Präeklampsie ist weltweit eine der Hauptursachen perinataler Morbidität und Mortalität für Mutter und Kind. Es wird vermutet, dass unterschiedliche pathophysiologische Mechanismen je nach Zeitpunkt des Auftretens der Präeklampsie vorliegen. Eine Unterscheidung zwischen früher, mittlerer und später Präeklampsie scheint relevant für Screening, klinische Manifestation und Management der Erkrankung zu sein. Ziel dieser Studie ist es die drei Typen der Präeklampsie bezüglich Risikofaktoren, Entbindungsmodalität und maternaler und neonataler Morbiditäten und Mortalitäten zu charakterisieren und zusätzlich mit denen der Gestationshypertonie und chronischen Hypertonie zu vergleichen. In einem retrospektiven Studienaufbau wurden 1089 Einlingsschwangerschaften mit hypertensiver Schwangerschaftserkrankung, deren Entbindung in einem Zeitraum von 10 Jahren (2003-2012) erfolgte, analysiert. Die maternalen und neonatalen Charakteristika der verschiedenen Gruppen hypertensiver Schwangerschaftserkrankungen wurden miteinander verglichen. Es wurden deskriptive und analytische (Chi-quadrat-Test und U-Test) statistische Methoden verwendet. Es zeigten sich signifikant unterschiedliche maternale Komorbiditäten und Risikofaktoren in den untersuchten Gruppen hypertensiver Schwangerschaftserkrankungen. Für die Mehrzahl der untersuchten Parameter waren Fälle mit Präeklampsie häufiger durch Morbidität und Mortalität betroffen waren. Patientinnen mit früher Präeklampsie fielen durch einen signifikant höheren mittleren arteriellen Druck vor Entbindung, eine erhöhte Kaiserschnittrate, eine ausgeprägtere Proteinurie und eine häufigere Korrelation zu HELLP-Syndrom, Eklampsie und vorzeitige Plazentalösung auf. Die Häufigkeit pathologischer Doppleruntersuchungen in den Arteriae uterinae und der Arteria umbilicalis verhielt sich umgekehrt proportional zur Schwangerschaftswoche zum Zeitpunkt der Entbindung. Ein nachteiliges fetales Outcome bezogen auf die perinatale und neonatale Mortalität, Beatmung über einen längeren Zeitraum als 24 Stunden, RDS-Syndrom, fetale Wachstumsrestriktion und Verlegung auf eine neonatologische Intensivstation trat unter früher Präeklampsie häufiger als unter mittlerer und bei mittlerer häufiger als unter später Präeklampsie auf. Das neonatale Outcome von Feten unter der 33. SSW war nicht vom Ausmaß der mütterlichen hypertensiven Erkrankung abhängig. Die späte Präeklampsie viel durch günstigere Outcomes als die Gestationshypertonie und chronische Hypertonie auf. Die Ergebnisse der Studie unterstützen die These, dass unterschiedliche pathophysiologische Mechanismen Präeklampsie bedingen können und dass frühe, mittlere und späte Präeklampsie entweder verschiedene Erkrankungen sind, oder die Präeklampsie eine Erkrankung darstellt, die durch verschiedene Einflussfaktoren ein unterschiedlich starkes Ausmaß annimmt. Das Gestationsalter ist demnach das entscheidende Kriterium für die klinische Ausprägung. Die unterschiedlichen Risikoprofile der einzelnen Formen hypertensiver Schwangerschaftserkrankungen fordern ein angepasstes klinisches Management.

