Biomarkers and the Risk of Preeclampsia

Abstract

(JAMA. 2023;329:539–541) Though maternal and fetal deaths due to preeclampsia and other hypertensive disorders of pregnancy have decreased in recent years, the incidence of preeclampsia has risen. Current clinical practice for preventing preeclampsia includes initiating a low-dose aspirin treatment at the end of the first trimester of pregnancy; it has been shown to largely mitigate the effects of preeclampsia and reduce incidence. One recent study by Mendoza et al examined the effect of discontinuation of aspirin treatment between 24 and 28 weeks of gestation and found discontinuation is non-inferior to continuation of treatment to 36 weeks. This study had some important findings and implications, but is hard to generalize to the United States, as there are some fundamental differences in the aspirin treatment regimen; the dosage in the United States is 81 mg rather than 150 mg, and there is no recommendation to stop treatment at 36 weeks of gestation. Diagnostically, the United States also does not use molecular biomarkers (the sFlt-1:PlGF ratio) but rather clinical factors to determine risk of preeclampsia. Implementing the methods proposed in this recent study would be a major overhaul of current clinical practice in the United States.