Diagnosis and Management of Preeclampsia: Suggested Guidance on the Use of Biomarkers

Abstract

Objective It is a challenge to consider preeclampsia (PE) diagnosis and management in low and middle-income settings, where it represents a major public health concern. The placenta is the underlying cause of disease, and the plasma concentrations of proangiogenic and antiangiogenic factors released by the placenta can reflect the risks of disease progression. Antiangiogenic proteins, such as soluble fms-like tyrosine kinase 1 (sFlt-1), and proangiogenic, like placental growth factors (PlGF), are directly and inversely correlated with the disease onset, respectively. Methods Narrative review on the use of biomarkers (sFlt-1 to PlGF ratio) with a suggested guidance protocol. Results Key considerations on the use of biomarkers: the sFlt-1/PlGF ratio is mainly relevant to rule out PE between 20 and 36 6/7 weeks in cases of suspected PE; however, it should not replace the routine exams for the diagnosis of PE. The sFlt-1/PlGF ratio should not be performed after confirmed PE diagnosis (only in research settings). In women with suspected PE, sFlt-1/PlGF ratio < 38 can rule out the diagnosis of PE for 1 week (VPN = 99.3) and up to 4 weeks (VPN= 94.3); sFlt-1/PlGF ratio > 38 does not confirm the diagnosis of PE; however, it can assist clinical management. In cases of severe hypertension and/or symptoms (imminent eclampsia), hospitalization is imperative, regardless of the result of the sFlt-1/PlGF ratio. Conclusion The use of biomarkers can help support clinical decisions on the management of suspected PE cases, especially to rule out PE diagnosis, thus avoiding unnecessary interventions, especially hospitalizations and elective prematurity

Role of biomarkers (sFlt-1/PlGF) in cases of COVID-19 for distinguishing preeclampsia and guiding clinical management

“…Our data, when comparing outcomes among cases with altered sFlt-1/PlGF ratio (using 38 as the threshold) did not present significant differences. Nevertheless, we had limited number of cases and only very few with sFlt-1/PlGF ratio over 85 (the most used ratio for PE diagnosis) 27 . Regardless, biological samples were collected at the time of SARS-CoV-2 infection and not at the time of PE diagnosis, which may have experimental implications.…”

Literature Review: The sFlt1/PlGF Ratio and Pregestational Maternal Comorbidities: New Risk Factors to Predict Pre-Eclampsia

“…The probability of a late abortion in asymptomatic pregnant women is independently correlated with sFlt-1 and PlGF ( Figure 2 C,F) [ 47 ]. Despite this, Costa et al concluded that the sFlt1/PlGF ratio should only be used to exclude pre-eclampsia at 20–36 weeks of gestation and cannot replace the standard approaches to the diagnosis of the disease [ 48 ].…”

Prediction and prevention of preeclampsia by physicians in Brazil: An original study

“…Recently, another biomarkers, like the soluble fms-like tyrosine kinase 1 (sFlt-1), endoglin, PlGF, neurokinin-B have been used to try to predict the preeclampsia's onset and/or preeclampsia's complications ( 15 – 20 ). The measurement of sFlt-1/PlGF ratio or PlGF alone is endorsed by some guidelines to rule out PE, since the negative predictive value of these tests are very high and reliable ( 14 , 21 ). Neurokinin-B, a neuropeptide produced by the placenta, also can be a possible role in the pathophysiology of the disease.…”