Thesis (MMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background - Preeclampsia is a multi-system disease characterized by hypertension and proteinuria in pregnant women at greater than 20 weeks of gestational age. It remains one of the leading causes of maternal and foetal mortality and morbidity. While the cause of preeclampsia is essentially unknown, the important theories strongly implicate disturbed placental function in early pregnancy. Additionally, some researchers have investigated the possibility of a seasonal relationship with the incidence of preeclampsia. Differences in incidences of preeclampsia, examined exclusively on the basis of delivery timing, have also been noted to have seasonal variation, but results have been inconsistent. Objective - Our primary objective was to investigate the seasonal variation in preeclampsia in relation to the timing of conception and the timing of presentation with clinical disease over the period of one year. Methods - We performed a retrospective descriptive study of all women with preeclampsia who delivered at Tygerberg Hospital in 2010. Preeclampsia was diagnosed as hypertension associated with proteinuria after the 20th week of gestation. Names of patients were identified from labour ward records and data was collected and recorded on a data-sheet. Data were primarily analysed in relation to the season of delivery and also the season of the last menstruation. Summer was diagnosed as lasting from summer solstice to autumn equinox, autumn as lasting from autumn equinox until winter solstice, winter as lasting from winter solstice until spring equinox and spring as lasting from spring equinox until summer solstice. The data was analysed using the SPSS software (Statistical Package for Social Science). Discrete data was compared by calculating relative risks with 95% confidence limits, as well as the chi2 test. Fisher‘s exact test was used to compare ratios where the expected value in any cell of a two-by-two table is less than five. The means of normally distributed continuous data was compared by analysis of variance, while the medians of continuous data which are not distributed normally, where calculated using the non-parametric Mann Whitney u test. A p-value of < 0.05 was considered to be statistically significant, where applicable. Results - The peak incidence of preeclampsia was during winter with 32.2% of all cases occurring during this season. This was significantly higher than during the summer when only 169 (17.17%) cases of preeclampsia were delivered. When we analysed the data looking at the timing of menstruation (and therefore conception), we found that 292 (29.7%) patients that developed preeclampsia had their last menstrual period in the spring, with November the month of peak incidence. The lowest incidence was found in winter, with only 218 (22.2%) patients. Conclusion - We have confirmed a previous finding of a seasonal variation in the occurence of preeclampsia in Tygerberg Hospital. We have also confirmed that this seasonal variation is not only influenced by the timing of delivery, but also by the timing of conception. / AFRIKAANSE OPSOMMING: Agtergrond - Preeklampsie is ‘n multi-sisteem siekte wat gekenmerk word deur hipertensie en proteinurie. Dit word slegs gedurende swangerskap aangetref - gewoonlik na 20 weke. Dit is steeds een van die voorste oorsake van moederlike en fetale morbiditeit en mortaliteit. Terwyl die oorsaak van preeklampsie steeds onbekend is, dui die belangrikste teorië op versteurde plasentale ontwikkeling en funksionering vroeg in swangerskap. Sekere navorsers het ook die moontlikheid van ‘n seisonale patroon in die voorkoms van preeklampsie ondersoek. ‘n Seisonale patroon is wel identifiseer, maar dit is slegs gebasseer op die datum van verlossing en die resultate tussen studies wissel. Doel - Ons primêre doel was om die seisonale patroon in die insidensie van preeklampsie te ondersoek oor ‘n tydperk van een jaar en dan die datum van bevrugting te vergelyk met die datum van diagnose en verlossing. Metodiek - Ons het ‘n retrospektiewe beskrywende studie gedoen oor al die pasiënte met preeklampsie wat tydens 2010 by Tygerberg Hospitaal verlos is. Preeklampsie is gediagnoseer as hipertensie met geassosieerde proteinurie met aankoms na 20 weke. Die name van die pasiënte is verkry uit die kraamsaal-registers en data is versamel en op ‘n datastel aangebring. Data is primer geanaliseer in terme van die seisoen van verlossing en die seisoen waartydens die laaste maandstonde plaasgevind het. Die seisoene is as volg geklassifiseer : somer vanaf die summer solstice to autumn equinox, autumn as lasting from autumn equinox until winter solstice, winter as lasting from winter solstice until spring equinox and spring as lasting from spring equinox until summer solstice. Die data is geanaliseer met die SPSS sagteware (Statistical Package for Social Science). Diskrete data is vergelyk deur die relatiewe risiko’s te bereken met vertrouensintervalle van 95%, sowel as die chi2 toets. Fisher se eksakte toets is gebruik om ratios te vergelyk waar die verwagte waarde van enige sel in ‘n 2-by-2 tabel minder as 5 is. Die gemiddeldes van normaal-verspreide aaneenlopende data is vergelyk deur die analise van variance. Die mediane van aaneenlopende data wat nie normaal versprei was nie, is bereken met die non-parametriese Mann-Whitney-U-toets. ‘n P-warde van <0,05 is beskou as statisties betekenisvol, waar van toepassing. Resultate - Die piek –insidensie van preeklampsie was gedurende die wintermaande, met 32.2% van alle gevalle. Dit was betekenisvol hoër as die gedurende die somer, waar slegs 169 (17.17%) van gevalle verlos is. Toe ons die data analiseer na gelang van die datum van laaste menstruasie (en gevolglik bevrugting), het ons gevind dat 292 (29.7%) van die pasiënte wat preeklampsie ontwikkel het, het hul laaste maandstonde gedurende die lente ervaar. Die piek-insidensie was gedurende November. Daarteenoor is die laagste insidensie gevind in pasiënte met ‘n laaste menstruasie in die winter, met slegs 218 (22.2%) pasiënte. Gevolgtrekking - Ons het die vorige bevinding by Tygerberg Hospitaal van ‘n seisonale patroon in die ontwikkeling van preeklampsie bevestig. Ons het ook bevestig dat dit nie die datum van diagnose en verlossing is wat’n rol speel nie, maar wel die datum van laaste maandstonde en bevrugting.

