Abstract
Preeclampsia (PE) is a common obstetric disorder typically affecting 2–8% of all pregnancies and can lead to several adverse obstetric outcomes for both mother and fetus with the greatest burden of severe outcomes in low middle-income countries (LMICs), therefore, screening for PE is vital. Globally, screening is based on maternal characteristics and medical history which are nonspecific for the disorder. In 2004, the World Health Organization acknowledged that no clinically useful test was able to predict the onset of PE, which prompted a universal search for alternative means of screening. Over the past decade or so, emphasis has been placed on the use of maternal characteristics in conjunction with biomarkers of disease combined into predictive algorithms, however these are yet to transition into the clinic and are cost prohibitive in LMICs. As a result, the screening paradigm for PE remains unchanged. It is evident that novel approaches are needed. Vibrational spectroscopy, specifically Raman spectroscopy and Fourier-transform infrared spectroscopy (FTIR), could provide better alternatives suited for implementation in low resource settings as no specialized reagents are required for conventional approaches and there is a drive to portable platforms usable in both urban and rual community settings. These techniques are based on light scattering and absorption, respectively, allowing detailed molecular analysis of samples to produce a unique molecular fingerprint of diseased states. The specificity of vibrational spectroscopy might well make it suited for application in other obstetric disorders such as gestational diabetes mellitus and obstetric cholestasis. In this review, we summarize current approaches sought as alternatives to current screening methodologies and introduce how vibrational spectroscopy could offer superior screening and diagnostic paradigms in obstetric care. Additionally, we propose a real benefit of such tools in LMICs where limited resources battle the higher prevalence of obstetric disorders.
Highlights
Antenatal screening programmes are used around the world to identify pregnant women at risk of common obstetric disorders
We summarize current approaches sought as alternatives to current screening methodologies and introduce how vibrational spectroscopy could offer superior screening and diagnostic paradigms in obstetric care
On the basis that vibrational spectroscopy can accurately discriminate multiple disease and healthy states, these technologies could be applied more widely to obstetric care fulfilling the need for alternative screening and diagnostic technologies
Summary
Antenatal screening programmes are used around the world to identify pregnant women at risk of common obstetric disorders. The current screening procedure for PE is limited to assessing maternal characteristics to determine the risk of later PE development, while blood pressure and proteinuria estimations are used to confer a diagnosis of PE These measures are non-specific and a focus on developing superior screening and diagnostic tests for PE has emerged. Current PE screening guidelines for the UK issued by the National Institute for Health and Care Excellence (NICE) involve determining a women’s risk at the booking appointment during the first trimester These include: >40 years of age, nulliparity, a 10year pregnancy interval, a previous diagnosis of preeclampsia or family history of the disease, BMI > 30, pre-existing vascular or renal disease and multiple pregnancies [11].
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