Materiały źródłowe

• #1 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension plus significant end-organ dysfunction with or without proteinuria, typically presenting after 20 weeks of gestation or postpartum. […] Approximately 90 percent of cases present in the late preterm (≥34 to <37 weeks), term, or postpartum period and have good maternal, fetal, and newborn outcomes; however, serious maternal and/or perinatal morbidity or mortality can occur. The remaining 10 percent of cases have an early presentation (<34 weeks) and are associated with higher risks of serious perinatal morbidity or mortality due to risks associated with moderately preterm, very preterm, or extremely preterm birth. [...] Although the disorder always resolves in the days or weeks after birth, individuals with a history of preeclampsia are at increased risk of recurrence and increased lifetime risk for cardiovascular-related morbidity and mortality.

• #2 Multicenter prospective clinical study to evaluate the prediction of short-term outcome in pregnant women with suspected preeclampsia (PROGNOSIS): study protocol

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4262142/

  Preeclampsia is defined as new onset of hypertension and proteinuria at gestational week 20 or after. […] Because of its unpredictability, varying clinical presentation and potential adverse outcomes, pregnant women with suspected preeclampsia require intensive monitoring or hospitalization. […] Beyond preeclampsia diagnosis, there is a high unmet medical need for more reliable predictive markers for preeclampsia to improve maternal and fetal outcomes and reduce unnecessary hospital admissions. […] The results of PROGNOSIS will provide the most comprehensive evidence to date on the accuracy of the sFlt-1/PlGF ratio for short-term prediction of preeclampsia/eclampsia/HELLP syndrome. […] Adoption of the sFlt-1/PlGF test in clinical practice has the potential to reduce the frequency of adverse pregnancy outcomes for both mother and fetus, and decrease healthcare costs associated with unnecessary hospitalization of women with suspected preeclampsia.

• #3 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension plus significant end-organ dysfunction with or without proteinuria, typically presenting after 20 weeks of gestation or postpartum. […] Approximately 90 percent of cases present in the late preterm (≥34 to <37 weeks), term, or postpartum period and have good maternal, fetal, and newborn outcomes; however, serious maternal and/or perinatal morbidity or mortality can occur. The remaining 10 percent of cases have an early presentation (<34 weeks) and are associated with higher risks of serious perinatal morbidity or mortality due to risks associated with moderately preterm, very preterm, or extremely preterm birth. [...] Although the disorder always resolves in the days or weeks after birth, individuals with a history of preeclampsia are at increased risk of recurrence and increased lifetime risk for cardiovascular-related morbidity and mortality.

• #4 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension plus significant end-organ dysfunction with or without proteinuria, typically presenting after 20 weeks of gestation or postpartum. […] Approximately 90 percent of cases present in the late preterm (≥34 to <37 weeks), term, or postpartum period and have good maternal, fetal, and newborn outcomes; however, serious maternal and/or perinatal morbidity or mortality can occur. The remaining 10 percent of cases have an early presentation (<34 weeks) and are associated with higher risks of serious perinatal morbidity or mortality due to risks associated with moderately preterm, very preterm, or extremely preterm birth. [...] Although the disorder always resolves in the days or weeks after birth, individuals with a history of preeclampsia are at increased risk of recurrence and increased lifetime risk for cardiovascular-related morbidity and mortality.

• #5 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Several subtypes of preeclampsia may exist, with a variety of pathophysiological pathways leading to maternal and fetal mortality and morbidity. […] The most commonly described subtypes are early onset (<34 weeks of gestation) and late onset (≥34 weeks of gestation). The clinical features overlap, but the spectrum of disease and outcomes differ: Early-onset disease has been associated with more severe placental and maternal/fetal clinical findings and, in turn, poorer maternal/fetal outcomes. [...] For this reason, it has been hypothesized that the two phenotypes have different origins and pathophysiologies. [...] A past history of preeclampsia increases the risk of developing preeclampsia in a subsequent pregnancy eightfold compared with patients without this history. [...] The severity of preeclampsia in the first pregnancy strongly impacts the risk of developing preeclampsia in the next pregnancy.

• #6 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Several subtypes of preeclampsia may exist, with a variety of pathophysiological pathways leading to maternal and fetal mortality and morbidity. […] The most commonly described subtypes are early onset (<34 weeks of gestation) and late onset (≥34 weeks of gestation). The clinical features overlap, but the spectrum of disease and outcomes differ: Early-onset disease has been associated with more severe placental and maternal/fetal clinical findings and, in turn, poorer maternal/fetal outcomes. [...] For this reason, it has been hypothesized that the two phenotypes have different origins and pathophysiologies. [...] A past history of preeclampsia increases the risk of developing preeclampsia in a subsequent pregnancy eightfold compared with patients without this history. [...] The severity of preeclampsia in the first pregnancy strongly impacts the risk of developing preeclampsia in the next pregnancy.

