New test released that can help screen for pre-eclampsia by Dr. Lailah Kara-Newton
By Dr. Lailah Kara-Newton
Something is happening across the globe, there is an air surrounding us where there is increased awareness of pregnancy complications and the fact that 84% of these are avoidable. We have seen prevention at the forefront of the fight against these complications. Today, it’s Preeclampsia’s turn to take on a new test which has come to the US very recently after great evidence from the UK and Europe! So let’s get into it starting with the first question, what even is Preeclampsia?
Preeclampsia is a common Hypertensive disorder of Pregnancy that usually develops after 20 weeks of gestation and manifests as elevated blood pressure in previously normotensive patient along with proteinuria or end organ damage (which show up as symptoms such as visual abnormalities, headache and abdominal pain).
It affects up to 10% of pregnancies in the US and shockingly worldwide and it can cause maternal mortality in 10-25% of cases (annually 70,000 maternal and 500,000 fetal deaths), especially when it progresses to Eclampsia (which is essentially Preeclampsia with seizures) or HELLP syndrome, a combination of life threatening features such as liver damage and low platelets. More than 60% of deaths related to preeclampsia are preventable by early detection and treatment. Previously, it has been almost impossible to detect or reliably predict preeclampsia before 20 weeks of gestation as hypertension and other symptoms (like visual abnormalities, headache, pain in epigastric region and swelling of hands and feet) tend to become evident after 20 weeks of gestation and more so in the third trimester. We have traditional risk factors that can inform us is a patient could develop the condition such as age, medical history, family history etc and can initiate preventative treatment with Aspirin if this is the case. In some cases (like mine) I wasn’t classified as high risk and still developed severe preeclampsia.
Recently, researchers have developed a ground breaking blood test that can detect the development of preeclampsia as early as 11 weeks of gestation and can be performed up to 14 weeks. It is now available in United States. With just a prick of needle, a blood sample will be analyzed for two proteins found in maternal blood:
PLGF (Placental growth factor) and PAPP-A (Pregnancy associated plasma protein A).
Two biophysical markers (from the first prenatal visit, and ultrasound) are also measured:
• Mean arterial pressure (dual-cuff blood pressure monitor)
• UtAPI (Uterine artery pulsatility index by transvaginal ultrasound/doppler).
Low levels of PLGF and PAPP-A indicate poor placental development and function, while high MAP and UtAPI levels indicate high blood pressure and elevated resistance to blood flow across the uterine artery. The results will tell us the risk of development or Preeclampsia later in pregnancy, before 34 weeks of gestation and provide risk identification earlier than traditional symptoms such as hypertension or protein in the urine, which tend to develop after 20 weeks. These four components studied in the SPREE study were shown to deliver a sensitivity and specificity of 82.4% in screening for Preeclampsia in 1st trimester which would lead to serious complications.
What are the benefits of this new 1st trimester screening? Well, early intervention can potentially improve outcomes and prevent complications like progression to Eclampsia, HELLP syndrome, Placental abruption, Preterm labor. Early identification facilitates closer monitoring and potential interventions, like lifestyle modifications or low-dose aspirin therapy that may help prevent or delay the onset of preeclampsia and significantly reduce maternal and fetal mortality rates. Emergency cesarean section is usually the outcome of preeclampsia if it becomes severe and this complication can be effectively prevented by early detection. In the longer run, early detection and effective treatment will also reduce healthcare cost associated with hospitalization due to preeclampsia. Realistically in practice a high risk patient can be found by a good medical history alone, this serves as an extra resource in those who present as ‘low-risk’ or borderline who would benefit from an additional test to determine if preventative therapies or extra monitoring would be required.
How can we access this screening test in US?
Labcorp, a leading national lab provider in the US, now offers the first-trimester PLGF screening test, read their announcement article here. This wider accessibility allows healthcare providers to incorporate this advanced screening tool into their pre-pregnancy and early pregnancy management protocols.
The expense of this advanced testing may limit accessibility, especially for those in underserved or low-income populations who might benefit the most from this 1st trimester screening. Evaluating the cost-effectiveness and ensuring equitable access are crucial to maximize the benefits of early detection and intervention. Policymakers and healthcare providers must also work together to address these challenges, ensuring that all pregnant women, regardless of socioeconomic status, can access all forms of potentially life-saving screening and care.
What is the take away?
In conclusion, the introduction of first-trimester screening for preeclampsia marks a significant advancement in prenatal care and can potentially save thousands of lives in the prevention of preeclampsia which causes endless complications to pregnant people and their babies. By facilitating early detection and intervention, we have a greater chance of continuing a ‘normal’ course of pregnancy, preventing emergency cesarean sections and allowing for a ‘normal’ vaginal delivery. This screening test has the ability to transform outcomes for countless families and their babies, paving the way for healthier pregnancies and reduced mortality rates worldwide.
