Materiały źródłowe

• #1 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.

• #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 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.

• #4 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. […] Addressing this unmet need may reduce the cost of monitoring by reducing unnecessary hospital admissions, and improve maternal and perinatal outcomes through earlier and better targeted management. […] The PRediction of short-term Outcome in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) was designed to demonstrate the utility of the sFlt-1/PlGF ratio, as determined by the Elecsys sFlt-1 and Elecsys PlGF assays, in the short-term (up to 4 weeks) prediction of preeclampsia. […] Reliable prediction of preeclampsia and related clinical maternal and fetal adverse outcomes is a high unmet medical need in pregnancy care.

• #5 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 need for novel biomarkers to improve preeclampsia prediction in nulliparous women without apparent risk factor is further emphasized by the fact that nulliparity is associated with increased risk (RR = 2.1 (1.9 to 2.4)) and accounts for the largest single population attributable fraction (32.3%) for preeclampsia. […] The aim of this work was to inform the development of a novel biomarker-assisted test for the early and accurate prediction of preeclampsia risk in low-risk nulliparous women.

• #6 Prediction of pre-eclampsia: a protocol for systematic reviews of test accuracy | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-6-29

  Pre-eclampsia, a syndrome of hypertension and proteinuria, is a major cause of maternal and perinatal morbidity and mortality. Accurate prediction of pre-eclampsia is important, since high risk women could benefit from intensive monitoring and preventive treatment. […] However, decision making is currently hampered due to lack of precise and up to date comprehensive evidence summaries on estimates of risk of developing pre-eclampsia. […] Accurate prediction of pre-eclampsia is important, because intensive monitoring and administration of early treatment with e.g. aspirin can be more selectively targeted at high-risk women, making timely intervention easier and possibly more cost-effective. This may prevent some of the mortality and morbidity. […] The results of the accuracy reviews will be integrated with results of effectiveness reviews of preventive interventions to assess cost-effectiveness of strategies (test-intervention combinations) for prediction and prevention of pre-eclampsia.

• #7 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.

• #8

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

  The objective of this review is to provide an overview of current methods for predicting and diagnosing PE. […] The main factors leading to PE-related adverse outcomes are (1) a lack of accuracy in the early diagnosis and (2) a lack of causative treatment. […] The wide variability of clinical presentations and a nonlinear relationship of high blood pressure/proteinuria to adverse outcomes, are main contributing factors. […] Next to its potentially life-threatening effect on the immediate pregnancy outcome, PE leads to long-term maternal complications including an increased risk of cardiovascular disease, such as hypertension, coronary artery disease, and cerebrovascular accident. […] The ACOG guidelines were the first to recommend a broader definition of PE. […] According to ISSHP proteinuria is no more obligatory to diagnose PE.

• #9

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

  The objective of this review is to provide an overview of current methods for predicting and diagnosing PE. […] The main factors leading to PE-related adverse outcomes are (1) a lack of accuracy in the early diagnosis and (2) a lack of causative treatment. […] The wide variability of clinical presentations and a nonlinear relationship of high blood pressure/proteinuria to adverse outcomes, are main contributing factors. […] Next to its potentially life-threatening effect on the immediate pregnancy outcome, PE leads to long-term maternal complications including an increased risk of cardiovascular disease, such as hypertension, coronary artery disease, and cerebrovascular accident. […] The ACOG guidelines were the first to recommend a broader definition of PE. […] According to ISSHP proteinuria is no more obligatory to diagnose PE.

• #10 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.

• #11 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.

• #12 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.

• #13

  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. […] The new definition increases the number of patients diagnosed as preeclamptic by nearly 21%, which is not accompanied by an increased severity of maternal outcomes. […] 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.

• #14

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

  However, outcomes in the cases diagnosed by application of the new definition were milder than those cases of PE, which were classified by the earlier ISSHP recommendations. […] 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. […] This work highlights the important role of the angiogenic biomarkers for predicting adverse outcomes. […] The above-mentioned work concentrated on the identification of the disease in patients at high risk. […] However, as positive prediction needs to be increased to lower the amount of falsely classified women, multi-marker modeling approaches show promising results with high PPVs. […] More research is needed, especially in the field of pathogenesis and therapeutic options, which hopefully will soon achieve a breakthrough to be able, after improved diagnosis and prediction, to lower maternal and/or fetal morbidity and mortality.

