Risk assessment of preeclampsia
DOI:
https://doi.org/10.12775/QS.2024.18.53569Keywords
preeclapsia, sFlt-1/PlGF ratio, biomarkers, hypertension, aspirinAbstract
Introduction and purpose:
Preeclampsia (PE) is a complication during pregnancy characterized by high blood pressure (≥140/90 mmHg) and signs of organ involvement appearing after 20 weeks’ of gestation. Various factors are known to increase the risk of this condition as well as clinical factors. The pathogenesis of the disease is complex and not fully understood.
State of Knowledge:
The main roles play two angiogenic factors: soluble fms-like tyrosine kinase 1 (sFlt-1), which is an antiangiogenic protein, and placental growth factor (PlGF), which is a pro-angiogenic protein. Elevated sFlt-1 and reduced PlGF levels in the mother’s blood can predict the future development of preeclampsia during pregnancy. The imbalance between these two angiogenic biomarkers indicates de new-onset preeclampsia, distinct from chronic hypertension. Both MAP and UTA-PI are essential components of first-trimester screening protocols, which, combined with maternal history and other biochemical markers, allow for accurate preeclampsia risk assessment and early intervention to improve maternal and fetal outcomes.
Conclusions:
Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. The integration of multiple biomarkers, such as PlGF and sFlt-1, along with advanced analytical techniques, enhances early detection and accurate risk stratification, improving maternal and fetal outcomes. Aspirin prophylaxis before 16 weeks’ gestation has been shown to reduce the risk of preeclampsia.
References
Khan B, Allah Yar R, Khakwani AK, Karim S, Arslan Ali H. Preeclampsia Incidence and
Its Maternal and Neonatal Outcomes With Associated Risk Factors. Cureus. 2022;14(11):e31143. DOI: 10.7759/cureus.31143
Visintin C, Mugglestone MA, Almerie MQ, Nherera LM, James D, Walkinshaw S, et al.
Management of hypertensive disorders during pregnancy: summary of NICE guidance. BMJ.
;341:c2207. DOI: 10.1136/bmj.c2207
ACOG Committee Opinion No. 743 Summary: Low-Dose Aspirin Use During Pregnancy.
Obstet Gynecol. 2018;132(1):254-6. DOI: 10.1097/AOG.0000000000002708
Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and
clinical implications. BMJ. 2019;366:l2381. DOI: 10.1136/bmj.l2381
Fox R, Kitt J, Leeson P, Aye CYL, Lewandowski AJ. Preeclampsia: Risk Factors,
Diagnosis, Management, and the Cardiovascular Impact on the Offspring. J Clin Med. 2019;8(10). DOI: 10.3390/jcm8101625
Tanner MS, Davey MA, Mol BW, Rolnik DL. The evolution of the diagnostic criteria of
preeclampsia-eclampsia. Am J Obstet Gynecol. 2022;226(2S):S835-S43. DOI: 10.1016/j.ajog.2021.11.1371
Meszaros B, Kukor Z, Valent S. Recent Advances in the Prevention and Screening of
Preeclampsia. J Clin Med. 2023;12(18). DOI: 10.3390/jcm12186020
Wang H, Zhang Z, Li H, Li J, Li H, Liu M, et al. A cost-effective machine learning-based
method for preeclampsia risk assessment and driver genes discovery. Cell Biosci. 2023;13(1):41. DOI: 10.1186/s13578-023-00991-y
Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. The
hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management
recommendations for international practice. Pregnancy Hypertens. 2018;13:291-310. DOI: 10.1161/HYPERTENSIONAHA.117.10803
Chaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening and
prediction. Am J Obstet Gynecol. 2022;226(2S):S1071-S97 e2. DOI: 10.1016/j.ajog.2020.07.020
Mol BWJ, Roberts CT, Thangaratinam S, Magee LA, de Groot CJM, Hofmeyr GJ. Pre-
eclampsia. Lancet. 2016;387(10022):999-1011. DOI: 10.1016/s0140-6736(15)00070-7
Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, et al. Prevention of
preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 2010;116(2 Pt 1):402-14. DOI: 10.1097/AOG.0b013e3181e9322a
Roberge S, Giguere Y, Villa P, Nicolaides K, Vainio M, Forest JC, et al. Early
administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. Am J Perinatol. 2012;29(7):551-6. DOI: 10.1159/000336662
Nicolaides KH. Aspirin versus Placebo in Pregnancies at High Risk for Preterm
Preeclampsia. N Engl J Med. 2017;377(24):2400. DOI: 10.1056/NEJMc1713798
Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, et al. The 2021
International Society for the Study of Hypertension in Pregnancy classification, diagnosis &
management recommendations for international practice. Pregnancy Hypertens. 2022;27:148-69. DOI: 10.1016/j.preghy.2021.09.008
Poon LC, Galindo A, Surbek D, Chantraine F, Stepan H, Hyett J, et al. From first-trimester screening to risk stratification of evolving pre-eclampsia in second and third trimesters of pregnancy: comprehensive approach. Ultrasound Obstet Gynecol. 2020;55(1):5-12. DOI: 10.1002/uog.21869
Tan MY, Wright D, Syngelaki A, Akolekar R, Cicero S, Janga D, et al. Comparison of
diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method
combining maternal factors and biomarkers: results of SPREE. Ultrasound Obstet Gynecol.
;51(6):743-50. DOI: 10.1002/uog.19039
Benko Z, Wright A, Rehal A, Cimpoca B, Syngelaki A, Delgado JL, et al. Prediction of pre-eclampsia in twin pregnancy by maternal factors and biomarkers at 11-13 weeks' gestation: data from EVENTS trial. Ultrasound Obstet Gynecol. 2021;57(2):257-65. DOI: 10.1002/uog.23531
Poon LC, Kametas NA, Maiz N, Akolekar R, Nicolaides KH. First-trimester prediction of
hypertensive disorders in pregnancy. Hypertension. 2009;53(5):812-8. DOI: 10.1161/HYPERTENSIONAHA.108.127977
Mosimann B, Amylidi-Mohr SK, Surbek D, Raio L. First Trimester Screening for
Preeclampsia - a Systematic Review. Hypertens Pregnancy. 2020;39(1):1-11. DOI: 10.1080/10641955.2019.1682009
Hu J, Gao J, Liu J, Meng H, Hao N, Song Y, et al. Prospective evaluation of first-trimester screening strategy for preterm pre-eclampsia and its clinical applicability in China. Ultrasound Obstet Gynecol. 2021;58(4):529-39. DOI: 10.1002/uog.23645
Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, et al. The International
Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet. 2019;145 Suppl 1(Suppl 1):1-33. DOI: 10.1002/ijgo.12802
Sotiriadis A, Hernandez-Andrade E, da Silva Costa F, Ghi T, Glanc P, Khalil A, et al.
ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia. Ultrasound Obstet Gynecol. 2019;53(1):7-22. DOI: 10.1002/uog.20105
Goto M, Koide K, Tokunaka M, Takita H, Hamada S, Nakamura M, et al. Accuracy of the
FMF Bayes theorem-based model for predicting preeclampsia at 11-13 weeks of gestation in a Japanese population. Hypertens Res. 2021;44(6):685-91. DOI: 10.1038/s41440-020-00571-4
Agrawal S, Shinar S, Cerdeira AS, Redman C, Vatish M. Predictive Performance of PlGF
(Placental Growth Factor) for Screening Preeclampsia in Asymptomatic Women: A Systematic Review and Meta-Analysis. Hypertension. 2019;74(5):1124-35. DOI: 10.1161/HYPERTENSIONAHA.119.13360
Barton JR, Woelkers DA, Newman RB, Combs CA, How HY, Boggess KA, et al. Placental growth factor predicts time to delivery in women with signs or symptoms of early preterm preeclampsia: a prospective multicenter study. Am J Obstet Gynecol. 2020;222(3):259 e1- e11. DOI: 10.1016/j.ajog.2019.09.003
Parchem JG, Brock CO, Chen HY, Kalluri R, Barton JR, Sibai BM, et al. Placental Growth Factor and the Risk of Adverse Neonatal and Maternal Outcomes. Obstet Gynecol.
