Clinical tools and biomarkers to predict preeclampsia

Abstract

Preeclampsia is pregnancy-specific, and significantly contributes to maternal, and perinatal morbidity and mortality worldwide. An effective predictive test for preeclampsia would facilitate early diagnosis, targeted surveillance and timely delivery; however limited options currently exist. A first-trimester screening algorithm has been developed and validated to predict preterm preeclampsia, with poor utility for term disease, where the greatest burden lies. Biomarkers such as sFlt-1 and placental growth factor are also now being used clinically in cases of suspected preterm preeclampsia; their high negative predictive value enables confident exclusion of disease in women with normal results, but sensitivity is modest. There has been a concerted effort to identify potential novel biomarkers that might improve prediction. These largely originate from organs involved in preeclampsia's pathogenesis, including placental, cardiovascular and urinary biomarkers. This review outlines the clinical imperative for an effective test and those already in use and summarises current preeclampsia biomarker research.

Keywords: Biomarkers; Placenta; Prediction; Preeclampsia.

Fig. 1

Schematic outlining the potential sources of biomarkers for preeclampsia and types that may be measured. Preeclampsia is associated with placental insufficiency that leads to significant endothelial dysfunction and organ involvement. As such, the placenta and endothelial cells represent potential sources of potential biomarkers that may be in the form of RNAs, DNA, metabolites proteins.