• #7 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Several subtypes of preeclampsia may exist, with a variety of pathophysiological pathways leading to maternal and fetal mortality and morbidity. […] The most commonly described subtypes are early onset (<34 weeks of gestation) and late onset (≥34 weeks of gestation). The clinical features overlap, but the spectrum of disease and outcomes differ: Early-onset disease has been associated with more severe placental and maternal/fetal clinical findings and, in turn, poorer maternal/fetal outcomes. [...] For this reason, it has been hypothesized that the two phenotypes have different origins and pathophysiologies. [...] A past history of preeclampsia increases the risk of developing preeclampsia in a subsequent pregnancy eightfold compared with patients without this history. [...] The severity of preeclampsia in the first pregnancy strongly impacts the risk of developing preeclampsia in the next pregnancy.

• #8 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Preeclampsia with severe features in the second trimester: preeclampsia occurs in 25 to 65 percent of the next pregnancies. […] Preeclampsia without severe features: preeclampsia occurs in 10 to 12 percent of the next pregnancies. […] Normotensive pregnancy: preeclampsia occurs in <1 percent of the next pregnancies. [...] Patients with preeclampsia are at increased risk for life-threatening events, including placental abruption, acute kidney injury, cerebral hemorrhage, hepatic failure or rupture, pulmonary edema, stroke, cardiac failure, and progression to eclampsia. [...] The fetus is at increased risk for growth restriction and medically or obstetrically indicated preterm birth. [...] Long-term maternal prognosis (recurrence risk, increased risk for related obstetric complications in future pregnancies, increased risk for cardiovascular and kidney disease in later life) and long-term prognosis for offspring are reviewed separately.

• #9 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Preeclampsia with severe features in the second trimester: preeclampsia occurs in 25 to 65 percent of the next pregnancies. […] Preeclampsia without severe features: preeclampsia occurs in 10 to 12 percent of the next pregnancies. […] Normotensive pregnancy: preeclampsia occurs in <1 percent of the next pregnancies. [...] Patients with preeclampsia are at increased risk for life-threatening events, including placental abruption, acute kidney injury, cerebral hemorrhage, hepatic failure or rupture, pulmonary edema, stroke, cardiac failure, and progression to eclampsia. [...] The fetus is at increased risk for growth restriction and medically or obstetrically indicated preterm birth. [...] Long-term maternal prognosis (recurrence risk, increased risk for related obstetric complications in future pregnancies, increased risk for cardiovascular and kidney disease in later life) and long-term prognosis for offspring are reviewed separately.

• #10 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Preeclampsia with severe features in the second trimester: preeclampsia occurs in 25 to 65 percent of the next pregnancies. […] Preeclampsia without severe features: preeclampsia occurs in 10 to 12 percent of the next pregnancies. […] Normotensive pregnancy: preeclampsia occurs in <1 percent of the next pregnancies. [...] Patients with preeclampsia are at increased risk for life-threatening events, including placental abruption, acute kidney injury, cerebral hemorrhage, hepatic failure or rupture, pulmonary edema, stroke, cardiac failure, and progression to eclampsia. [...] The fetus is at increased risk for growth restriction and medically or obstetrically indicated preterm birth. [...] Long-term maternal prognosis (recurrence risk, increased risk for related obstetric complications in future pregnancies, increased risk for cardiovascular and kidney disease in later life) and long-term prognosis for offspring are reviewed separately.

• #11 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Preeclampsia with severe features in the second trimester: preeclampsia occurs in 25 to 65 percent of the next pregnancies. […] Preeclampsia without severe features: preeclampsia occurs in 10 to 12 percent of the next pregnancies. […] Normotensive pregnancy: preeclampsia occurs in <1 percent of the next pregnancies. [...] Patients with preeclampsia are at increased risk for life-threatening events, including placental abruption, acute kidney injury, cerebral hemorrhage, hepatic failure or rupture, pulmonary edema, stroke, cardiac failure, and progression to eclampsia. [...] The fetus is at increased risk for growth restriction and medically or obstetrically indicated preterm birth. [...] Long-term maternal prognosis (recurrence risk, increased risk for related obstetric complications in future pregnancies, increased risk for cardiovascular and kidney disease in later life) and long-term prognosis for offspring are reviewed separately.

• #12 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Preeclampsia with severe features in the second trimester: preeclampsia occurs in 25 to 65 percent of the next pregnancies. […] Preeclampsia without severe features: preeclampsia occurs in 10 to 12 percent of the next pregnancies. […] Normotensive pregnancy: preeclampsia occurs in <1 percent of the next pregnancies. [...] Patients with preeclampsia are at increased risk for life-threatening events, including placental abruption, acute kidney injury, cerebral hemorrhage, hepatic failure or rupture, pulmonary edema, stroke, cardiac failure, and progression to eclampsia. [...] The fetus is at increased risk for growth restriction and medically or obstetrically indicated preterm birth. [...] Long-term maternal prognosis (recurrence risk, increased risk for related obstetric complications in future pregnancies, increased risk for cardiovascular and kidney disease in later life) and long-term prognosis for offspring are reviewed separately.