Einleitung: Die Dysbalance proangiogener (Placental Growth Factor = PlGF) und antiangiogener Faktoren (soluble fms-like tyrosine kinase 1 = sFlt-1) gilt heute als pathophysiologische Grundlage bei der Entstehung einer Präeklampsie (PE), eines HELLP-Syndroms (Haemolysis, Elevated Liver enzymes, Low Platelets) oder einer intrauterinen Wachstumsretardierung (IUGR). Der sFlt1/PlGF-Quotient, ein sensitiver und robuster diagnostischer Marker, ist bereits Wochen vor der Krankheitsmanifestation erhöht. Ziel dieser Studie war es, die Wertigkeit des sFlt1/PlGFQuotienten als prädiktiven Faktor bei Risikopatientinnen zu untersuchen. Patienten und Methode: In diese prospektive Studie wurden 68 Patientinnen mit einer Einlingsschwangerschaft und mindestens einem Risikofaktor für das Auftreten einer PE, eines HELLP-Syndrom oder einer IUGR im Schwangerschaftsverlauf eingeschlossen. Die Patientinnen wurden je nach Verlauf der Schwangerschaft in eine Gruppe mit Symptomen (Fallgruppe) und eine Gruppe ohne Symptome (Kontrollgruppe) für eine der oben genannten Erkrankungen unterteilt. Der sFlt1/PlGF-Quotient wurde bei der Aufnahme in die Studie und im weiteren Schwangerschaftsverlauf bestimmt. Ergebnisse: Eine PE, ein HELLP-Syndrom oder eine IUGR trat bei 41 % der Risikopatientinnen auf… Der absolute Wert des sFlt-1/PlGF-Quotienten war nur bei der Gruppe mit Symptomen auf ≥ 85 erhöht und zeigte sich in der 25 + 0-31 + 0 SSW (p = 0,005) und ab der 35 + 0 SSW (p = 0,044) als prädiktiver Faktor für eine PE, ein HELLP-Syndrom oder eine IUGR. Ab 7–10 Wochen vor der Entbindung war, in der Fallgruppe stärker als in der Kontrollgruppe, ein Anstieg des sFlt1/PlGFQuotienten zu beobachten. Dieser war 0–2 Wochen vor der Entbindung bei beiden Gruppen (Kontrollgruppe (MW ± SA 66,9 ± 134) vs. Fallgruppe (MW ± SA 393,3 ± 147,4, p = 0,021) am ,stärksten und zeigte sich ebenfalls als prädiktiver Faktor für eine der genannten Schwangerschaftserkrankungen (p = 0,025). Schlussfolgerung: Bei Risikoschwangeren kann der sFlt1/ PlGF-Quotient für die Einschätzung des individuellen Risikos für eine PE, ein HELLP-Syndrom oder eine IUGR im Schwangerschaftsverlauf genutzt werden. Wiederholte Messungen des Quotienten versprechen eine risikoangepasste Betreuung dieser Patientinnen. / Background: A dysbalance of proangiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase 1 (sFlt-1)] proteins is known to cause the symptoms of preeclampsia (PE), HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) or intrauterine growth restriction (IUGR). An increased sFlt-1/ PlGF ratio ≥ 85 is considered a reliable diagnostic marker. Altered sFlt1 and PlGF concentrations can be detected several weeks prior to the onset of clinical symptoms. In this study we analysed the role of the sFlt1/PlGF ratio as a predictive marker for preeclampsia in a high-risk patient group. Patients and materials: We prospectively included 68 singleton pregnancies with at least one risk factor for PE, HELLP syndrome or IUGR. During the study the patients were divided into one group with symptoms (patient group) and one group without symptoms (control group) for the above-mentioned