eclampsia suggest that this disorder is most likely to arise in a woman who (1) becomes pregnant early in her coital experience and is confronted initially with a large, healthy placenta whose size and invasive propensity of its trophoblast cells in