Predictors and risk factors of pre-eclampsia

Understanding the mechanisms of disease responsible for the syndrome of pre-eclampsia (PE) as well as early risk assessment is still a major challenge. Risk factors for PE are nulliparity, a family or own history of PE, pre-existing diabetes or increased body mass index, multiple pregnancy, maternal age, renal disease, hypertension or raised blood pressure at booking and chronic autoimmune disease. Other factors are thrombophilias and insulin resistance together with obesity. On the other hand identification of predictors of the development of pre-eclampsia would enhance the ability to diagnose women likely to develop pre-eclampsia before the onset of the disease and would improve their monitoring and enable to convey them to randomized trials for evaluating prophylactic treatment. A number of biochemical agents have been assessed as markers for predicting pre-eclampsia. None of them has been proved to be of clinical value yet. Much effort has been put into evaluating novel potential markers and their combination with other screening methods such as Doppler sonography. The most promising biochemical markers, to date, are placenta protein 13 (PP-13) as well as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng). These markers allow screening at a relatively early stage and, most importantly, show relatively high predictive values and improved diagnostic performance if combined with first trimester Doppler sonography. However, until now, too little data are available to justify the clinical use of these markers. Large-scale prospective studies, assessing these markers, are important to advance progress in reducing maternal and perinatal morbidity and relieving the heavy burden of pre-eclampsia.