Early Prediction of Preeclampsia: Hope for Early Intervention?

Preeclampsia is a hypertensive disorder of pregnancy that is diagnosed after the 20th week of gestation. It is defined by the American College of Obstetrics and Gynecology as de novo hypertension of at least 140/90 in a pregnant woman. Proteinuria with the hypertension is sufficient but not required for the diagnosis, especially if a woman displays severe symptoms such as headache, blurry vision, right upper quadrant pain, and low platelet count [1]. Despite significant research, preeclampsia continues to kill 76,000 mothers and 500,000 babies per year worldwide [2]. It causes short and long term consequences such as future metabolic and cardiovascular events for the mother and the child born during a pregnancy affected by preeclampsia [3-5]. A delay in diagnosis and delayed access to appropriate care is a core cause of the preeclampsia related morbidity and severe mortality worldwide. The complex pathogenesis of preeclampsia has challenged the ability to effectively predict preeclampsia to decrease the delay in this diagnosis. Consequently, early intervention or triage to higher level obstetric care is hindered. The lack of an early biomarker for preeclampsia also represents a major barrier to treat preeclampsia before major clinical symptoms emerge and the cycle of future cardiovascular risk for mom and baby begins. Novel, very early pregnancy predictive tests for preeclampsia may provide significant clinical utility. This review addresses current strong biomarkers of preeclampsia and their relevance to the prediction and the pathogenesis of preeclampsia.