**Abstract**

The ability of the placenta to interact with surrounding microenvironment of hypoxia can serve as a predictive marker for the development of preeclampsia. Lessons can be studied from highlands inhabitants and their ability to survive extreme conditions of hypobaric hypoxia. Many candidate genes loci that are associated with adaptation to high altitude hypoxia and healthy exercise are also associated with adaptation to hypoxia in normal pregnancy. This can pave the way to a new approach based on the concept of evolution and adaptation stating that "genes can undergo a process of natural selection for the fittest adaptive variants, so as to reach a state of adaptation to the scarce microenvironments." Accordingly, the degree of adaptation in candidate genes and their polymorphisms can serve as predictive markers for the development of preeclampsia. This can be seen in the high degree of concordance between gene expression and the lesions seen in the placenta and other remote organs in the different subtypes of preeclampsia. To conclude, "adaptive or less adaptive" can be the genetic result that answers the question of disease prediction, recurrence, and possible complications.

**Keywords:** placenta, adaptation, hypoxia, predictive marker