• #13 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Preeclampsia with severe features in the second trimester: preeclampsia occurs in 25 to 65 percent of the next pregnancies. […] Preeclampsia without severe features: preeclampsia occurs in 10 to 12 percent of the next pregnancies. […] Normotensive pregnancy: preeclampsia occurs in <1 percent of the next pregnancies. [...] Patients with preeclampsia are at increased risk for life-threatening events, including placental abruption, acute kidney injury, cerebral hemorrhage, hepatic failure or rupture, pulmonary edema, stroke, cardiac failure, and progression to eclampsia. [...] The fetus is at increased risk for growth restriction and medically or obstetrically indicated preterm birth. [...] Long-term maternal prognosis (recurrence risk, increased risk for related obstetric complications in future pregnancies, increased risk for cardiovascular and kidney disease in later life) and long-term prognosis for offspring are reviewed separately.

• #14 Multicenter prospective clinical study to evaluate the prediction of short-term outcome in pregnant women with suspected preeclampsia (PROGNOSIS): study protocol

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4262142/

  Preeclampsia is defined as new onset of hypertension and proteinuria at gestational week 20 or after. […] Because of its unpredictability, varying clinical presentation and potential adverse outcomes, pregnant women with suspected preeclampsia require intensive monitoring or hospitalization. […] Beyond preeclampsia diagnosis, there is a high unmet medical need for more reliable predictive markers for preeclampsia to improve maternal and fetal outcomes and reduce unnecessary hospital admissions. […] The results of PROGNOSIS will provide the most comprehensive evidence to date on the accuracy of the sFlt-1/PlGF ratio for short-term prediction of preeclampsia/eclampsia/HELLP syndrome. […] Adoption of the sFlt-1/PlGF test in clinical practice has the potential to reduce the frequency of adverse pregnancy outcomes for both mother and fetus, and decrease healthcare costs associated with unnecessary hospitalization of women with suspected preeclampsia.

• #15

  https://link.springer.com/article/10.1007/s00404-022-06864-y

  With the angiogenic biomarkers, substantial progress has been made to achieve a better prediction of preeclampsia-associated adverse outcomes. […] The current understanding of the pathophysiology of preeclampsia: The etiology of the disease and its adverse outcomes centers around a dysfunctional placenta. […] The studies presented here have, to our knowledge, not been independently verified. Machine-learning performance can substantially vary when algorithms which were trained on one dataset are presented with new, independently collected data. […] There is an unmet medical need to improve prediction of preeclampsia-related adverse outcomes. […] With the advent of the angiogenic biomarkers, substantial progress has been made to better identify women at risk for adverse outcomes on the one hand, and rule out the disease despite clinical suspicion on the other hand. […] This is a main goal of future research.

• #16 Multicenter prospective clinical study to evaluate the prediction of short-term outcome in pregnant women with suspected preeclampsia (PROGNOSIS): study protocol

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4262142/

  Improving the sensitivity and accuracy of assays for predicting preeclampsia has the potential to prevent over-diagnosis and over-treatment of women with suspected preeclampsia and may allow more efficient allocation of healthcare resources according to the patients risk. […] The sFlt-1/PlGF ratio is a valuable aid in the diagnosis of preeclampsia and discriminates between different types of pregnancy-related hypertensive disorders. […] PROGNOSIS will provide the most comprehensive evidence to date on the accuracy of the sFlt-1/PlGF ratio as a short-term predictive marker for preeclampsia. Accurate prediction of preeclampsia has the potential to reduce the frequency of adverse maternal and fetal outcomes, including iatrogenic preterm delivery, and to decrease healthcare costs associated with hospitalization.

• #17

  https://link.springer.com/article/10.1007/s00404-022-06864-y

  With the angiogenic biomarkers, substantial progress has been made to achieve a better prediction of preeclampsia-associated adverse outcomes. […] The current understanding of the pathophysiology of preeclampsia: The etiology of the disease and its adverse outcomes centers around a dysfunctional placenta. […] The studies presented here have, to our knowledge, not been independently verified. Machine-learning performance can substantially vary when algorithms which were trained on one dataset are presented with new, independently collected data. […] There is an unmet medical need to improve prediction of preeclampsia-related adverse outcomes. […] With the advent of the angiogenic biomarkers, substantial progress has been made to better identify women at risk for adverse outcomes on the one hand, and rule out the disease despite clinical suspicion on the other hand. […] This is a main goal of future research.

