Similar to previous studies, exclusive breastfeeding was found to have great importance, since this practice protects the child's health and allows for a better development, despite unfavorable social and economic conditions. In particular, it seems that the protection conferred by breastfeeding is stronger when home conditions are poor, but this same condition presents an intervention opportunity, particularly the assurance of potable water provision for the infant when breastfeeding is not an option.

Objective: To determine the usefulness of salivary cortisol as a predictor of preeclampsia in adolescents. Methods: We carried out a nested case- control study. Somatometric, clinical, and biochemical data were obtained from 100 healthy pregnant adolescents and salivary cortisol was measured at 8:00, 12:00, and 20:00 hours on two occasions during pregnancy, before 20 weeks, and after 30 weeks of gestation. The cortisol values between the group of healthy pregnant women and the group that developed preeclampsia were compared by using the Student’s t, Mann-Whitney, and Wilcoxon tests. Also, the ROC curve of cortisol values and the Positive and Negative Predictive values of cortisol were estimated. Results: Values >14.9 nmol/L of cortisol were observed in the group that developed preeclampsia, providing a positive predictive value of 1 (100%). Values <10.1 nmol/L were observed in the control group, the negative predictive value was 1 (100%). The cutoff point of the ROC curve -before 20 weeks of gestation- in the members of the cohort was 13.9 nmol/L. Conclusions: The salivary cortisol values observed in the two evaluations made to each of the groups showed statistically significant differences between the groups at 8 and 12 hours of the day. The values obtained enable establishing gradients that allow separating the group of healthy women that got ill with preeclampsia from the group that did not develop the illness before week 20. After week 30, the cortisol gradients are established more clearly in the group with preeclampsia and in the control group. The validation of these findings in larger samples would allow implementing this procedure as a screening test for preeclampsia in groups of pregnant adolescents.

There are analyzed some of the main aspects related to the causality of preeclampsia, privileging two types of models: the clinic model and the epidemiologic model, first one represented by the hypothesis of the reduced placental perfusion and the second one considering the epidemiologic findings related to the high levels of psychosocial stress and its association with preeclampsia. It is reasoned out the relevance of raising the causality of the disease from an interdisciplinary perspective, integrating the valuable information generated from both types, clinical and epidemiologic, and finally a tentative explanatory model of preeclampsia is proposed, the subclinical and sociocultural aspects that predispose and trigger the disease are emphasized making aspects to stand out: the importance of reduced placental perfusion as an indicator of individual risk, and the high levels of physiological stress, as a result of the unfavorable conditions of the psychosocial surroundings (indicator of population risk) of the pregnant women.

This article highlights the importance of preeclampsia as a global public health problem and the lack of a satisfactory model to explain its genesis. Scientific advances relevant to the placental pathophysiology, which have resulted in a deeper understanding of the immunological mechanisms associated to preeclampsia and have been translated into better treatment options, are also highlighted, although to date these approaches cannot explain the origin of the disease. From a theoretical approach underpinned by the concepts related to the social determinants of the health, and specifically from current psychosocial epidemiology, an alternative approach that gives account for the genesis of preeclampsia is proposed. The proposal is based in the scientific literature as well as in the work of the authors; it takes as references unfavorable socioeconomic and psychosocial conditions in pregnant women, linking these conditions to a series of failed adaptive biological processes closely related to an ineffective allostatic response by the body, which ultimately determines the occurrence of the disease.

Introduction: Hypertensive disorders are of interest in obstetrics and gynecology because they are the second place among causes of maternal mortality and a source of complications in the short, mid, and long term. Even if the pathophysiological process behind preeclampsia (PE) is still unknown, stress factors have been revealed to play an important role in the genesis of this pathologic process. Methods: A case-control study was designed with the purpose of determining if there is a differential methylation in NR3C1, HSD11B2, CYP11A1, CRHBP, TEAD3, and HSP90AA1 genes, related to signaling of the hypothalamic-pituitary-adrenal axis, and its regulation on early-onset PE (EOPE). Results: A total of 20 cases and 20 controls were studied by DNA methylation analysis, demonstrating differences among groups in the percentage of methylation of the NR3C1 gene. After a contingency analysis, an odds ratio (OR) for PE of 12.25 was identified for NR3C1 and 9.9 for HSP90AA1 genes. NR3C1, TEAD3, and HSP90AA1 genes showed a positive correlation with the systolic and diastolic blood pressure levels with a p ≤ 0.05. Conclusion: This study found a differential methylation in the glucocorticoid receptor (GR) NR3C1 and its co-chaperone HSP90AA1 in women with PE, with a possible regulatory role in the response to stress in pregnancy and is a likely physiopathological mechanism in PE.