Saving mothers and babies through earlier screening and better care
Preeclampsia is a pregnancy complication affecting between two and eight out of every 100 pregnant women.
The exact cause is unknown, but its risks are clear: left untreated, preeclampsia can cause growth-restriction or preterm birth of the child, and in some cases, lead to maternal and perinatal mortality. But with screening, the high risk of the more severe forms of pre-eclampsia, early-onset and preterm preeclampsia, can be predicted and prevented.
of pregnant women around the world develop preeclampsia annually
Pre-term births are caused by preeclampsia each year
Babies die every year due to preeclampsia
Women die every year due to preeclampsia
Prediction and prevention
When should women be screened for preeclampsia?
Timing matters more than ever.
When it comes to preeclampsia prevention, the earlier you identify women as having a high risk for developing the condition, the better the outcome for mother and child. Based on evidence from research studies, such as the ASPRE study, a combined screening program is recommended at 11–13 weeks’ gestation to identify women at high risk of preeclampsia, when steps can still be taken to prevent its onset.
Who should be screened for preeclampsia?
Any woman can be at high risk
All women should have access to screening, even if there are no maternal risk factors or history of preeclampsia. Being able to predict preterm preeclampsia early in the pregnancy is key to its prevention.
Preeclampsia screening markers
Specific marker for pre-eclampsia – PIGF
In pregnancies that develop preeclampsia, maternal serum placental growth factor (PlGF) levels decrease significantly in the first trimester. This makes it an important biomarker used to predict the onset of preeclampsia. PerkinElmer’s high-sensitivity PlGF 1-2-3™ assay is optimized for first trimester screening of preeclampsia, and is the only assay which has been clinically validated by the ASPRE trial.
Low dose aspirin for preventive care
Reducing the risk of pre-eclampsia.
Clinicians can recommend prophylactic aspirin treatment to women identified as having high risk of preeclampsia through screening aimed at preventing pre-eclampsia or, at least, delaying its onset. The Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) study showed that simple treatment with a daily dose of aspirin — 150mg taken each night — significantly reduces the risk of preterm preeclampsia in pregnant women when started during the first trimester of pregnancy. (Aspirin should only be used for preventive care by women screened and found to be at high risk for preterm pre-eclampsia.)
The Combined Screening Program
Based on the evidence from research studies, international guidelines are recommending a combined screening program for preeclampsia at 11-13+6 weeks as the most effective way to identify women at high risk of pre-eclampsia in the early stages of pregnancy.
The combined screening program is made up of four simple steps that require short training and minimal additional investment in equipment. PerkinElmer’s Lifecycle Software™ can generate a unique patient risk profile and report based on these combined screening markers.
Record medical history, height and weight
Certain factors are known to increase the risk of preeclampsia, so as part of combined preeclampsia screening, so it’s important to determine and document any background risks, including previous or family history of preeclampsia, ethnicity, chronic hypertension and smoking.
Take Blood Sample for PIGF Test
PerkinElmer’s high-sensitivity PlGF 1-2-3™ assay can be utilized for the measurement of maternal serum placental growth factor for pre-eclampsia in the first trimester. PerkinElmer’s PAPP-A assay has also been validated as an alternative or addition for preeclampsia 1st trimester screening. The same blood sample can be used for both preeclampsia screening and aneuploidy screening using the same instrument and markers; no additional blood sample is required.
Measure blood pressure
In the prediction of preeclampsia, the calculated MAP (systolic blood pressure – diastolic blood pressure)/3 + diastolic blood pressure) can be a useful marker. For these readings, two measurements are taken from both arms simultaneously using two automated blood pressure monitors.
Measure Pulsatility Index
Additionally the uterine artery pulsatility index can be measured via transvaginal or transabdominal ultrasound. (Combined pre-eclampsia screening without the pulsatility index is still a good option if access to ultrasound is limited.)
Prenatal screening – DELFIA® Xpress platform
AutoDELFIA® immunoassay system
What is the role of angiogenic markers?
Screening for maternal serum concentrations
Women with signs or symptoms of preeclampsia do not always develop preeclampsia. Angiogenic markers can be used to help identify women with increased risk for developing preeclampsia in the coming days.
After 20 weeks of pregnancy PlGF and sFlt-1 are both predictive and diagnostic for preeclampsia. These biomarkers can be used to identify high risk women that are likely to develop preterm preeclampsia later in their pregnancy and to predict the onset of preeclampsia. Biomarker levels are also found to be correlating with severity of disease.
Improved prognosis and diagnosis
Determining serum PlGF concentration, used as a single marker, or sFlt-1 and PlGF, used as a ratio, improve the clinical management and decision making (risk stratification) with women showing signs and symptoms of preeclampsia.
Two alternatives – PlGF as a single marker or sFlt-1/PlGF ratio
PlGF alone compared to sFlt-1/PlGF ratio for preeclampsia rule-in and rule-out has a comparable performance, and both options are equally recommended for clinical use. In addition to sFlt-1/PlGF ratio, PLGF alone, with concentration based cut-offs, could provide more simpler and affordable alternative to dual biomarker testing.
Using PlGF has additional advantages. Studies have shown that PlGF is a good marker (decreased serum PlGF level) for identifying pregnancies with placental insufficiency including fetal growth restriction and/or stillbirth.
User configurable LifeCycle™ software
LifeCycle™ software enables monitoring of preeclampsia status with PlGF concentration or the sFlt-1/PlGF ratio. The results can be linked to the patient case in LifeCycle™ software allowing the user to view all available results in one place. The assay cut-offs for preeclampsia management are user configurable.
2T & 3T Pre-Eclampsia Management Products
Prenatal screening – DELFIA® Xpress platform
AutoDELFIA® immunoassay system
More information on pre-eclampsia
Pre-eclampsia Learning & Resources
Rule-in and rule-out of pre-eclampsia using DELFIA Xpress PlGF 1-2-3 and sFlt-1: PlGF ratio
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PerkinElmer does not endorse or make recommendations with respect to research, medication, or treatments. All information presented is for informational purposes only and is not intended as medical advice. For country specific recommendations please consult your local health care professionals.
1. Daniel L. Rolnik et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. DOI: 10.1056/NEJMoa1704559, New England J Med June 2017
2. Wright D et al. Aspirin for Evidence-Based Preeclampsia Prevention trial: influence of compliance on beneficial effect of aspirin in prevention of preterm preeclampsia. Am J Obstet Gynecol. 2017 Sep 6
3. Poon LC et al., ASPRE trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and
medical and obstetrical history. Am J Obstet Gynecol 2017
4. Kuklina EV, et al. Hypertensive Disorders and Severe Obstetric Morbidity in the United States. Obstet Gynecol 2009; 113:1299-306
5. COMPARE study: Performance of commercially available placental growth factor tests in women with suspected preterm pre-eclampsia, Ultrasound in Obstetric Gynecology
6. Herraiz et al Update on the Diagnosis and Prognosis of Preeclampsia with the Aid of the sFlt-1/PlGF Ratio in Singleton Pregnancies. Fetal Diagn Ther (2017) PROGNOSIS Hund et al. BMC Pregnancy and Childbirth 2014, 14:324
7. ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia, Ultrasound Obstet Gynecol 2018 DOI: 10.1002/uog.20105
8. Poon L, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on Pre-eclampsia: A Pragmatic Guide for First-Trimester Screening and Prevention. International Journal of Gynegology & Obstetrics. May 2019