• #18 Multicenter prospective clinical study to evaluate the prediction of short-term outcome in pregnant women with suspected preeclampsia (PROGNOSIS): study protocol

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4262142/

  Improving the sensitivity and accuracy of assays for predicting preeclampsia has the potential to prevent over-diagnosis and over-treatment of women with suspected preeclampsia and may allow more efficient allocation of healthcare resources according to the patients risk. […] The sFlt-1/PlGF ratio is a valuable aid in the diagnosis of preeclampsia and discriminates between different types of pregnancy-related hypertensive disorders. […] PROGNOSIS will provide the most comprehensive evidence to date on the accuracy of the sFlt-1/PlGF ratio as a short-term predictive marker for preeclampsia. Accurate prediction of preeclampsia has the potential to reduce the frequency of adverse maternal and fetal outcomes, including iatrogenic preterm delivery, and to decrease healthcare costs associated with hospitalization.

• #19

  https://journals.lww.com/mfm/fulltext/2021/04000/short_term_prediction_of_preeclampsia.5.aspx

  Preeclampsia (PE), a multisystem disorder in pregnancy, is a main cause of perinatal mortality and is associated with long-term maternal complications. […] It had been shown that this gold standard definition is not able to provide a sufficient prediction of PE-related fetal and/or maternal complications. […] Including angiogenic biomarkers, however, has been shown to increase detection of adverse outcomes. […] The Prediction of short-term outcome in pregnant women with suspected preeclampsia (PROGNOSIS) study has shown that the high negative predictive value (99.3%) of the sFlt-1/PlGF-ratio below 38 in patients with suspected PE rules out the onset of the disease within one week. […] The objective of this review is to provide an overview of current methods for predicting and diagnosing PE.

• #20

  https://journals.lww.com/mfm/fulltext/2021/04000/short_term_prediction_of_preeclampsia.5.aspx

  This work generates important evidence in support of the broader forms of the definition of PE. […] The results of the PROGNOSIS study have been confirmed in an Asian population. […] The high NPV of the sFlt-1/PlGF-ratio at the cut-off of 38 was confirmed: in patients with signs and symptoms of the disease and a sFlt-1/PlGF-ratio 38, PE within 1 week is ruled out with an NPV of 98.6%. […] The above-mentioned work concentrated on the identification of the disease in patients at high risk. […] The economic effect of the sFlt-1/PlGF-ratio was measured in the UK based on PROGNOSIS results. […] Nonetheless, such ratings cannot be directly extrapolated from one health system to another and should be assessed predicated on each country’s individual system. […] The task of this review was to summarize the recent advances in the short term prediction of PE, with a special focus of PE-related adverse outcomes. […] It has been convincingly shown that inclusion of angiogenic and anti-angiogenic biomarkers into the definition improves maternal adverse outcome prediction.

• #21 Development and validation of prediction models for risk of adverse outcomes in women with early-onset pre-eclampsia: protocol of the prospective cohort PREP study | Diagnostic and Prognostic Research | Full Text

  https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-016-0004-8

  Early-onset pre-eclampsia with raised blood pressure and protein in the urine before 34 weeks gestation is one of the leading causes of maternal deaths in the UK. […] Accurate prediction models of risks are needed to plan management. […] The PREP study will quantify the risk of maternal complications at various time points and provide individualised estimates of overall risk in women with early-onset pre-eclampsia to plan the management. […] We aim to develop prediction models to quantify the overall risk of adverse maternal outcomes in women with early-onset pre-eclampsia and at various time points after diagnosis. […] The primary objectives are to develop and internally validate a prediction model in women admitted with early-onset pre-eclampsia from 20 weeks and 0 day to 33 weeks and 6 days of gestation, for assessment of the risk of adverse maternal outcomes at 48 h and by discharge.

• #22 Prediction of complications in early-onset pre-eclampsia (PREP): development and external multinational validation of prognostic models | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0827-3

  Unexpected clinical deterioration before 34 weeks gestation is an undesired course in early-onset pre-eclampsia. To safely prolong preterm gestation, accurate and timely prediction of complications is required. […] We developed multivariable prognostic models for providing individual risks of adverse maternal outcomes, including delivery of preterm infant before 34 weeks, in women with early-onset pre-eclampsia in the UK, by 48 hours and by discharge. […] The PREP models enable the individualised risk prediction of complications in early-onset pre-eclampsia for overall risk and by 48 hours. They use routinely collected data and show promising performance upon internal and external validation. They can now be considered for use to support healthcare professionals and parents in making decisions on place of care, intensity of monitoring, and early in utero tertiary transfer to appropriate units.