• #15 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

  We found that combining dilinoleoyl-glycerol (DLG) with PlGF effectively predicted increased preterm preeclampsia risk at ca. 15 weeks of gestation. […] The resulting partitioning rule-in model (PlGF || DLG) is shown in Fig 1. […] By combining PlGF with a two-predictor partial least squares discriminant analysis (PLS-DA) model constituting DLG and 1-HGP (PlGF || (DLG+1-HGP)), the sensitivity could be increased further to 78% (PPV = 0.05). […] In this study we re-evaluated the relevance of a set of putative metabolite biomarkers to further inform the development of a test to predict preeclampsia in nulliparous women without apparent risk factors. […] A strength of this study lies in the well-defined pregnancy risk profile within the SCOPE study, allowing us to focus this translation biomarker research to the pregnancy population most in need for biomarker-assisted risk prediction. […] The next steps in our test development work will involve developing a multiplex clinical assay for the selected markers, as well as further assessment of their generalisability to complement PlGF for the prediction in preeclampsia in other pregnancy populations.

• #16 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

  We found that combining dilinoleoyl-glycerol (DLG) with PlGF effectively predicted increased preterm preeclampsia risk at ca. 15 weeks of gestation. […] The resulting partitioning rule-in model (PlGF || DLG) is shown in Fig 1. […] By combining PlGF with a two-predictor partial least squares discriminant analysis (PLS-DA) model constituting DLG and 1-HGP (PlGF || (DLG+1-HGP)), the sensitivity could be increased further to 78% (PPV = 0.05). […] In this study we re-evaluated the relevance of a set of putative metabolite biomarkers to further inform the development of a test to predict preeclampsia in nulliparous women without apparent risk factors. […] A strength of this study lies in the well-defined pregnancy risk profile within the SCOPE study, allowing us to focus this translation biomarker research to the pregnancy population most in need for biomarker-assisted risk prediction. […] The next steps in our test development work will involve developing a multiplex clinical assay for the selected markers, as well as further assessment of their generalisability to complement PlGF for the prediction in preeclampsia in other pregnancy populations.

• #17 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

  Using a 10-year cohort of 2,793 pregnant women who diagnosed as pre-eclampsia in West China Second University Hospital of Sichuan University from 2005 to 2014, we developed and validated internally a prediction model of severe maternal outcomes in pregnant women with pre-eclampsia, and got a good discrimination (e.g. 82.2% of area under the ROC curve). 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.

• #18 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

  Using a 10-year cohort of 2,793 pregnant women who diagnosed as pre-eclampsia in West China Second University Hospital of Sichuan University from 2005 to 2014, we developed and validated internally a prediction model of severe maternal outcomes in pregnant women with pre-eclampsia, and got a good discrimination (e.g. 82.2% of area under the ROC curve). 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.

• #19 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. Given that the medical resources and healthcare capability are heterogenous among Chinese medical institutions, timely transferal for pre-eclampsia women at high risk might be an effective response to reduce the risk of severe maternal outcomes. […] In this study, a prediction model for severe maternal outcomes in pregnant women with pre-eclampsia was established using a multivariable logistic regression model. This model has a good predictive ability by internal validation. Further external validation is required to clarify the clinical applicability of our model.

• #20 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. […] A total of 169 mothers (18%) in the PREP dataset had adverse outcomes by 48 hours, and 633 (67%) by discharge. […] PREP models can be used to obtain predictions of adverse maternal outcome risk, including early preterm delivery, by 48 hours (PREP-S) and by discharge (PREP-L), in women with early onset pre-eclampsia in the context of current care. […] 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.

• #21 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

  The apparent and optimism-adjusted Harrells C-statistic of the developed PREP-S model were 0.77 (95% CI, 0.750.79) and 0.75 (95% CI, 0.730.78), respectively. […] The apparent C-statistic for the PREP-L model was 0.84 (95% CI, 0.820.87) and following bootstrap adjustment for optimism it was 0.82 (95% CI, 0.800.84). […] 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.

