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Lecture - New Laboratory Markers for Early Detection of Preeclampsia
FML at EOFF 2014 in Dubai
New Laboratory Markers for the Early Detection of Pre-eclampsia
PD Dr. med. habil. Michaela Jaksch
Consultant in Laboratory Medicine
Freiburg Medical Laboratory, Dubai, UAE
Preeclampsia is one of the most life-threatening medical conditions (actually the leading cause of maternal mortality in developing and developed countries) for mother and baby during the later stages of pregnancy, affecting 3% to 5% of pregnant women. Clinical symptoms usually start after the 20th week of pregnancy and are mainly hypertension and proteinuria.
In the past years, a significant link was identified between preeclampsia and several angiogenic factors, in particular PlGF (Placental Growth Factor) and its receptor Flt-1 (Fms like tyrosine kinase receptor-1) as well as a circulating soluble form of the receptor, sFlt-1. These two factors are promising biochemical markers that together show high sensitivity from the mid-second trimester.
In patients with both, early and late onset preeclampsia, significantly elevated levels of Flt and sFlt receptor and lowered levels of PlGF can be detected several weeks before the onset of symptoms. However, the test has been evaluated only from the 20th week of gestation. Studies show that the maternal serum levels mirror the placental levels and are significantly altered compared to levels in women with uncomplicated pregnancies. Based on these opposing changes of the parameters, a ratio was calculated to better distinguish between uncomplicated pregnancies and those with preeclampsia. This ratio of sFlt-1/PlGF gives a more reliable prediction of clinical preeclampsia than just measuring the levels of one protein alone. Its value increases 6-8 weeks before the onset of preeclampsia.
Early detection is possible by screening pregnant women at risk for preeclampsia.
Note: A ratio of 85 or higher indicates the onset of preeclampsia. In cases with suspected preeclampsia but borderline values, the levels should be monitored periodically, maximum every 2 weeks. An increase indicates a worsening of the condition.
Literature for review:
Kim YJ. Pathogenesis and promising non-invasive markers for preeclampsia. Obstet Gynecol Sci 2013; 56(1):2-7.
Anderson UD et al. Biochemical markers to predict preeclampsia. Placenta 2012;33:S42-S47.
Levine RJ et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 2004; 350:672–683.