Prediction and diagnosis of pre-eclampsia; the scientific basis

The accurate prediction of women at risk of pre-eclampsia, and certain diagnosis are central to optimal management and treatment. Prediction has improved, particularly through measurement of angiogenic/antiangiogenic factors but sensitivity and specificity remains suboptimal, and the heterogeneity of underlying clinical risk confounds generalisability of a single early pregnancy test for all women. The 'omics' methodologies offer the potential for discovery of novel biomarkers and proteomics, metabolomics and transcriptomic approaches are beginning to identify multiple new candidates for evaluation. However, once pregnancy is established the potential for modification of established pathological processes, increasingly identifiable by accurate biomarkers, remains an unanswered and possibly unattainable challenge. The potential for more accurate pre-conceptional identification of risk, and subsequent modification of risk, presents an increasingly attractive alternative to prevention of pre-eclampsia. Advances have certainly been made in diagnosis; the measurement of PlGF in women with suspected pre-eclampsia is likely to become an integral component of clinical care, improving detection and management of pre-eclampsia.