Novel biomarkers for preeclampsia: Promises and pitfalls

Advances in the understanding of preeclampsia are reshaping recognition of the disease and forcing reappraisal of traditional clinical definitions. Historically, the diagnosis of preeclampsia relied on nonspecific criteria not rooted in the biology of the disease. Efforts to refine these criteria led to diagnostic expansion and clinical uncertainty, creating challenges for prediction, treatment, and management. Recently available preeclampsia biomarkers offer the promise of more accurate diagnosis and risk stratification. The purpose of this review is to provide physiologic context for preeclampsia biomarkers, to summarize clinical performance, and to highlight gaps in knowledge that may hinder adoption.

Over the past decade, several preeclampsia biomarkers have been proposed, primarily angiogenic and anti-angiogenic factors that modulate placental and maternal vascular growth and adaptation. The recent availability of rapid and precise laboratory assays has allowed researchers to demonstrate high diagnostic concordance with the syndrome of preeclampsia, and superior prediction of adverse outcomes as compared with traditional clinical criteria. Nonetheless, widespread implementation remains in its early stages because of the absence of validated intervention pathways.

This review provides an update of the most promising diagnostic advances in preeclampsia, highlighting both their potential benefits and the challenges of redefining the disease with biomarkers.