diseases. The sFlt1/PlGF ratios were measured on admission and during the course of pregnancy. Results: During pregnancy 41 % of patients developed PE, HELLP syndrome or IUGR. An increase of the absolute value of the sFlt1/PlGF ratio ≥ 85 was only observed in the patient group and was found to be a predictive factor for PE, HELLP syndrome or IUGR at 25 + 0 to 31 + 0 weeks of gestation (p = 0.005) and after 35 + 0 weeks of gestation (p = 0.044). Alterations of the sFlt1/PlGF ratio were observed in all patients but were higher in the patient group from 7–10 weeks prior to delivery and with the highest peak 0–2 weeks prior to delivery. Compared to the control group (mean ± SD 66.9 ± 134) absolute values of sFlt1/PlGF ratio were signifi cantly (p = 0.021) increased 0–2 weeks prior to delivery in the patient group (mean ± SD 393.3 ± 147.4). An increase of the sFlt1/PlGF ratio ≥ 85 0–2 weeks before delivery has shown to be predictive for one of the mentioned diseases (p = 0.025).Conclusions: In high-risk patients the sFlt1/PlGF ratio can be used for an individual risk assessment with regard to PE, HELLP syndrome or IUGR. Serial measurements permit a risk-adapted prenatal care of these patients.

Determina la relación entre las complicaciones obstétricas y los niveles de depresión en gestantes atendidas en el Instituto Nacional Materno Perinatal durante el año 2014. El estudio es de enfoque cuantitativo de tipo correlacional y retrospectivo de corte transversal. Participan 75 gestantes que fueron diagnosticadas con depresión durante su visita al consultorio de psicología en el año 2014 y a la vez presentaron alguna complicación obstétrica. Utiliza un análisis descriptivo calculándose medidas de tendencia central y de dispersión, así como frecuencias absolutas y relativas. En la estadística bivariada se usa la prueba chi-cuadrado. Encuentra que de las gestantes evaluadas, el 50.7% de las gestantes culminaron en parto por cesárea y el 49.3% en parto vaginal. El 14.7% tiene depresión moderada y el 85.3% tiene depresión leve. No se observa relación entre las complicaciones obstétricas infecciosas (p=0.865), las complicaciones obstétricas hemorrágicas (p=0.201) y el tipo de depresión; sin embargo, se observa relación muy significativa entre la presencia de depresión moderada y la presencia entre alguna complicación obstétrica hipertensiva (p=0.000). La sepsis como complicaciones obstétricas infecciosas se relaciona con la presencia de depresión moderada (p=0.001). El desprendimiento prematuro de placenta se relaciona con la presencia de depresión moderada (p=0.015). La preeclampsia se relaciona con la presencia de depresión moderada (p=0.007). El diagnóstico de eclampsia se relaciona con la presencia de depresión moderada (p=0.015) y el diagnóstico de síndrome de HELLP se relaciona con la presencia de depresión moderada (p=0.015). Concluye que la relación entre las complicaciones obstétricas y los niveles de depresión en gestantes atendidas en el Instituto Nacional Materno Perinatal durante el año 2014 es significativa para el caso de la complicación hipertensiva y la depresión moderada (p=0.000).

