Prediction of preeclampsia

Leslie Myatt, M. Miodovnik

Research output: Contribution to journalArticle

134 Citations (Scopus)

Abstract

The onset of preeclampsia at or near to term is associated with low maternal and neonatal morbidity and mortality. In contrast, those patients (1%) who suffer early onset preeclampsia engender significant maternal and perinatal morbidity and mortality. Therefore, because of the lack of proven prophylaxis for preeclampsia, prediction of risk or identification of subclinical disease is desirable to identify patients for more intensive observation. There are certain at-risk groups of patients such as those with chronic hypertension, pregestational diabetes, multifetal gestation, and previous preeclampsia. These patients account for the majority of cases of preeclampsia in multiparas, yet only account for 14% of preeclampsia in nulliparous women. Thus, the majority of cases of preeclampsia arises from nulliparous women without medical complications at low risk. Differences in the time of onset, severity, and organ system involvement suggest there may be different underlying etiologies that ultimately lead to preeclampsia manifested as the triad of maternal hypertension, proteinuria, and edema. Distinct markers therefore may identify subgroups of at-risk patients with separate underlying causes. These markers ultimately could be used for diagnosis of disease before the clinical appearance of maternal disease (hypertension, proteinuria, and edema). Based on data from patients with established disease, with the involvement of various organ systems, potential candidate markers would include renal function (kallikrein-creatinine); coagulation and fibrinolytic systems and platelet activation (platelet volume); markers of vascular function (fibronectin, prostacyclin, thromboxane) and oxidant stress (lipid peroxides, 8-isoprostane, antioxidants, anticardiolipin antibodies, hemoglobin, iron, transferrin, homocysteine, hypertriglyceridemia, albumin isoforms); placental peptide hormones (CRH, CRHbp, activin, inhibin, hCG); vascular resistance (uteroplacental flow velocity waveforms); genetic markers; insulin resistance; and glucose intolerance. Although cross-sectional studies have identified these potential markers, they need to be evaluated in prospective longitudinal studies with rigorous definition of outcome to determine if they are useful in predicting preeclampsia and whether they can identify different subgroups of patients.

Original languageEnglish (US)
Pages (from-to)45-57
Number of pages13
JournalSeminars in Perinatology
Volume23
Issue number1
StatePublished - 1999
Externally publishedYes

Fingerprint

Pre-Eclampsia
Mothers
8-epi-prostaglandin F2alpha
Hypertension
Proteinuria
Edema
Placental Hormones
Morbidity
Activins
Anticardiolipin Antibodies
Inhibins
Kallikreins
Glucose Intolerance
Peptide Hormones
Hypertriglyceridemia
Lipid Peroxides
Perinatal Mortality
Thromboxanes
Platelet Activation
Infant Mortality

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Myatt, L., & Miodovnik, M. (1999). Prediction of preeclampsia. Seminars in Perinatology, 23(1), 45-57.

Prediction of preeclampsia. / Myatt, Leslie; Miodovnik, M.

In: Seminars in Perinatology, Vol. 23, No. 1, 1999, p. 45-57.

Research output: Contribution to journalArticle

Myatt, L & Miodovnik, M 1999, 'Prediction of preeclampsia', Seminars in Perinatology, vol. 23, no. 1, pp. 45-57.
Myatt, Leslie ; Miodovnik, M. / Prediction of preeclampsia. In: Seminars in Perinatology. 1999 ; Vol. 23, No. 1. pp. 45-57.
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