• #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

  The apparent and optimism-adjusted Harrells C-statistic of the developed PREP-S model were 0.77 (95% CI, 0.750.79) and 0.75 (95% CI, 0.730.78), respectively. […] The apparent C-statistic for the PREP-L model was 0.84 (95% CI, 0.820.87) and following bootstrap adjustment for optimism it was 0.82 (95% CI, 0.800.84). […] 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.

• #23 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

  The apparent and optimism-adjusted Harrells C-statistic of the developed PREP-S model were 0.77 (95% CI, 0.750.79) and 0.75 (95% CI, 0.730.78), respectively. […] The apparent C-statistic for the PREP-L model was 0.84 (95% CI, 0.820.87) and following bootstrap adjustment for optimism it was 0.82 (95% CI, 0.800.84). […] 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.

• #24 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Complications […] The risk of cardiovascular disease is increased later in life in women with a history of preeclampsia. Rates of acute myocardial infarction and stroke are four- and threefold higher, respectively, among women with preeclampsia than among those without preeclampsia 10 years after delivery. […] Recurrence […] In general, the recurrence risk of preeclampsia in a woman whose previous pregnancy was complicated by preeclampsia near term is approximately 10%. If a woman has previously had preeclampsia with severe features (including HELLP [hemolysis, elevated liver enzyme, low platelets] syndrome and/or eclampsia), she has a 20% risk of developing preeclampsia some time during a subsequent pregnancy. If a woman has had HELLP syndrome or eclampsia, the recurrence risk of HELLP syndrome is 5% and that of eclampsia is 2%. The earlier the disease manifests during the index pregnancy, the higher the likelihood of recurrence rises. If preeclampsia presented clinically before 30 weeks’ gestation, the chance of recurrence may be as high as 40%. […] The fullPIERS model has been validated and was successful in predicting adverse outcomes in advance; therefore, it is potentially able to influence treatment choices before complications arise.

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

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

  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. […] 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.

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

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

  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. […] 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.

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

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

  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. […] 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.

• #28 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  The severity of preeclampsia in the first pregnancy strongly impacts the risk of developing preeclampsia in the next pregnancy. […] 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.

• #29 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  The severity of preeclampsia in the first pregnancy strongly impacts the risk of developing preeclampsia in the next pregnancy. […] 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.

• #30 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  The severity of preeclampsia in the first pregnancy strongly impacts the risk of developing preeclampsia in the next pregnancy. […] 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.

• #31 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  The severity of preeclampsia in the first pregnancy strongly impacts the risk of developing preeclampsia in the next pregnancy. […] 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.

• #32 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Complications […] The risk of cardiovascular disease is increased later in life in women with a history of preeclampsia. Rates of acute myocardial infarction and stroke are four- and threefold higher, respectively, among women with preeclampsia than among those without preeclampsia 10 years after delivery. […] Recurrence […] In general, the recurrence risk of preeclampsia in a woman whose previous pregnancy was complicated by preeclampsia near term is approximately 10%. If a woman has previously had preeclampsia with severe features (including HELLP [hemolysis, elevated liver enzyme, low platelets] syndrome and/or eclampsia), she has a 20% risk of developing preeclampsia some time during a subsequent pregnancy. If a woman has had HELLP syndrome or eclampsia, the recurrence risk of HELLP syndrome is 5% and that of eclampsia is 2%. The earlier the disease manifests during the index pregnancy, the higher the likelihood of recurrence rises. If preeclampsia presented clinically before 30 weeks’ gestation, the chance of recurrence may be as high as 40%. […] The fullPIERS model has been validated and was successful in predicting adverse outcomes in advance; therefore, it is potentially able to influence treatment choices before complications arise.

