title: Blood laboratory testing for early prediction of preeclampsia: chasing the finish line or at the starting blocks?
abstract: Preeclampsia (PE) affects 2-8% of pregnancies worldwide, thus representing an important cause of maternal and neonatal morbidity, up to death. Many studies have been designed to identify putative biomarkers for accurate and timely diagnosing PE, but only some of them were focused on specific and sensitive biomarkers for early prediction of this life-threatening condition. In particular, some prospective studies aimed to investigate the predictive role of circulating biomarkers before 20 weeks of gestation in the general pregnant population yielded conflicting results. This article is hence centered on results obtained in studies investigating the predictive performances of angiogenic, anti-angiogenic, inflammatory, endocrine, and epigenetic biomarkers. The available evidence suggests that angiogenic and anti-angiogenic molecules, in particular the sFlt1:PlGF ratio, may be considered the biomarkers with the best diagnostic performance in the second trimester. However, doubts remain about their use in clinical settings before the 20th gestational week. Even lower evidence is available for other biomarkers, due to the fact that some positive results have not been confirmed in ensuing investigations, whereas unresolved analytical issues still contribute to make their clinical reliability rather questionable. Differential expression of microRNAs seems also a promising evidence for early prediction of PE, but additional research and well-designed prospective studies are needed to identify and validate routine predictive tests. KEY MESSAGES Preeclampsia affects 2-8% of pregnant women worldwide, thus remaining one of the leading causes of maternal and neonatal morbidity and mortality. Several studies have investigated the predictive role of circulating biomarkers before 20th week of gestation with conflicting results. Additional research and well-designed prospective studies are needed to identify and validate predictive tests in clinical practice.
authors: a Sezione di Biochimica Clinica, Dipartimento di Neuroscienze , Biomedicina e Movimento Università di Verona , Italy.
authors: Martina
authors: M
authors: Montagnana
authors: a Sezione di Biochimica Clinica, Dipartimento di Neuroscienze , Biomedicina e Movimento Università di Verona , Italy.
authors: Elisa
authors: E
authors: Danese
authors: a Sezione di Biochimica Clinica, Dipartimento di Neuroscienze , Biomedicina e Movimento Università di Verona , Italy.
authors: Giuseppe
authors: G
authors: Lippi
authors: b Sezione di Medicina Interna C, Dipartimento di Medicina , Università di Verona , Italy.
authors: Cristiano
authors: C
authors: Fava
mesh_terms: D015415:Biomarkers / Q000097:blood*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D035683:MicroRNAs / Q000378:metabolism; D000072483:Placenta Growth Factor / Q000378:metabolism; D011225:Pre-Eclampsia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000378:metabolism; D015203:Reproducibility of Results; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D015415:Biomarkers; D035683:MicroRNAs; C000608036:PGF protein, human; D042461:Vascular Endothelial Growth Factor A; D000072483:Placenta Growth Factor
keywords: Preeclampsia; biomarkers; diagnosis; prediction; pregnancy