Objetivo: Determinar la asociación de violencia intrafamiliar como factor de riesgo de preeclampsia en gestantes atendidas en el Instituto Nacional Materno Perinatal (INMP) durante el periodo Marzo 2012 a Mayo del 2013. Material y métodos: Estudio transversal analítico de casos y controles, realizado en 240 pacientes con diagnóstico de preeclampsia y normotensas atendidas en el Instituto Nacional Materno Perinatal. Instrumentos: Cuestionario de la medición del abuso ejercido (AAS), Cuestionario de apoyo social MOS, Escala de resiliencia de Wagnild y Young. Se trabajó con un intervalo de confianza de 95% y un nivel de significancia de 0.05. Resultados: Respecto a la información socio demográfica, según el estado civil se encontró que el 75% de las pacientes preeclámpticas eran convivientes comparado con el 58.3% de las pacientes normotensas; Según el grado de instrucción se encontró que el 46.7% de pacientes preeclámpticas tenían nivel de instrucción secundaria completa comparada con un 61.7% de los controles; primaria 12.5% en los casos y 6.7% en los controles; En cuanto a la ocupación, el 84% de las pacientes preeclámpticas se dedicaban a labores del hogar comparado con un 76.7% en el grupo de pacientes normotensas; Según el aporte económico en las pacientes preeclámpticas, el 85.8% no aporta económicamente al hogar, comparado con un 81.7% en las pacientes normotensas. En el caso de la violencia intrafamiliar, el 42.5% de pacientes preeclámpticas refirió haber sido alguna vez abusada emocional o físicamente por su pareja o alguien importante para ella, en comparación con el 40.8% de pacientes normotensas (OR =1.07) IC (0.64 - 1.79).En cuanto a la violencia física ejercida durante el embarazo se obtuvo que el 4.2% de preeclámpticas como normotensas presentaron este tipo de violencia en la misma proporción, hallándose un OR de 1, IC (0.3 - 3.5). Al medir el apoyo social, en pacientes preeclámpticas, recibieron apoyo social en un 83.3%, mientras que en las pacientes normotensas en un 79.2%. Respecto al nivel de resiliencia evaluado se obtuvo como resultado que fue baja en el 86.7 % de pacientes preeclámpticas comparado con las pacientes normotensas que también fue baja 66.7%, con un valor p de 0.000 y un OR=0.3 IC (0.2-0.6), lo que muestra una relación estadísticamente significativa entre ambas variables. Conclusiones: La violencia intrafamiliar no es un factor de riesgo de preeclampsia, en pacientes atendidas en el Instituto Nacional Materno Perinatal. En el grupo de pacientes preeclámpticas (casos) la frecuencia de violencia intrafamiliar fue mayor frente a las gestantes normotensas (control). El apoyo social presente no actúa como factor protector de preeclampsia, mientras que el nivel de resiliencia alta sí lo hace. En las mujeres víctimas de violencia intrafamiliar el apoyo social más frecuente es el ausente en comparación con las mujeres que no sufren de violencia .Las mujeres víctimas de violencia intrafamiliar y con apoyo social ausente, presentan más riesgo de hacer preeclampsia en el embarazo que las que presentan apoyo social.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Evidence shows the activation of neutrophils in the systemic vasculature of obese and preeclamptic women. In this study, I evaluated whether expression of neutrophil products, myeloperoxidase (MPO) and matrix metalloproteinase 8 (MMPS), was associated with neutrophil infiltration in systemic vascular tissue of obese and preeclamptic women. I tested my hypotheses by using immunohistochemical studies to look at the expression of MPO and MMP8 in the vasculature of obese and preeclamptic women. There was a significantly greater expression of MPO and MMP8 in the vasculature of preeclamptic women as compared to normal pregnant and normalnonpregnant women. The vasculature of obese women also had a significantly greater expression of MPO and MMP8 as compared to overweight and normal weight patients.These studies are the first to report that activated neutrophils in systemic vasculature are releasing MPO and MMP8. These findings also indicate that the vascular phenotype of obese and preeclamptic women is similar in that they both show an increased presence of MPO and MMP8 in the systemic vasculature as a result of neutrophil infiltration. This suggests that obese women are at increased risk for preeclampsia because their vasculature is already exposed to increased levels of MPO and MMP8, so when they become pregnant and experience further oxidative stress imposed by the placenta along with an increase in neutrophil number, they develop the clinical symptoms of preeclampsia.

