Published online before print March 9, 2009, doi: 10.1161/HYPERTENSIONAHA.109.129379
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(Hypertension. 2009;53:747.)
© 2009 American Heart Association, Inc.
Editorial Commentaries |
First-Trimester Prediction of Early Preeclampsia
A Possibility at Last!
From the Division of Epidemiology, Statistics, and Prevention Research (R.J.L.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md; and the Departments of Obstetrics and Gynecology and Medicine (M.D.L.), University of Chicago, Ill.
Correspondence to Richard J. Levine, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Building 6100, Room 7B03, Bethesda, MD 20892. E-mail LevineRJ@mail.nih.gov or Marshall D. Lindheimer, University of Chicago Hospitals, 5807 S Dorchester, Apt 5E, Chicago, IL 60637. E-mail mlindhei@medicine.bsd.uchicago.edu
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Preeclampsia, which presents after midgestation, is the most common pregnancy complication associated with serious maternal-fetal morbidity and mortality; and at present the only effective treatment is delivery of the placenta. The ability to predict in very early pregnancy those women at risk for preeclampsia might decrease maternal and fetal morbidity through closer surveillance by physicians experienced or specialized in high-risk obstetrics, as well as delivery at tertiary care centers. Reliable prediction would also permit institution of preventive or treatment regimens, unavailable in 2009, although exciting possibilities are under scrutiny.1
Investigators have been evaluating tests to predict preeclampsia for >50 years without much success.2,3 These have included tests relating to placental perfusion and vascular resistance (eg, the "rollover" and cold pressor tests, as well as uterine artery Doppler evaluation); placental products (eg, proangiogenic and antiangiogenic proteins, human chorionic gonadotropin, placental protein 13, and inhibin A); renal dysfunction (eg, fractional urate clearance and microalbuminuria); and endothelial dysfunction (eg, fibronectin, P- and L-selectin, and vascular cell adhesion molecule 1). The list is enormous, and recently investigators have begun exploring the fields of proteomics and metabolomics for tests to predict preeclampsia.
A large systemic review published in 20042 and to be updated in 20093 concluded that no single test met clinical standards for a predictive test. The authors recommended further evaluation of approaches measuring maternal blood and urine levels of certain angiogenic and antiangiogenic factors and suggested that success might require the combination of several different tests. Clinically useful prediction tests, it was stated,
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