Biomarkers for Preeclampsia Prediction and Diagnosis

Pathophysiological Basis

Preeclampsia involves angiogenic imbalance characterized by elevated soluble fms-like tyrosine kinase 1 (sFlt-1), reduced placental growth factor (PlGF), and elevated soluble endoglin (sEng), reflecting the underlying pathophysiology of preeclampsia, which includes placental ischemia, abnormal immune system activation, and metabolic dysfunction 1, 3, 4

The International Society for the Study of Hypertension in Pregnancy (ISSHP) does not recommend routine use of biomarkers as rule-out tests for preeclampsia 5, 6
The National Institute for Health and Care Excellence (NICE) recommends the use of the sFlt-1/PlGF ratio or the Triage PlGF test with standard clinical assessment to help rule out preeclampsia requiring delivery within 7-14 days in women with suspected preeclampsia between 20 and 34+6 weeks' gestation 6
Further research is needed through well-designed, multi-center trials to test the clinical utility of biomarkers in improving pregnancy outcomes while balancing costs and potential unnecessary interventions resulting from false positive screening 7

The heterogeneity of preeclampsia (early vs late onset, with vs without severe features) may require different biomarker thresholds or combinations for optimal prediction 1, 3