Preeclampsia is a serious complication of pregnancy characterized by new-onset hypertension and proteinuria in the third trimester, often leading to severe maternal and fetal complications. It is a leading cause of maternal death and severe maternal morbidity in the United States. Preeclampsia is associated with long-term cardiovascular and metabolic risks for mothers and children, particularly in cases of preterm preeclampsia. The pathogenesis of preeclampsia involves abnormal placentation and the release of antiangiogenic factors such as sFLT1, leading to endothelial dysfunction and systemic disease. Key risk factors include a history of preeclampsia, chronic hypertension, pregestational diabetes, and obesity. Genetic susceptibility, such as the rs4769613 locus near the FLT1 gene, has been identified. The clinical definition of preeclampsia has evolved to include severe features without proteinuria. The disease progresses in two stages: abnormal placentation in the first trimester and a maternal syndrome in the later trimesters characterized by antiangiogenic factors. Hypoxia, oxidative stress, and impaired trophoblast invasion contribute to the pathogenesis. The role of NK cells in placental development and the imbalance of angiogenic factors like sFLT1 and PlGF are critical in disease progression. Inflammatory cytokines and immune cell alterations also play a role. The renin-angiotensin pathway and sympathetic nervous system are involved in the pathophysiology. Animal models, such as the RUPP model, help study preeclampsia, but they do not fully replicate human disease. Biomarkers like sFLT1, sENG, and PlGF are used for diagnosis, prediction, and prognosis. Early screening with these biomarkers allows for early intervention and prevention of preeclampsia. Treatment includes antenatal aspirin, magnesium sulfate, and timely delivery. Hyperuricemia is a biomarker for preeclampsia progression. Overall, preeclampsia remains a significant challenge in pregnancy, requiring further research and improved management strategies.Preeclampsia is a serious complication of pregnancy characterized by new-onset hypertension and proteinuria in the third trimester, often leading to severe maternal and fetal complications. It is a leading cause of maternal death and severe maternal morbidity in the United States. Preeclampsia is associated with long-term cardiovascular and metabolic risks for mothers and children, particularly in cases of preterm preeclampsia. The pathogenesis of preeclampsia involves abnormal placentation and the release of antiangiogenic factors such as sFLT1, leading to endothelial dysfunction and systemic disease. Key risk factors include a history of preeclampsia, chronic hypertension, pregestational diabetes, and obesity. Genetic susceptibility, such as the rs4769613 locus near the FLT1 gene, has been identified. The clinical definition of preeclampsia has evolved to include severe features without proteinuria. The disease progresses in two stages: abnormal placentation in the first trimester and a maternal syndrome in the later trimesters characterized by antiangiogenic factors. Hypoxia, oxidative stress, and impaired trophoblast invasion contribute to the pathogenesis. The role of NK cells in placental development and the imbalance of angiogenic factors like sFLT1 and PlGF are critical in disease progression. Inflammatory cytokines and immune cell alterations also play a role. The renin-angiotensin pathway and sympathetic nervous system are involved in the pathophysiology. Animal models, such as the RUPP model, help study preeclampsia, but they do not fully replicate human disease. Biomarkers like sFLT1, sENG, and PlGF are used for diagnosis, prediction, and prognosis. Early screening with these biomarkers allows for early intervention and prevention of preeclampsia. Treatment includes antenatal aspirin, magnesium sulfate, and timely delivery. Hyperuricemia is a biomarker for preeclampsia progression. Overall, preeclampsia remains a significant challenge in pregnancy, requiring further research and improved management strategies.