Improving the prediction of preeclampsia
- 7 January 2016
- Maternal & Fetal Health
Preeclampsia is a leading cause of maternal and neonatal death worldwide, yet effective strategies are lacking for prevention and treatment. A new paper published in the New England Journal of Medicine, explores the Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia.
PREECLAMPSIA - WHAT WE KNOW
Preeclampsia, a heterogeneous, multisystem disorder defined by the new onset of hypertension and proteinuria after 20 weeks of gestation, affects 2 to 5% of pregnancies worldwide. It is characterized by high blood pressure and a large amount of protein in the urine. Preeclampsia is associated with high risks of iatrogenic preterm delivery, intrauterine growth restriction, placental abruption, and perinatal mortality, along with maternal morbidity and mortality.
The cause of preeclampsia is incompletely understood, but the disorder is thought to be due to placental malperfusion resulting from abnormal remodeling of maternal spiral arteries. In preeclampsia, circulating maternal serum levels of soluble fms-like tyrosine kinase 1 (sFlt-1) are increased, and placental growth factor (PlGF) levels are decreased. An antagonist of PlGF and vascular endothelial growth factor, sFlt-1 causes vasoconstriction and endothelial damage that may lead to fetal growth restriction and preeclampsia. A high ratio of sFlt-1 to PlGF is associated with an increased risk of preeclampsia and may be a better predictor of risk than either biomarker alone.
There is a need for a reliable predictor of preeclampsia (particularly its absence) in the short term in women with suspected preeclampsia. Women with suggestive symptoms or signs are often hospitalized until preeclampsia and related adverse outcomes have been ruled out. Others who require hospitalization may be overlooked. Although no preventive or therapeutic strategy is yet available, with the exception of low-dose acetylsalicylic acid, which has a moderate preventive effect in high-risk pregnancies after the first trimester, clinical experience suggests that early detection and monitoring are beneficial.
Dr. Manu Vatish Senior Clinical Fellow in Obstetrics from the Nuffield Department of Obstetrics & Gynaecology collaborated on a new paper: Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. (New England Journal of Medicine)
Dr. Manu Vatish, Senior Clinical Fellow in Obstetrics