• #33 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Complications […] The risk of cardiovascular disease is increased later in life in women with a history of preeclampsia. Rates of acute myocardial infarction and stroke are four- and threefold higher, respectively, among women with preeclampsia than among those without preeclampsia 10 years after delivery. […] Recurrence […] In general, the recurrence risk of preeclampsia in a woman whose previous pregnancy was complicated by preeclampsia near term is approximately 10%. If a woman has previously had preeclampsia with severe features (including HELLP [hemolysis, elevated liver enzyme, low platelets] syndrome and/or eclampsia), she has a 20% risk of developing preeclampsia some time during a subsequent pregnancy. If a woman has had HELLP syndrome or eclampsia, the recurrence risk of HELLP syndrome is 5% and that of eclampsia is 2%. The earlier the disease manifests during the index pregnancy, the higher the likelihood of recurrence rises. If preeclampsia presented clinically before 30 weeks’ gestation, the chance of recurrence may be as high as 40%. […] The fullPIERS model has been validated and was successful in predicting adverse outcomes in advance; therefore, it is potentially able to influence treatment choices before complications arise.

• #34 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Complications […] The risk of cardiovascular disease is increased later in life in women with a history of preeclampsia. Rates of acute myocardial infarction and stroke are four- and threefold higher, respectively, among women with preeclampsia than among those without preeclampsia 10 years after delivery. […] Recurrence […] In general, the recurrence risk of preeclampsia in a woman whose previous pregnancy was complicated by preeclampsia near term is approximately 10%. If a woman has previously had preeclampsia with severe features (including HELLP [hemolysis, elevated liver enzyme, low platelets] syndrome and/or eclampsia), she has a 20% risk of developing preeclampsia some time during a subsequent pregnancy. If a woman has had HELLP syndrome or eclampsia, the recurrence risk of HELLP syndrome is 5% and that of eclampsia is 2%. The earlier the disease manifests during the index pregnancy, the higher the likelihood of recurrence rises. If preeclampsia presented clinically before 30 weeks’ gestation, the chance of recurrence may be as high as 40%. […] The fullPIERS model has been validated and was successful in predicting adverse outcomes in advance; therefore, it is potentially able to influence treatment choices before complications arise.

• #35 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Complications […] The risk of cardiovascular disease is increased later in life in women with a history of preeclampsia. Rates of acute myocardial infarction and stroke are four- and threefold higher, respectively, among women with preeclampsia than among those without preeclampsia 10 years after delivery. […] Recurrence […] In general, the recurrence risk of preeclampsia in a woman whose previous pregnancy was complicated by preeclampsia near term is approximately 10%. If a woman has previously had preeclampsia with severe features (including HELLP [hemolysis, elevated liver enzyme, low platelets] syndrome and/or eclampsia), she has a 20% risk of developing preeclampsia some time during a subsequent pregnancy. If a woman has had HELLP syndrome or eclampsia, the recurrence risk of HELLP syndrome is 5% and that of eclampsia is 2%. The earlier the disease manifests during the index pregnancy, the higher the likelihood of recurrence rises. If preeclampsia presented clinically before 30 weeks’ gestation, the chance of recurrence may be as high as 40%. […] The fullPIERS model has been validated and was successful in predicting adverse outcomes in advance; therefore, it is potentially able to influence treatment choices before complications arise.

• #36 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Complications […] The risk of cardiovascular disease is increased later in life in women with a history of preeclampsia. Rates of acute myocardial infarction and stroke are four- and threefold higher, respectively, among women with preeclampsia than among those without preeclampsia 10 years after delivery. […] Recurrence […] In general, the recurrence risk of preeclampsia in a woman whose previous pregnancy was complicated by preeclampsia near term is approximately 10%. If a woman has previously had preeclampsia with severe features (including HELLP [hemolysis, elevated liver enzyme, low platelets] syndrome and/or eclampsia), she has a 20% risk of developing preeclampsia some time during a subsequent pregnancy. If a woman has had HELLP syndrome or eclampsia, the recurrence risk of HELLP syndrome is 5% and that of eclampsia is 2%. The earlier the disease manifests during the index pregnancy, the higher the likelihood of recurrence rises. If preeclampsia presented clinically before 30 weeks’ gestation, the chance of recurrence may be as high as 40%. […] The fullPIERS model has been validated and was successful in predicting adverse outcomes in advance; therefore, it is potentially able to influence treatment choices before complications arise.

