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A specific protein imbalance detected in blood tests can help quantify the risk of preeclampsia
In a study of pregnant women in the United States, Cedars-Sinai researchers found that a specific imbalance of two placental proteins could predict which women were at risk of developing a severe form of preeclampsia, a life-threatening blood pressure disorder. A new Cedars-Sinai study may help identify pregnant women at risk of developing preeclampsia. Photo credit: Getty The study was published in the journal NEJM Evidence. We discovered that a blood test that measures the ratio between two proteins involved in blood vessel development in the placenta could identify which of the women would develop premature preeclampsia with severe features. This test…
A specific protein imbalance detected in blood tests can help quantify the risk of preeclampsia
In a study of pregnant women in the United States, Cedars-Sinai researchers found that a specific imbalance of two placental proteins could predict which women were at risk of developing a severe form of preeclampsia, a life-threatening blood pressure disorder.
Eine neue Cedars-Sinai-Studie könnte helfen, schwangere Frauen mit einem Risiko für die Entwicklung einer Präeklampsie zu identifizieren. Bildnachweis: Getty
The study was published in the journal NEJM Evidence.
We discovered that a blood test that measures the ratio between two proteins involved in blood vessel development in the placenta could identify which of the women would develop premature preeclampsia with severe features. This test was significantly better than all standard-of-care markers for preeclampsia with severe features. It predicted with over 90% accuracy whether the patient would develop preeclampsia with severe features or not, whereas the usual markers were accurate in less than 75% of cases.”
Sarah Kilpatrick, MD, PhD, co-senior author of the study, chair of the Department of Obstetrics and Gynecology, Cedars-Sinai
The blinded, prospective study of women initially hospitalized for premature hypertension included 1,014 patients from 18 hospitals across the country.
“We expect this blood test will ultimately lead to better health outcomes for mothers and their babies,” Kilpatrick said. "It is well known that preeclampsia progresses to birth in virtually all patients. However, it can be very difficult to predict the optimal time for delivery. An accurate test would help us ensure that the mother was at the right hospital for her care and that of her premature baby."
The researchers found that a specific protein imbalance detected in blood tests of the hospitalized pregnant women provided a way to quantify their risk of developing severe preeclampsia. These are levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PLGF) in the bloodstream.
"An sFlt-1 to PLGF ratio of 40 or greater predicted the development of severe preeclampsia, adverse outcomes, and preterm birth within two weeks, two-thirds of the time," said S. Ananth Karumanchi, MD, the co-senior author of the study and the Medallion Chair in Vascular Biology.
“Conversely, if the critical ratio between the two proteins was below 40, we found that the risk that the patient would progress to preeclampsia with severe features within two weeks of the blood test was less than 5%,” said Karumanchi, who is also director of nephrology at Cedars-Sinai.
Currently, childbirth is the only cure for preeclampsia. A test that indicates that a premature baby, a woman who has completed less than 37 weeks of pregnancy, is likely to develop a serious illness could help optimize care.
“We expect this blood test will ultimately lead to better health outcomes for mothers and their babies,” Kilpatrick said. "It is well known that preeclampsia progresses to birth in virtually all patients. However, it can be very difficult to predict the optimal time for delivery. An accurate test would help us ensure that the mother was at the right hospital for her care and that of her premature baby."
Preeclampsia rates have been steadily increasing, largely due to increases in obesity and high blood pressure in the country. Black, Native American, and Alaska Native women have significantly higher rates of illness than white women and a higher risk of death.
Researchers also hope the results may point the way to potential drug therapies for at-risk women.
“We know that sFlt-1 is the protein that increases even before symptoms of preeclampsia appear, and the ratio of sFlt-1 to PlGF predicts worsening of the disease,” Karumanchi said. "Further research could identify a drug mechanism that could reduce sFlt-1 levels and be used to safely prolong pregnancy; this would be a game-changer for very premature preeclampsia patients."
While the study involved a single blood test of two proteins, researchers are encouraged that more research involving large numbers of subjects will provide better tools for preventing preeclampsia before it can seriously harm patients and their babies.
“We conducted this study to identify a simple, accurate biomarker to help clinicians determine who is at highest risk of developing preeclampsia with severe features and who would be a good candidate for treatments we could develop for this devastating condition,” said the study coordinator. Senior author Ravi Thadhani, MD, MPH, professor of medicine at Harvard Medical School, chief academic officer at Mass General Brigham in Boston, Massachusetts, and visiting scholar at Cedars-Sinai. “I believe we have achieved this goal.”
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Reference:
Thadhani, R., et al. (2022) Levels of circulating angiogenic factors in hypertensive disorders of pregnancy. NEJM proof. doi.org/10.1056/EVIDoa2200161.
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