• #23

  https://journals.lww.com/mfm/fulltext/2021/04000/management_of_preeclampsia_in_low__and.8.aspx

  Preeclampsia remains associated with an increased risk of maternal and perinatal morbidity and mortality, and the burden of that excess risk is largely borne by pregnant women and their families in low- and middle-income countries (LMICs). […] There is an identified need to understand biological pathways that underlie the causation of preeclampsia in LMICs. […] Personalized maternal time-of-disease risk estimates are available through the PIERS (Preeclampsia Integrated Estimate of RiSk) models, either with (fullPIERS) or without (miniPIERS) access to laboratory testing. […] Assessment of perinatal risks in LMICs is largely driven by gestational age; however, evidence of significant angiogenic imbalance may identify risk of intrauterine fetal death. […] The miniPIERS multivariable model was developed using data from 2081 hypertensive pregnant women admitted to hospitals in Brazil, Fiji, Pakistan, South Africa, and Uganda.

• #24

  https://journals.lww.com/mfm/fulltext/2021/04000/management_of_preeclampsia_in_low__and.8.aspx

  Preeclampsia remains associated with an increased risk of maternal and perinatal morbidity and mortality, and the burden of that excess risk is largely borne by pregnant women and their families in low- and middle-income countries (LMICs). […] There is an identified need to understand biological pathways that underlie the causation of preeclampsia in LMICs. […] Personalized maternal time-of-disease risk estimates are available through the PIERS (Preeclampsia Integrated Estimate of RiSk) models, either with (fullPIERS) or without (miniPIERS) access to laboratory testing. […] Assessment of perinatal risks in LMICs is largely driven by gestational age; however, evidence of significant angiogenic imbalance may identify risk of intrauterine fetal death. […] The miniPIERS multivariable model was developed using data from 2081 hypertensive pregnant women admitted to hospitals in Brazil, Fiji, Pakistan, South Africa, and Uganda.

• #25

  https://journals.lww.com/mfm/fulltext/2021/04000/management_of_preeclampsia_in_low__and.8.aspx

  The fullPIERS model predicted adverse maternal outcomes within 48 hours of admission (AUC ROC 0.88, 95% CI: 0.84, 0.92), and has been externally validated using data from the miniPIERS cohort for LMICs. […] The best treatment for the mother is always delivery, limiting her exposure to preeclampsia. […] Delivery should not be equated with cure.

• #26 Prediction of pre‐eclampsia‐related complications in women with suspected or confirmed pre‐eclampsia: development and internal validation of clinical prediction model

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8596877/

  Continuous values of sFlt1/PlGF ratio, PCR and gestational age at the time of blood sampling for biomarker measurements were strong predictors of the development of composite adverse PE related outcome. […] The resulting risk predictions for a complication within 7, 14 and 30 days after biomarker measurements could aid in key clinical decisions that are not addressed by existing single-timepoint prognostic criteria. […] The final model, consisting of gestational age, PCR and sFlt1/PlGF ratio, for the prediction of a PE related complication within 7 days, yielded a higher c-statistic than that achieved by other models investigated previously in this population. […] We present a multivariable prediction model with an additional tool to calculate the absolute risk of developing a composite outcome of PE related pregnancy complications, consisting of maternal and fetal adverse events, in the subsequent 7, 14 and 30 days, in women with suspected or confirmed PE.

• #27 Prediction of pre‐eclampsia‐related complications in women with suspected or confirmed pre‐eclampsia: development and internal validation of clinical prediction model

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8596877/

  Continuous values of sFlt1/PlGF ratio, PCR and gestational age at the time of blood sampling for biomarker measurements were strong predictors of the development of composite adverse PE related outcome. […] The resulting risk predictions for a complication within 7, 14 and 30 days after biomarker measurements could aid in key clinical decisions that are not addressed by existing single-timepoint prognostic criteria. […] The final model, consisting of gestational age, PCR and sFlt1/PlGF ratio, for the prediction of a PE related complication within 7 days, yielded a higher c-statistic than that achieved by other models investigated previously in this population. […] We present a multivariable prediction model with an additional tool to calculate the absolute risk of developing a composite outcome of PE related pregnancy complications, consisting of maternal and fetal adverse events, in the subsequent 7, 14 and 30 days, in women with suspected or confirmed PE.

