Predicting Preeclampsia
As the only current treatment for preeclampsia is delivery, a good screening test would be helpful to identify women at risk, diagnose them early, and to provide them with appropriate management that might lead to improved maternal and perinatal outcomes. Women with known risk factors should be assessed early in pregnancy by a physician who is experienced in the management of preeclampsia. Both human and animal data described earlier in "Circulating Angiogenic Factors" suggest that ang-iogenic factors may be important in the pathogenesis of preeclampsia. Alterations in the levels of VEGF, PlGF, sFltl, and sEng have been found in the serum of women who develop preeclampsia, and these alterations precede the onset of preeclampsia by weeks to months (51, 56-60, 103-105).
Measurements have also been performed in the urine (106-108), with one of the studies focusing on urinary PlGF. It was found that urinary PlGF increased during the first two trimesters, peaking at 29-32 weeks and then decreasing; however, in the women who went on to develop preeclampsia, they had lower levels of PlGF at each sampling point, beginning at 25 weeks of gestation. At 21-32 weeks, the PlGF of the lowest quartile was predictive of preeclampsia before term (OR 22.5, 95% CI 7.467.8), but less predictive of term preeclampsia (OR 2.2, 95% CI 1.2-4.3) (106). Some suggest that using a ratio of sFlt1/VEGF or sFlt1/PlGF is superior than using absolute levels of angiogenic factors to predict preeclampsia (57, 108). A review evaluating sFlt1 and PlGF concluded that after 25 weeks of gestation these factors were predictive of severe preeclampsia, but in the absence of prospective studies there is no evidence to recommend these tests for screening at this time (109).
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