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How to identify pregnant women at risk of pre-eclampsia? — a review of the current literature
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Abstract
Pre-eclampsia remains a major cause of poor perinatal outcome worldwide. As administering acetylsalicylic acid in a high risk population reduces the risk of PE, it is essential to identify women at risk of PE. Several algorithms for PE risk assessment have been developed. They include maternal factors combined with uterine artery pulsatility index, mean arterial pressure, serum pregnancy-associated plasma protein-A, placental growth factor, and serum soluble fms-like tyrosine kinase-1. Beside PE prophylaxis with acetylsalicylic acid, a proper management of women considered at a high risk of PE is essential. The sFlt-1:PlGF ratio between 20 and 34 + 6 weeks may be used to predict a short-term absence of PE or to predict the risk of PE diagnosis within 4 weeks and a significant shortening of the duration of pregnancy associated with it. The sFlt-1:PlGF ratio may be helpful in deciding about hospitalization or choosing the optimal time for corticosteroid administration in women at risk of PE. It may also help to reduce overall healthcare costs.
Abstract
Pre-eclampsia remains a major cause of poor perinatal outcome worldwide. As administering acetylsalicylic acid in a high risk population reduces the risk of PE, it is essential to identify women at risk of PE. Several algorithms for PE risk assessment have been developed. They include maternal factors combined with uterine artery pulsatility index, mean arterial pressure, serum pregnancy-associated plasma protein-A, placental growth factor, and serum soluble fms-like tyrosine kinase-1. Beside PE prophylaxis with acetylsalicylic acid, a proper management of women considered at a high risk of PE is essential. The sFlt-1:PlGF ratio between 20 and 34 + 6 weeks may be used to predict a short-term absence of PE or to predict the risk of PE diagnosis within 4 weeks and a significant shortening of the duration of pregnancy associated with it. The sFlt-1:PlGF ratio may be helpful in deciding about hospitalization or choosing the optimal time for corticosteroid administration in women at risk of PE. It may also help to reduce overall healthcare costs.
Keywords
pre-eclampsia, prediction, PlGF, sFlt-1, risk factors
About this articleTitle
How to identify pregnant women at risk of pre-eclampsia? — a review of the current literature
Journal
Issue
Article type
Review paper
Pages
335-338
Published online
2018-06-29
Page views
2216
Article views/downloads
2035
DOI
Pubmed
Bibliographic record
Ginekol Pol 2018;89(6):335-338.
Keywords
pre-eclampsia
prediction
PlGF
sFlt-1
risk factors
Authors
Katarzyna Kosińska-Kaczyńska
Mirosław Wielgoś
References (25)- American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013; 122(5): 1122–1131.
- Gallo DM, Wright D, Casanova C, et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 19-24 weeks' gestation. Am J Obstet Gynecol. 2016; 214(5): 619.e1–619.e17.
- Agrawal S, Cerdeira AS, Redman C, et al. Meta-Analysis and Systematic Review to Assess the Role of Soluble FMS-Like Tyrosine Kinase-1 and Placenta Growth Factor Ratio in Prediction of Preeclampsia: The SaPPPhirE Study. Hypertension. 2018; 71(2): 306–316.
- The World Health Report 2005 - make every mother and child count. Geneva. World Health Organization. ; 2005.
- Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ. 2013; 347: f6564.
- Rolnik DL, Wright D, Poon LC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017; 377(7): 613–622.
- Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol. 2018; 218(3): 287–293.e1.
- Regulation of the Minister of Health on the standards of medical proceedings when providing health care in obstetrics and gynaecology regarding perinatal obstetric and gynaecological care provided to women during pregnancy, labour and postpartum period, in cases of specific complications and care of women in cases of adverse pregnancy outcomes (as of 9 November 2015, Journal of Acts 2015, item 2007).
- Kosinski P, Sarzynska-Nowacka U, Fiolna M, et al. The practical use of acetylsalicylic acid in the era of the ASPRE trial. Update and literature review. Ginekol Pol. 2018; 89(2): 107–111.
- The National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. Clinical Guidelines CG2017. London, UK: NICE. ; 2011.
- Wright D, Syngelaki A, Akolekar R, et al. Competing risks model in screening for preeclampsia by maternal characteristics and medical history. Am J Obstet Gynecol. 2015; 213(1): 62.e1–62.10.
- O'Gorman N, Wright D, Syngelaki A, et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am J Obstet Gynecol. 2016; 214(1): 103.e1–103.e12.
- Maynard SE, Min JY, Merchan J, et al. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest. 2003; 111(5): 649–658.
- Levine RJ, Lam C, Qian C, et al. CPEP Study Group. Soluble endoglin and other circulating antiangiogenic factors in preeclampsia. N Engl J Med. 2006; 355(10): 992–1005.
- Lu F, Longo M, Tamayo E, et al. The effect of over-expression of sFlt-1 on blood pressure and the occurrence of other manifestations of preeclampsia in unrestrained conscious pregnant mice. Am J Obstet Gynecol. 2007; 196(4): 396.e1–7; discussion 396.e7.
- Levine RJ, Maynard SE, Qian C, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004; 350(7): 672–683.
- Tsiakkas A, Saiid Y, Wright A, et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 30-34 weeks' gestation. Am J Obstet Gynecol. 2016; 215(1): 87.e1–87.e17.
- Andrietti S, Silva M, Wright A, et al. Competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 35-37 weeks' gestation. Ultrasound Obstet Gynecol. 2016; 48(1): 72–79.
- Zeisler H, Llurba E, Chantraine F, et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med. 2016; 374(1): 13–22.
- Zeisler H, Llurba E, Chantraine F, et al. Soluble fms-Like Tyrosine Kinase-1-to-Placental Growth Factor Ratio and Time to Delivery in Women With Suspected Preeclampsia. Obstet Gynecol. 2016; 128(2): 261–269.
- Lapaire O, Shennan A, Stepan H. The preeclampsia biomarkers soluble fms-like tyrosine kinase-1 and placental growth factor: current knowledge, clinical implications and future application. Eur J Obstet Gynecol Reprod Biol. 2010; 151(2): 122–129.
- Frusca T, Gervasi MT, Paolini D, et al. Budget impact analysis of sFlt-1/PlGF ratio as prediction test in Italian women with suspected preeclampsia. J Matern Fetal Neonatal Med. 2017; 30(18): 2166–2173.
- Vatish M, Strunz-McKendry T, Hund M, et al. sFlt-1/PlGF ratio test for pre-eclampsia: an economic assessment for the UK. Ultrasound Obstet Gynecol. 2016; 48(6): 765–771.
- National Institute for Clinical Excellence. PlGF-Based Testing to Help Diagnose Suspected Pre-eclampsia (Triage PlGF Test, Elecsys Immunoassay sFlt-1/PlGF Ratio, DELFIA Xpress PlGF 1-2-3 Test, and BRAHMS sFlt-1 Kryptor/BRAHMS PlGF Plus Kryptor PE Ratio).
- Sabrià Ba, Lequerica-Fernández P, Lafuente-Ganuza P, et al. Addition of NT-proBNP to sFlt-1/PlGF ratio improves prediction of pre-eclampsia requiring delivery within 1 week, when sFlt-1/PlGF ratio is above 38: results of longitudinal cohort study. Ultrasound Obstet Gynecol. 2018 Mar 2.: Mar.