• #28 Development and validation of a prediction model on severe maternal outcomes among pregnant women with pre-eclampsia: a 10-year cohort study | Scientific Reports

  https://www.nature.com/articles/s41598-020-72527-0

  Pre-eclampsia is a severe hypertensive disorder of pregnancy and could lead to severe maternal morbidities and death. Our study aimed to develop and validate a prognostic prediction model for severe maternal outcomes among Chinese population with pre-eclampsia. A total of 397 pregnant women suffered from severe maternal outcomes among 2,793 eligible participants, with an incidence of 14.21% (95% confidence interval (CI) 12.91%15.51%). Combined with quadratic and interactive terms, the Model 2 showed higher area under the ROC curve (82.2%, 95% CI 79.6%84.7%) and good calibration. By the bootstrapping validation, similar model performances were present. […] The model was presented as follows: logit (P)=33.4680.051 gestational week+1.033 placenta previa+0.690 HBsAg positivity+1.308 cardiac diseases+1.060 IDA+1.075 dyspnea+0.006 systolic blood pressure11.976 log-transformed platelets0.964 log-fibrinogen+0.198 log-transformed aspartate transferase+0.391 log-transformed bilirubin0.497 log-transformed creatinine+0.946 urine protein (+)+0.926 urine protein (++)+1.239 urine protein (+++)+1.340 urine protein (++++)+0.832 log-transformed platelets2+0.085 log-transformed plateletslog-transformed creatinine. When 0.14 was used as the cut-off value, the sensitivity of the model was 72.70%, the specificity was 76.13%, the predictive accuracy was 75.60%, the positive predictive value was 35.68%, and the negative predictive value was 93.87%. The calibration ability of the model was also well.

• #29 Development and validation of a prediction model on severe maternal outcomes among pregnant women with pre-eclampsia: a 10-year cohort study | Scientific Reports

  https://www.nature.com/articles/s41598-020-72527-0

  Our model provided a plausible predictive tool for identifying the high-risk pregnant women diagnosed pre-eclampsia among Chinese population. When a pregnant woman was diagnosed with pre-eclampsia, this model may offer a probability of severe maternal outcome which would assist clinician to determine whether the pregnant women need to be hospitalized and monitored more closely, as well as the decision-making about timing of delivery. This is particularly the case for junior clinicians and midwives in primary healthcare institutions.

• #30 Prediction Models for Late-Onset Preeclampsia: A Study Based on Logistic Regression, Support Vector Machine, and Extreme Gradient Boosting Models

  https://www.mdpi.com/2227-9059/13/2/347

  Prediction Models for Late-Onset Preeclampsia: A Study Based on Logistic Regression, Support Vector Machine, and Extreme Gradient Boosting Models […] Background: Preeclampsia, affecting 2–4% of pregnancies worldwide, poses a substantial risk to maternal health. Late-onset preeclampsia, in particular, has a high incidence among preeclampsia cases. However, existing prediction models are limited in terms of the early detection capabilities and often rely on costly and less accessible indicators, making them less applicable in resource-limited settings. […] Conclusion: Compared with the logistic regression model, both the support vector machine and extreme gradient boosting models significantly improved the detection rates for late-onset preeclampsia. However, the support vector machine model had a comparatively higher false positive rate. Notably, the logistic regression and extreme gradient boosting models exhibited high negative predictive values of 99.3%, underscoring their effectiveness in accurately identifying pregnant women less likely to develop late-onset preeclampsia. Additionally, logistic regression showed the highest areas under the ROC curve, suggesting that the traditional model has unique advantages in relation to prediction.

• #31 Prediction Model for Pre-Eclampsia Using Gestational-Age-Specific Serum Creatinine Distribution

  https://www.mdpi.com/2079-7737/12/6/816

  Prediction of pre-eclampsia (PE) is a crucial task both medically and socioeconomically. […] The model developed in this study is practical and can be easily applied in primary care settings without requiring significant hospital database upgrades. […] This study aimed to establish a PE prediction model using expert knowledge and by considering renal physiologic adaptation during pregnancy. […] The current study that predicted PE demonstrated that the incorporation of knowledge domain (i.e., pregnancy-related renal hyperfiltration) improved the predictive accuracy. […] Specifically, when predicting PE, any case and triple cases (PE + PTB + FGR), while adding GA-specific SCr information, provided an enhanced predictive performance. […] Our study identified that the GA-specific SCr distribution has predictive utility for PE based on a machine-learning-based method.

• #32 Prediction Model for Pre-Eclampsia Using Gestational-Age-Specific Serum Creatinine Distribution

  https://www.mdpi.com/2079-7737/12/6/816

  The current study showed that the SCr value obtained from blood sampling during the 2nd trimester of pregnancy, especially at 14–16 weeks of gestation, exhibited the best predictive power, which has significant clinical implications. […] Taken together, with the ease of the clinical application of our prediction model in real-world clinical setting and the potential for additional drug therapy, this study could contribute importantly to the preservation of the lives of pregnant women and fetuses. […] We demonstrated a significant improvement in the prediction of PE when SCr levels derived from a real-world hospital database and prior knowledge (renal physiological adaptation during pregnancy) were integrated into the predictive model. […] The implementation of both SCr and GAQ as predictors resulted in a substantial improvement in predicting PE_any and PE_triple.

