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Interview with Dr. Jaksch, 2014
Long-awaited breakthrough in the diagnosis of preeclampsia
PD Dr. med. Michaela Jaksch
Freiburg Medical Laboratory, Dubai, UAE
Measuring the sFlt-1/PlGF ratio by Immunoassay
With the vast number of biological and physiological factors that can influence the health of a pregnant woman and her unborn child, accurate monitoring throughout the pregnancy is essential. One of the conditions that can affect a mother and child during pregnancy is preeclampsia, a hypertensive disorder that complicates 3-5% of pregnancies¹. The challenge facing clinicians with preeclampsia today is its similarities with other conditions such as pregnancy-induced hypertension. Although preeclampsia can be potentially life-threatening for both mother and fetus, recent medical advancements in the last decade have paved the way for improved accuracy in its diagnosis.
Characterized by both hypertension and proteinuria, which are leading detectable risk factors for stillbirth, preeclampsia is a leading cause of maternal and infant illness and mortality. Certain factors can put some women at greater risk for developing preeclampsia, according to PD Dr. med. Michaela Jaksch, General Manager of Freiburg Medical Laboratory Middle East LLC and Associate Professor with the Munich University in Germany. “Pre-existing conditions such as high blood pressure, type 2 diabetes, renal or autoimmune disease can increase the likelihood of a women developing preeclampsia. Probability can also increase if the mother had preeclampsia in a previous pregnancy, has a high body mass index, or has her first pregnancy over the age of 40,” said Dr. Jaksch. Early onset of preeclampsia, the more severe case, can appear from week 20 of the pregnancy and late onset is usually after week 34.
Unmet medical needs in diagnosis
The growing need for a rapid and accurate aid in diagnosing preeclampsia to facilitate effective clinical management and improve outcome for mother and fetus has long been evident. Typically diagnosed on the basis of high blood pressure and protein in the urine, the cause of preeclampsia is not yet clearly identified and its variable symptoms have made it difficult for clinicians to diagnose. High-blood pressure and proteinuria, for example, can both be linked to other conditions such as bacterial infections or pregnancy- associated hypertension, respectively.
However, Dr. Jaksch points out that recent evidence demonstrates that angiogenic growth factors such as placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) have a major role in the development of preeclampsia. PlGF is required to stimulate blood vessel growth in the placenta to support the fetus’s nutritional needs. In preeclampsia, the placenta releases more soluble sFlt-1 than it should, which bind to the PlGF and decrease PlGF levels. “Detecting an imbalance of these two biomarkers can help clinicians diagnose cases of preeclampsia, where sFlt-1 levels are raised and PlGF levels are decreased,” said Dr. Jaksch.
“I would always suggest testing for both angiogenic growth factors together instead of only one to assist in the diagnosis of preeclampsia,” recommends Dr. Jaksch. The sFlt-1/PlFG immunoassay, which is the first available and approved automated diagnostic test, could allow clinicians to make a major advance in the diagnosis of preeclampsia, which has remained unchanged for years. With a simple laboratory test, this test helps optimize clinical management for an improved outcome by giving physicians more to rely on than the low sensitivity and specificity measurement of blood pressure and urine protein sampling. In addition to the test’s availability, highlighting the importance of testing for the sFlt-1/ PlGF ratio among the medical community is essential to improve detection.
In regular pregnancy management, testing the sFlt-1/PlGF ratio helps identify women who are most at need for intensified care by creating a precise, consistent, and reliable picture for an accurate diagnosis and timely intervention, and measuring both the sFlt-1 and PlGF levels has shown to be more useful than either measurement individually, forming an objective tool to substantiate signs of preeclampsia.
1. Roberts, J. M., & Cooper, D. W. (2001). Pathogenesis and genetics of pre-eclampsia. The Lancet, 357, 53-56.