Decoding Preeclampsia - The Importance of Timely and Accurate Diagnosis in Protecting Maternal and Fetal Health

Preeclampsia is a serious hypertensive disorder that affects nearly 3-5% of pregnant individuals worldwide and can cause major complications in pregnancy.1 Over the last 3 decades, the prevalence of these disorders nearly doubled in Canada2, demanding the urgent need for preeclampsia awareness, diagnosis, and treatment. As one of the leading causes of maternal and fetal morbidity and mortality,3 it is crucial to shed light on this condition, its implications, and the pivotal role of timely and accurate diagnosis to safeguard pregnant individuals and their babies. At Roche Canada, we are committed to advancing the dialogue on women’s health and championing solutions that empower healthcare professionals and expecting mothers alike. 

DIAGNOSTIC CHALLENGES WITH PREECLAMPSIA

Preeclampsia is characterized by a new onset of high blood pressure after 20 weeks’ gestation and can be accompanied by a range of symptoms, including protein in the urine, liver dysfunction, neurological features (headaches, visual disturbances), fetal growth restriction, and hemolysis.1 However, the clinical presentation of this condition can vary greatly from patient to patient. The most common diagnostic tools used to identify preeclampsia include collecting a patient’s blood pressure and testing their urine for protein, however these tests are limited in their ability to accurately predict the severity and progression of the condition.4 Furthermore, the only way to currently treat preeclampsia is by removing the placenta and delivering the baby.4 Studies have highlighted the need for a reliable test to identify preeclampsia to help chart better treatment plans for patients.4,5 

THE ROLE OF BIOMARKERS IN PREECLAMPSIA DIAGNOSIS

The role of angiogenic factors such as placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) have been investigated for their use in preeclampsia diagnosis in Canada and globally.6 Decreased concentrations of PlGF can be seen early in pregnancy and may indicate an individual who is at risk of developing early-onset preeclampsia (before 34 weeks’ gestation).7 sFlt-1 is another important biomarker that can help diagnose preeclampsia in at-risk pregnant individuals, since increased concentrations of sFlt-1 can be seen several weeks before the onset of the condition.7 More specifically, a ratio of high sFlt-1 to low PlGF has been found in women with both early-onset and late-onset preeclampsia.6,7 These biomarkers can be used in two clinical settings: 

1. The use of the PlGF biomarker as a screening tool in the first trimester to help identify pregnant individuals at increased risk who could benefit from early intervention and monitoring during their pregnancies.8

2. The use of the sFlt-1/PlGF ratio test in pregnant individuals with signs and symptoms of preeclampsia - to assist in short-term prediction and diagnosis of the condition in the second or third trimesters of pregnancy.8 

In May 2022, the Society of Obstetricians and Gynaecologists of Canada (SOGC) updated their clinical practice guideline for hypertensive disorders of pregnancy. One recommendation includes the implementation of first trimester screening (11-14 weeks) using a combination of risk markers, including PlGF, where possible.8  An additional recommended change in practice includes using angiogenic markers such as sFlt-1 and PlGF to assess individuals with suspected preeclampsia for greater diagnostic accuracy of the condition.8 Changes to Canadian clinical practice guidelines highlight the importance of incorporating biomarkers to better predict preeclampsia. There continues to be a need to highlight this serious condition and the changes being made to improve maternal and fetal outcomes in pregnancy. 

THE PATIENT JOURNEY WITH PREECLAMPSIA

Preeclampsia can impact many family members and loved ones involved throughout the pregnancy journey; highlighting these stories is important to understanding the work that needs to be done to support everyone involved. Watch Chaniece’s story below to learn more about one family’s journey with preeclampsia and an important message about the signs and symptoms of the condition:

CONCLUSION

At Roche Canada, we are committed to raising awareness about preeclampsia, its impact, and the diagnostic innovations available to more accurately identify this condition. The timely and accurate diagnosis of preeclampsia plays a crucial role in ensuring the health and well-being of both mother and baby. By closely monitoring blood pressure, protein levels, and other risk markers like PlGF and the sFlt-1/PlGF ratio, healthcare professionals can identify the condition early and take necessary measures to manage it effectively. Early diagnosis not only helps prevent serious complications but also enables healthcare providers to offer appropriate guidance and support to expectant mothers. Through awareness, education, and proactive healthcare, we can work together to ensure a safer and healthier pregnancy journey for all.

References:

1 Chappell LC, Cluver CA, Kingdom J, Tong S. Preeclampsia. Lancet 2021;398:341–54

2 N. Auger, Z.C. Luo, A.M. Nuyt, et al. (2016). Can J Cardiol, 32, pp. 987.e15-987.e23

3 Powe, C.E., et al. (2011). Circulation 23(24), 2856-2869.

4 Verlohren S et al. Clin Sci 2012;122(2):43-52

5 Rana S et al. Circulation 2012;125(7):911-9

6 Miller JJ, Higgins V, Ren A, Logan S, Yip PM, Fu L. Advances in preeclampsia testing. Adv Clin Chem. 2023;117:103-161. doi: 10.1016/bs.acc.2023.08.004. Epub 2023 Sep 26. PMID: 37973318.

7 Levine, RJ., et al. (2004). N Engl J Med 350, 672-83

8 Magee LA, Smith GN, Bloch C, Côté AM, Jain V, Nerenberg K, von Dadelszen P, Helewa M, Rey E. Guideline No. 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management. J Obstet Gynaecol Can. 2022 May;44(5):547-571.e1. doi: 10.1016/j.jogc.2022.03.002. PMID: 35577426.