TESTS TO PREDICT PREECLAMPSIA, Andrei Rebarber, MD (Digital)
Pre-eclampsia is a disorder that may develop anytime from the later part of the second trimester to the first several weeks postpartum. The ability to predict the disorder has limited current clinical benefit given that there is no known therapeutic intervention to alter its course or severity besides delivery. However, accurate prediction may help identify patients which may be appropriately transferred to high-risk care settings and/or allow for timely maternal interventions (ie. Antenatal steroids) to allow for improved perinatal outcomes.
Several maternal analytic tests have been developed to help doctors predict pre-eclampsia disease. Examples include utilization of several angiogenic factors (ie. vascular endothelial growth factor (VEGF) and placental growth factor (PlGF)),as well as, two anti-angiogenic proteins (ie. soluble endoglin (sEng) and the truncated form of the full-length VEGF receptor type-1 (Flt1), known as soluble fms-like tyrosine kinase 1 (sFlt-1)), and uterine artery Doppler, and combinations of biomarkers (ie. Plasma Protein 13, ADAM 12, PAPP-A) with patient characteristics (ie. Mean Arterial Pressure (MAP), prior history, and parity).
At this time no clinically available tests performs well enough in low-risk settings to determine women who go on to develop preeclampsia. Additionally, no test whether in a high risk or low-risk setting has been shown to improve either maternal or fetal outcome due to its clinical adaption into a care paradigm.
For patients who think they might be at risk for developing preeclampsia we recommend preconception counseling and review of any modifiable risk factors (eg. High BMI, poor control of diabetes). Once pregnant, patient’s at risk should receive patient education on the signs and symptoms of preeclampsia, increased antenatal vigilance and ultrasound screening, and possible utilization of baby aspirin inappropriately selected populations may be beneficial. If preterm preeclampsia occurred in a prior pregnancy possible screening for certain immune-mediated clotting predilections (ie. Antiphospholipid antibody syndrome) may be warranted, however, we do not routinely recommend screening for genetic thrombophilias at this time. Baseline evaluation of renal function and liver function is advisable either prior to pregnancy or at the first couple of visits. At this time, our group and the American Congress of Obstetrics and Gynecology (ACOG) does not recommend using laboratory or imaging tests to screen for preeclampsia.
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!