• #33 Prediction Model for Pre-Eclampsia Using Gestational-Age-Specific Serum Creatinine Distribution

  https://www.mdpi.com/2079-7737/12/6/816

  The current study showed that the SCr value obtained from blood sampling during the 2nd trimester of pregnancy, especially at 14–16 weeks of gestation, exhibited the best predictive power, which has significant clinical implications. […] Taken together, with the ease of the clinical application of our prediction model in real-world clinical setting and the potential for additional drug therapy, this study could contribute importantly to the preservation of the lives of pregnant women and fetuses. […] We demonstrated a significant improvement in the prediction of PE when SCr levels derived from a real-world hospital database and prior knowledge (renal physiological adaptation during pregnancy) were integrated into the predictive model. […] The implementation of both SCr and GAQ as predictors resulted in a substantial improvement in predicting PE_any and PE_triple.

• #34 Prediction of preeclampsia risk in first time pregnant women: Metabolite biomarkers for a clinical test | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244369

  Preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality. Accurate prediction of preeclampsia risk would enable more effective, risk-based prenatal care pathways. […] The accurate prediction of preeclampsia risk early in pregnancy has been flagged as a research priority in many clinical guidelines as it would enable risk-based prenatal care pathways, and hence more effective utilisation of prenatal care resources. […] The possible patient benefits of accurate preeclampsia risk prediction have recently been reaffirmed in the ASPRE trial, which reported that aspirin prophylaxis in women identified to be at risk of preeclampsia before 37 weeks of gestation, so-called preterm preeclampsia, reduced the incidence rate of preterm preeclampsia by 62%. […] However, these studies also re-iterated that the predictive performance decreased significantly in first-time pregnant women.

• #35 Prediction of preeclampsia risk in first time pregnant women: Metabolite biomarkers for a clinical test | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244369

  Preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality. Accurate prediction of preeclampsia risk would enable more effective, risk-based prenatal care pathways. […] The accurate prediction of preeclampsia risk early in pregnancy has been flagged as a research priority in many clinical guidelines as it would enable risk-based prenatal care pathways, and hence more effective utilisation of prenatal care resources. […] The possible patient benefits of accurate preeclampsia risk prediction have recently been reaffirmed in the ASPRE trial, which reported that aspirin prophylaxis in women identified to be at risk of preeclampsia before 37 weeks of gestation, so-called preterm preeclampsia, reduced the incidence rate of preterm preeclampsia by 62%. […] However, these studies also re-iterated that the predictive performance decreased significantly in first-time pregnant women.

• #36 Prediction of pre‐eclampsia‐related complications in women with suspected or confirmed pre‐eclampsia: development and internal validation of clinical prediction model

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8596877/

  A model that can predict reliably the risk of preeclampsia (PE) related pregnancy complications does not exist. The aim of this study was to develop and validate internally a clinical prediction model to predict the risk of a composite outcome of PE related maternal and fetal complications within 7, 14 and 30 days of testing in women with suspected or confirmed PE. […] Important predictors of adverse PE related outcome included sFlt1/PlGF ratio, gestational age at the time of biomarker measurement and protein-to-creatinine ratio as continuous variables. […] We propose a simple clinical prediction model with good discriminative performance to predict PE related complications. […] Our model could help physicians to identify low-risk patients with suspected or confirmed PE who could be offered expectant management, leading to a decrease in the number and duration of admissions to the obstetric ward and potentially a reduction in costs, while simultaneously not compromising maternal and fetal health outcomes.

• #37

  https://journals.lww.com/mfm/fulltext/2021/04000/short_term_prediction_of_preeclampsia.5.aspx

  This work generates important evidence in support of the broader forms of the definition of PE. […] The results of the PROGNOSIS study have been confirmed in an Asian population. […] The high NPV of the sFlt-1/PlGF-ratio at the cut-off of 38 was confirmed: in patients with signs and symptoms of the disease and a sFlt-1/PlGF-ratio 38, PE within 1 week is ruled out with an NPV of 98.6%. […] The above-mentioned work concentrated on the identification of the disease in patients at high risk. […] The economic effect of the sFlt-1/PlGF-ratio was measured in the UK based on PROGNOSIS results. […] Nonetheless, such ratings cannot be directly extrapolated from one health system to another and should be assessed predicated on each country’s individual system. […] The task of this review was to summarize the recent advances in the short term prediction of PE, with a special focus of PE-related adverse outcomes. […] It has been convincingly shown that inclusion of angiogenic and anti-angiogenic biomarkers into the definition improves maternal adverse outcome prediction.

