Abstract
Preeclampsia and associated hypertensive disorders of pregnancy represent a leading cause of global maternal and neonatal morbidity and mortality. Identification of women at high risk for developing preterm-preeclampsia and prophylaxis with low-dose aspirin has the potential to significantly reduce the rate of preterm-preeclampsia. In addition, risk assessment and monitoring of women in the second and third trimester of pregnancy, to aid in early detection of evolving disease, timely referral to specialist care, and active monitoring of women with confirmed or suspected preeclampsia is essential for improving maternal and neonatal outcomes. The angiogenesis-related biomarkers sFlt-1 and PlGF have been shown to have clinical value to aid in the prediction, diagnosis, and risk stratification of preeclampsia when used either alone or in combination with other risk factors. However, currently there is no consensus on the optimum strategy to link first trimester screening for preterm-preeclampsia with appropriate second and third trimester risk assessment strategies. This opinion paper will outline the current evidence for first trimester preeclampsia screening and prevention, as well as the evidence for various risk stratification approaches for detection of evolving preeclampsia through the second and third trimesters of pregnancy, and proposes a potential model integrating these tools. This article is protected by copyright. All rights reserved.
Highlights
Preeclampsia is a heterogeneous, multiorgan disorder of pregnant women affecting ~2–5% of all pregnancies[1, 2]
This study demonstrated a negative predictive value (NPV) of 99.3% for an soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio cut-off of ≤38 for ruling out the occurrence of preeclampsia within 1 week in women with signs and symptoms suggestive of preeclampsia
The ability to identify those women at high risk of developing pretermpreeclampsia in early pregnancy, who would benefit from administration of low-dose aspirin, has the potential to significantly reduce the rate of preterm-preeclampsia
Summary
Preeclampsia is a heterogeneous, multiorgan disorder of pregnant women affecting ~2–5% of all pregnancies[1, 2]. With regards to risk assessment in the third trimester of pregnancy, the FMF have developed a risk algorithm for assessment at 35–36+6 weeks of gestation in a population of 13,350 women with singleton pregnancies attending routine antenatal care This model, which uses a combination of maternal factors, MAP, serum PlGF and sFlt-1, demonstrated a 70%. Different approaches to screening through the second and third trimesters have been reported, and these have largely not followed on from first trimester prediction and prevention These strategies have demonstrated the potential value of angiogenic biomarkers (sFlt-1 and PlGF) and sonographic markers (uterine artery Doppler) but it is not completely clear how high-risk pregnancies should be selected, what combination of tools are best used for risk prediction, the most appropriate gestational age for testing, or whether management can be altered to improve maternal and neonatal outcomes. There is an urgent need for prospective interventional trials investigating the usefulness of these biomarkers, alone or in combination with other predictive tools, in this situation
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