Redefining preeclampsia using placenta-derived biomarkers.

TLDR: The classic definitions of preeclampsia have become outdated and that the definition could be modernized to take account of the current understanding of disease pathophysiology, and a first step is proposed that incorporates the placental biomarker placenta growth factor (PlGF).

Abstract: Preeclampsia affects 3% to 8% of all pregnancies.1 Acute maternal complications include eclampsia, stroke, placental abruption, disseminated intravascular coagulation, HELLP (hemolysis, elevated liver enzymes, low platelets), liver hemorrhage or rupture, pulmonary edema, adult respiratory distress syndrome, acute renal failure, and death.2 Preeclampsia complications account for more than 50 000 maternal deaths annually.2,3 In developing countries, where lack of access to appropriate maternal care is a major problem, maternal death rates are as high as 15% as compared with 0% to 1.8% in industrialized countries.2 Perinatal consequences include stillbirth, preterm delivery, fetal growth restriction (FGR), neonatal complications, and later sequelae.4 Long-term maternal risks include chronic hypertension, diabetes mellitus, coronary artery disease,5 neurological deficit, and premature death.2 Here, we argue that the classic definitions of preeclampsia, based on concepts that are now more than 50 years old, have become outdated and that the definition could be modernized to take account of our current understanding of disease pathophysiology. We propose a first step that incorporates the placental biomarker placenta growth factor (PlGF), but we allow for the possibility that the definition may need to be expanded to include other factors, such as the antiangiogenic factors, soluble fms-like tyrosine kinase-1 (sFLT1) or soluble endoglin (sENG),6 in due course. This is intended as an exploratory rather than a final development. Diseases may be defined and classified by cause, pathogenesis, or by clinical findings. Clear definitions and classification are difficult when pathogenesis is unknown. As a result, diagnostic labels may reflect only a set of symptoms and signs, defining a syndrome. Syndromes are never precise, because the features are multiple, nonspecific, and therefore may have diverse causes. Preeclampsia is a syndrome of new onset hypertension and proteinuria in the second half of pregnancy, that was defined …