Obesity is a known risk factor for preeclampsia, but the reason for this risk is unknown. We sought to demonstrate how obese individuals are predisposed to preeclampsia by mechanisms involving inflammation and the innate immune system. First, we used immunohistochemical studies to identify neutrophil infiltration, NF-κB activation and COX-2 expression in vascular tissue of obese women. We then demonstrated similar neutrophil infiltration and vascular inflammation in preeclamptic women.We used in vitro experiments to test if neutrophils and their products, reactive oxygen species (ROS) and tumor necrosis factor-alpha (TNFα) can activate NF-κB and cause expression of its inflammatory products, COX-2, thromboxane (TX) and IL-8. Co-culture of neutrophils or treatments of ROS or TNFα caused activation of NF-κB and expression of COX-2, TX and IL-8 in vascular smooth muscle cells.This investigation is the first to demonstrate activation of NF-κB and expression of COX-2 coincident with neutrophil infiltration in systemic vascular tissue of obese and preeclamptic women. These data implicate neutrophils as a cause of vascular inflammation. They also suggest that if an obese woman's vasculature was in an inflamed state she is at increased risk for preeclampsia when exposed to the additional burden of oxidative stress and neutrophil activation imposed by the placenta, causing her to develop vascular dysfunction and clinical symptoms of PE (hypertension and edema).

DNA methylation is the most recognizable epigenetic mechanism. In general, DNA hypomethylation is associated with increased gene expression whereas DNA hypermethylation is associated with decreased gene expression. To date, little is known about the role of DNA methylation in the pathophysiology of preeclampsia. In this study, we examined the differences in DNA methylation in omental arteries of normal pregnant and preeclamptic women using the high throughput Illumina HumanMethylation27 BeadChip assay. We found 1,685 genes with a significant difference in DNA methylation at a false discovery rate of < 10% with many inflammatory genes having reduced methylation. The thromboxane synthase gene was the most hypomethylated gene in preeclamptic women as compared to normal pregnant women. When we examined the expression of thromboxane synthase in omental arteries of normal pregnant and preeclamptic women we found it to be significantly increased in preeclamptic women. The increased expression was observed in vascular smooth muscle cells, endothelial cells and infiltrating neutrophils. Experimentally induced DNA hypomethylation increased the expression of thromboxane synthase in the neutrophil-like HL-60 cell line, whereas tumor necrosis factor α (TNFα), a neutrophil product, increased its expression in cultured human vascular smooth muscle cells (VSMC). These finding suggest that DNA methylation and release of TNFα by infiltrating neutrophils could contribute to the increased expression of thromboxane synthase in systemic blood vessels of preeclamptic women, contributing to the hypertension and coagulation abnormalities. We also explored the possible contribution of DNA methylation to the altered expression of genes involved in collagen metabolism in preeclampsia. Several matrix metalloproteinase (MMP) genes, including MMP1 and MMP8, were significantly less methylated in preeclamptic women, whereas TIMP and COL genes were either significantly more methylated or had no significant change in their DNA methylation status. Experimentally induced DNA hypomethylation increased the expression of MMP-1, but not TIMP-1 or COL1A1, in cultured VSMCs and increased the expression of MMP-1 and MMP-8 in HL-60 cells. These findings suggest that DNA methylation contributes to the imbalance in genes involved in collagen metabolism in blood vessels of preeclamptic women.