;135(3):665-73. DOI:10.1097/AOG.0000000000003694
Chappell LC, Duckworth S, Seed PT, Griffin M, Myers J, Mackillop L, et al. Diagnostic
accuracy of placental growth factor in women with suspected preeclampsia: a prospective
multicenter study. Circulation. 2013;128(19):2121-31. DOI: 10.1161/CIRCULATIONAHA.113.003215
Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004;350(7):672-83. DOI: 10.1016/j.ajog.2010.08.049
Duhig KE, Myers J, Seed PT, Sparkes J, Lowe J, Hunter RM, et al. Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial. Lancet. 2019;393(10183):1807-18. DOI: 10.1016/S0140-6736(18)33212-4
Chirila CN, Marginean C, Chirila PM, Gliga ML. The Current Role of the sFlt-1/PlGF Ratio and the Uterine-Umbilical-Cerebral Doppler Ultrasound in Predicting and Monitoring Hypertensive Disorders of Pregnancy: An Update with a Review of the Literature. Children (Basel). 2023;10(9). DOI: 10.3390/children10091430
Wright D, Rolnik DL, Syngelaki A, de Paco Matallana C, Machuca M, de Alvarado M, et
al. Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin on length of stay in the neonatal intensive care unit. Am J Obstet Gynecol. 2018;218(6):612 e1- e6. DOI: 10.1016/j.ajog.2018.02.014
Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol. 2022;226(2S):S1108-S19. DOI: 10.1016/j.ajog.2020.08.045
Rolnik DL, Syngelaki A, O'Gorman N, Wright D, Nicolaides KH, Poon LC. Aspirin for
evidence-based preeclampsia prevention trial: effects of aspirin on maternal serum pregnancy-associated plasma protein A and placental growth factor trajectories in pregnancy. Am J Obstet Gynecol. 2023. DOI: 10.1016/j.ajog.2023.12.031
Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(2):110-20 e6. DOI: 10.1016/j.ajog.2016.09.076
Hoffman MK, Goudar SS, Kodkany BS, Metgud M, Somannavar M, Okitawutshu J, et al.
Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial. Lancet. 2020;395(10220):285-93. DOI: 10.1016/S0140-6736(19)32973-3
Roberge S, Nicolaides KH, Demers S, Villa P, Bujold E. Prevention of perinatal death and
adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol. 2013;41(5):491-9. DOI: 10.1002/uog.12421
Sakowicz A. The Targeting of Nuclear Factor Kappa B by Drugs Adopted for the
Prevention and Treatment of Preeclampsia. Int J Mol Sci. 2022;23(5). DOI: 10.3390/ijms23052881
Thadhani R, Lemoine E, Rana S, Costantine MM, Calsavara VF, Boggess K, et al.
Circulating Angiogenic Factor Levels in Hypertensive Disorders of Pregnancy. NEJM Evid.
;1(12):EVIDoa2200161. DOI: 10.1056/EVIDoa2200161
Emeruwa UN, Gyamfi-Bannerman C, C, Laurent LC. Biomarkers and the Risk of
Preeclampsia. JAMA. 2023;329(7):539-41. DOI: 10.1001/jama.2022.24906
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Copyright (c) 2024 Zuzanna Tomczewska, Aleksandra Rykucka, Natalia Zozula, Marcin Wąs, Justyna Kiełbasa, Agata Kowalczyk, Katarzyna Bil, Iga Ślesicka, Aleksandra Latała, Magda Przestrzelska
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