Introduction:
Preeclampsia is the main cause of maternal death worldwide and is responsible for neonatal mortality and morbidity. Preeclampsia risk throughout the pregnancy remains a key aspect of prenatal care worldwide. In numerous clinical investigations, accurate preeclampsia risk prediction in early pregnancy has been highlighted, and prenatal care resources are being used more effectively.
What Is Preeclampsia?
Preeclampsia is a pregnancy complication. High levels of protein in the urine and increased blood pressure indicate kidney damage and other signs of organ damage. Preeclampsia begins at 20 weeks of pregnancy and mostly affects women with a standard range of blood pressure. Preeclampsia can lead to serious complications and conditions if left untreated and can even turn fatal for both baby and mother. Preeclampsia that develops after delivery of the baby is termed postpartum preeclampsia.
What Are the Symptoms of Preeclampsia?
Preeclampsia’s characteristic feature is to have high blood pressure, proteinuria, and other signs of damage to kidneys and other organs. In some cases, there are no noticeable symptoms. Preeclampsia can often be detected by routine prenatal visits.
High blood pressure and preeclampsia signs and symptoms are:
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Decreased levels of platelets in the blood.
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Increased liver enzymes indicate liver issues.
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Proteinuria (increased protein in urine).
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Changes in vision, hearing loss, blurred vision, and sensitivity to light.
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Severe headaches.
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Fluid in the lungs leads to shortness of breath.
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Nausea and vomiting.
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Pain under the lower ribs and pain in the upper belly.
What Are the Risk Factors of Preeclampsia?
The risk factors for preeclampsia include the following:
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Usually occurs in the first pregnancy.
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Family history of preeclampsia.
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Common in pregnant women carrying twins.
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Women with gestational diabetes.
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History of medical conditions like high blood pressure, diabetes, kidney disease, headaches, urinary tract infections, rheumatoid arthritis, and periodontal disease.
What Complications Occur Due to the Risk of Preeclampsia?
Some potential complications of preeclampsia include the following:
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Preterm Delivery: Preeclampsia can cause the baby to be born prematurely, which can increase the risk of health problems for the baby.
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Placental Abruption: Preeclampsia can cause the placenta to separate from the uterine wall, which can lead to bleeding and a lack of oxygen for the baby.
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Fetal Growth Restriction: Preeclampsia can restrict the growth of the fetus, leading to a smaller-than-normal baby.
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Seizures: Preeclampsia can progress to a condition known as eclampsia, which is characterized by seizures.
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Stroke: Preeclampsia can increase the risk of stroke in the mother.
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Organ Damage: Preeclampsia can cause damage to organs such as the liver, kidneys, and lungs.
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HELLP Syndrome: HELLP (hemolysis, elevated liver enzymes, low platelet count) is a severe form of preeclampsia that can cause liver damage, low platelet count, and other complications.
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Maternal Death: In rare cases, preeclampsia can be life-threatening for the mother.
How Is the Diagnosis of Preeclampsia Made?
Diagnosis of preeclampsia is made mostly during the screening of 20 weeks of pregnancy:
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Signs of kidney issues.
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Low blood platelet count.
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Fluid in lungs.
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Elevated liver enzymes show an impaired liver.
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Vision disturbances.
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Impaired hearing loss.
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Prolong headaches.
Additional tests like
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Urinalysis - 24-hour urine, and a single urine sample are taken to determine the functionality of the kidneys.
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Blood Test - A blood test to measure levels of the normal blood count and other blood parameters checked.
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Fetal Ultrasound - The baby’s growth and development are monitored through an ultrasound. This allows for checking the baby’s weight and amount of fluid.
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Non-stress Test or Biophysical Profile - This is a simple test that checks the baby’s heart rate, and ultrasound checks the baby’s breathing, the volume of amniotic fluid, and muscle tone.
What Are the Biomarkers That Predict Preeclampsia?
Placental growth factor (PIGF) levels are likely to fall in a subset of women who are predisposed to developing preeclampsia risk in low-risk nulliparous women. Preeclampsia is a syndromic condition, and accurate prediction of preeclampsia will require several biomarkers for different preeclampsia subtypes and individual risk factors. An analytic technique that is well-established is used in clinical laboratories.
Biomarkers of preeclampsia are:
Biomarkers of preeclampsia are identified by proteomics technology that includes gelsolin, clusterin, fibronectin, and retinol-binding protein-4.
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Pro-angiogenic Factor Anti-angiogenic Factor - Essential in forming great placental perfusion, plays a key role in the process.
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Soluble Fms-like Tyrosine Kinase 1 and PIGFb - It is a pro-angiogenic factor.
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Vascular Endothelial Growth Factor - A protein composed of macrophages. Subtypes like VEGF- A, B, C, D, E, and F and placental growth factors promote angiogenesis.
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Soluble Endoglin - Protein that initiates nitric oxide production by endothelial cells that inhibits apoptosis.
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Pregnancy-Associated Plasma Protein - It is a glycoprotein produced in placental trophoblast cells that can reflect a degree of hypoxia and placental ischemia.
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Placental Protein 13 - Also known as Galectin-13, a type of carbohydrate-binding protein related to apoptosis, immune response, and inflammation.
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Heat Shock Protein - HSP is a conserved protein and plays a key role in cell cycle regulation, immune regulations, and protein complexes.
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Fetal Hemoglobin - HbF can induce oxidative stress, which is considered closely related to PE. Oxidative stress is found in the placenta and blood of individuals with preeclampsia.
What Are the Inclusion and Exclusion Criteria?
Inclusion criteria like gestational age, singleton pregnancy n nulliparity, and between fourteen to zero days and 16 weeks and six days. The exclusion criteria applied included;
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Uncertainty about the last menstrual period and unwillingness to have an ultrasound scan at 20 weeks gestation can be a factor.
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Known major fetal abnormality and anomaly karyotype.
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Underlying medical conditions like hypertension, renal disease, systemic lupus erythematosus, anti-phospholipid syndrome, previous knife cone biopsy, miscarriages, and terminations,
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Major uterine anomaly, cervical suture treatment with long-term steroids, low-dose Aspirin, calcium, vitamin C, eicosapentaenoic acid and vitamin E, and molecular weight Heparin.
Conclusion:
These advances helped in understanding the pathogenesis of preeclampsia. New biomarkers that help in diagnosing preeclampsia, like sFlt-1, sEng, and pro-angiogenic factors, like VEGF, and PIGF, are the most promising biomarkers. Biomarkers do have certain drawbacks, like predicting the onset of disease in the initial stages of gestation, lack of highly sensitive assay, lack of prognostic value, low specificity, and other issues.