Made available in DSpace on 2016-04-28T20:37:54Z (GMT). No. of bitstreams: 1 Patricia Lomonaco Magno.pdf: 1015656 bytes, checksum: d1a092cd529b48eaae364ee80a8eec97 (MD5) Previous issue date: 2011-10-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Gestational hypertensive disorders are the main cause of maternal and fetus mortality in Brazil and in the world. Studies addressing the psychological dimensions of pregnancy-induced hypertension (PIH) are still scarce, despite their increase in the last few years. Objective: This study performed a systematic review of the literature addressing the psychological aspects of hypertensive pregnant women and PIH, in order to investigate if a relationship can be established between variables and their significance. Method: To comprise the bibliographic review, twenty-four articles were located in the Scielo, Pubmed and Web of Science databases. The key words in Portuguese researched were: hipertensão , hipertensão gestacional , gestacional , pré-eclampsia , eclampsia , síndrome HELLP , gravidez , gestante , gestação de alto risco , gestação de risco , repouso hospitalar , aspectos psicológicos , psicossomática , ansiedade , estresse and Kahhale . In English, the key words used to perform the research were: hypertension , preeclampsia , pre eclampsia , eclampsia , HELLP syndrome , hospitalization , high risk pregnancy , pregnancy , pregnant , psycological , psycosocial , psychosomatics , pregnancy induced hypertension , anxiety , stress , depression and motherhood and diseases . To serve as a basis for the theoretical concepts presented in this study, specific chapters dealing with PIH, psychosomatics and psychoneuroimmunology and psychological aspects of pregnant women were drafted. The articles selected were translated, analyzed and their results were compared. Analysis and Discussion: Although the root cause of this disorder is still unknown, the studies that comprise this systematic review indicate that there is strong evidence suggesting that psychological aspects can influence in the appearance and development of this diagnosis, especially stress (distress). Possible mechanisms for coping with stressful situations and results of this diagnosis are also examined by the relevant literature, with an aim to understand the functioning of distress. Conclusion: Although the studies presented indicate that psychological aspects are related to PIH, additional studies are recommended to better identify and understand the relationship between the different variables and their actual consequences. Psychotherapeutic treatment, as well as psychosocial support and the formation of a good relationship with the medical staff, can help women who have limited or ineffective mechanisms, in situations of stress / As doenças hipertensivas da gravidez são a maior causa de morte materno fetal no Brasil e no mundo. Os trabalhos que consideram a dimensão psicológica presente nas doenças hipertensivas gestacionais (DHG) são ainda escassos, apesar de terem crescido nos últimos anos. Objetivo: Este estudo realizou uma revisão sistemática da literatura dos artigos que abordam os aspectos psicológicos das gestantes hipertensas e as DHG, para investigar se existe relação entre as variáveis e o limite entre elas. Método: Para compor a revisão bibliográfica, foram analisados 24 artigos encontrados nas bases Scielo, Pubmed e Web of Science. As palavras-chaves em português utilizadas foram: hipertensão , hipertensão gestacional , gestacional , pré-eclampsia , eclampsia , síndrome HELLP , gravidez , gestante , gestação de alto risco , gestação de risco , repouso hospitalar , aspectos psicológicos , psicossomática , ansiedade , estresse e Kahhale . Em inglês, as palavraschaves utilizadas foram: hypertension , preeclampsia , pre eclampsia , eclampsia , HELLP syndrome , hospitalization , high risk pregnancy , pregnancy , pregnant , psycological , psycosocial , psychosomatics , pregnancy induced hypertension , anxiety , stress , depression , motherhood e diseases . Para embasar os conceitos teóricos utilizados no decorrer deste trabalho, foram elaborados capítulos sobre as DHG, sobre a psicossomática e a psiconeuroimunologia e sobre os aspectos psicológicos da gestante. Os trabalhos selecionados foram traduzidos, estudados e tiveram seus resultados comparados. Análise e Discussão: Apesar da etiologia dessa doença ainda ser incerta, as pesquisas que compõem esta revisão sistemática apontam fortes evidências de que os aspectos psicológicos podem influenciar no aparecimento e evolução do diagnóstico, principalmente o estresse (distresse). Os possíveis mecanismos de enfrentamento com situações de estresse e desfechos da vivência do diagnóstico também são investigados pela literatura, com objetivo de mapear o distresse. Conclusão: Apesar dos estudos apresentados apontarem que os aspectos psicológicos estão relacionados com as DHG, pesquisas futuras são indicadas para melhor identificação e entendimento da relação e limite entre as variáveis em questão e suas reais consequências. O tratamento psicoterapêutico, assim como o apoio psicossocial e o estabelecimento de uma boa relação com a equipe médica, pode auxiliar mulheres que tenham poucos mecanismos de enfrentamento ou mecanismos ineficazes, em situações de estresse