• #38 Multicenter prospective clinical study to evaluate the prediction of short-term outcome in pregnant women with suspected preeclampsia (PROGNOSIS): study protocol

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4262142/

  Preeclampsia is defined as new onset of hypertension and proteinuria at gestational week 20 or after. […] Because of its unpredictability, varying clinical presentation and potential adverse outcomes, pregnant women with suspected preeclampsia require intensive monitoring or hospitalization. […] Beyond preeclampsia diagnosis, there is a high unmet medical need for more reliable predictive markers for preeclampsia to improve maternal and fetal outcomes and reduce unnecessary hospital admissions. […] The results of PROGNOSIS will provide the most comprehensive evidence to date on the accuracy of the sFlt-1/PlGF ratio for short-term prediction of preeclampsia/eclampsia/HELLP syndrome. […] Adoption of the sFlt-1/PlGF test in clinical practice has the potential to reduce the frequency of adverse pregnancy outcomes for both mother and fetus, and decrease healthcare costs associated with unnecessary hospitalization of women with suspected preeclampsia.

• #39

  https://link.springer.com/article/10.1007/s00404-022-06864-y

  With the angiogenic biomarkers, substantial progress has been made to achieve a better prediction of preeclampsia-associated adverse outcomes. […] The current understanding of the pathophysiology of preeclampsia: The etiology of the disease and its adverse outcomes centers around a dysfunctional placenta. […] The studies presented here have, to our knowledge, not been independently verified. Machine-learning performance can substantially vary when algorithms which were trained on one dataset are presented with new, independently collected data. […] There is an unmet medical need to improve prediction of preeclampsia-related adverse outcomes. […] With the advent of the angiogenic biomarkers, substantial progress has been made to better identify women at risk for adverse outcomes on the one hand, and rule out the disease despite clinical suspicion on the other hand. […] This is a main goal of future research.

• #40 Development and validation of prediction models for risk of adverse outcomes in women with early-onset pre-eclampsia: protocol of the prospective cohort PREP study | Diagnostic and Prognostic Research | Full Text

  https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-016-0004-8

  The models we develop (which use data from women diagnosed with pre-eclampsia) will also be tested in women defined with suspected pre-eclampsia. […] Provision of individualised risk estimates for adverse maternal outcomes through the PREP study will help clinicians make suitable decisions after discussion with the parents. […] To show that the PREP prognostic model is valuable, it is not sufficient to show that it successfully predicts outcome in the initial development data even after having it being internally validated.

• #41

  https://journals.lww.com/mfm/fulltext/2021/04000/management_of_preeclampsia_in_low__and.8.aspx

  Preeclampsia remains associated with an increased risk of maternal and perinatal morbidity and mortality, and the burden of that excess risk is largely borne by pregnant women and their families in low- and middle-income countries (LMICs). […] There is an identified need to understand biological pathways that underlie the causation of preeclampsia in LMICs. […] Personalized maternal time-of-disease risk estimates are available through the PIERS (Preeclampsia Integrated Estimate of RiSk) models, either with (fullPIERS) or without (miniPIERS) access to laboratory testing. […] Assessment of perinatal risks in LMICs is largely driven by gestational age; however, evidence of significant angiogenic imbalance may identify risk of intrauterine fetal death. […] The miniPIERS multivariable model was developed using data from 2081 hypertensive pregnant women admitted to hospitals in Brazil, Fiji, Pakistan, South Africa, and Uganda.

• #42

  https://journals.lww.com/mfm/fulltext/2021/04000/management_of_preeclampsia_in_low__and.8.aspx

  The fullPIERS model predicted adverse maternal outcomes within 48 hours of admission (AUC ROC 0.88, 95% CI: 0.84, 0.92), and has been externally validated using data from the miniPIERS cohort for LMICs. […] The best treatment for the mother is always delivery, limiting her exposure to preeclampsia. […] Delivery should not be equated with cure.

• #43 Pre-eclampsia | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-023-00417-6

  Pre-eclampsia is a life-threatening disease of pregnancy unique to humans and a leading cause of maternal and neonatal morbidity and mortality. Women who survive pre-eclampsia have reduced life expectancy, with increased risks of stroke, cardiovascular disease and diabetes, while babies from a pre-eclamptic pregnancy have increased risks of preterm birth, perinatal death and neurodevelopmental disability and cardiovascular and metabolic disease later in life. […] Significant advances have been made in the prediction and prevention of preterm pre-eclampsia, which is predicted in early pregnancy through combined screening and is prevented with daily low-dose aspirin, starting before 16 weeks of gestation. By contrast, the prediction of term and postpartum pre-eclampsia is limited and there are no preventive treatments. Future research must investigate the pathogenesis of pre-eclampsia, in particular of term and postpartum pre-eclampsia, and evaluate new prognostic tests and treatments in adequately powered clinical trials. […] A convincing large trial of aspirin to prevent pre-eclampsia in women at high risk for preterm preeclampsia that sparked many follow-up trials and resulted in the worldwide clinical use of aspirin to prevent preterm pre-eclampsia.

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