• #37 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Complications […] The risk of cardiovascular disease is increased later in life in women with a history of preeclampsia. Rates of acute myocardial infarction and stroke are four- and threefold higher, respectively, among women with preeclampsia than among those without preeclampsia 10 years after delivery. […] Recurrence […] In general, the recurrence risk of preeclampsia in a woman whose previous pregnancy was complicated by preeclampsia near term is approximately 10%. If a woman has previously had preeclampsia with severe features (including HELLP [hemolysis, elevated liver enzyme, low platelets] syndrome and/or eclampsia), she has a 20% risk of developing preeclampsia some time during a subsequent pregnancy. If a woman has had HELLP syndrome or eclampsia, the recurrence risk of HELLP syndrome is 5% and that of eclampsia is 2%. The earlier the disease manifests during the index pregnancy, the higher the likelihood of recurrence rises. If preeclampsia presented clinically before 30 weeks’ gestation, the chance of recurrence may be as high as 40%. […] The fullPIERS model has been validated and was successful in predicting adverse outcomes in advance; therefore, it is potentially able to influence treatment choices before complications arise.

• #38 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  The severity of preeclampsia in the first pregnancy strongly impacts the risk of developing preeclampsia in the next pregnancy. […] 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.

• #39 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  The severity of preeclampsia in the first pregnancy strongly impacts the risk of developing preeclampsia in the next pregnancy. […] 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.

• #40 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Prognosis […] Morbidity/mortality […] Worldwide, preeclampsia and eclampsia are estimated to be responsible for approximately 14% of maternal deaths per year (50,000-75,000). Morbidity and mortality in preeclampsia and eclampsia are related to the following conditions: […] Systemic endothelial dysfunction […] Vasospasm and small-vessel thrombosis leading to tissue and organ ischemia […] Central nervous system (CNS) events, such as seizures, strokes, and hemorrhage […] Acute tubular necrosis […] Coagulopathies […] Placental abruption […] In the fetus, preeclampsia can lead to ischemic encephalopathy, growth restriction, and the various sequelae of premature birth. […] Fetal exposure to preeclampsia may be linked to autism and developmental delay. In a population-based study of 1061 children from singleton pregnancies including 517 with autism spectrum disorder (ASD), 194 with developmental delay, and 350 who were typically developing fetal exposure to preeclampsia was associated with a greater than twofold increase in the risk of ASD and a greater than fivefold increase in the risk of developmental delay.

• #41

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

  However, outcomes in the cases diagnosed by application of the new definition were milder than those cases of PE, which were classified by the earlier ISSHP recommendations. […] 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. […] This work highlights the important role of the angiogenic biomarkers for predicting adverse outcomes. […] The above-mentioned work concentrated on the identification of the disease in patients at high risk. […] However, as positive prediction needs to be increased to lower the amount of falsely classified women, multi-marker modeling approaches show promising results with high PPVs. […] More research is needed, especially in the field of pathogenesis and therapeutic options, which hopefully will soon achieve a breakthrough to be able, after improved diagnosis and prediction, to lower maternal and/or fetal morbidity and mortality.

• #42 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.

• #43 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

  We found that combining dilinoleoyl-glycerol (DLG) with PlGF effectively predicted increased preterm preeclampsia risk at ca. 15 weeks of gestation. […] The resulting partitioning rule-in model (PlGF || DLG) is shown in Fig 1. […] By combining PlGF with a two-predictor partial least squares discriminant analysis (PLS-DA) model constituting DLG and 1-HGP (PlGF || (DLG+1-HGP)), the sensitivity could be increased further to 78% (PPV = 0.05). […] In this study we re-evaluated the relevance of a set of putative metabolite biomarkers to further inform the development of a test to predict preeclampsia in nulliparous women without apparent risk factors. […] A strength of this study lies in the well-defined pregnancy risk profile within the SCOPE study, allowing us to focus this translation biomarker research to the pregnancy population most in need for biomarker-assisted risk prediction. […] The next steps in our test development work will involve developing a multiplex clinical assay for the selected markers, as well as further assessment of their generalisability to complement PlGF for the prediction in preeclampsia in other pregnancy populations.

• #44 Prediction of pre-eclampsia: a protocol for systematic reviews of test accuracy | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-6-29

  Pre-eclampsia, a syndrome of hypertension and proteinuria, is a major cause of maternal and perinatal morbidity and mortality. Accurate prediction of pre-eclampsia is important, since high risk women could benefit from intensive monitoring and preventive treatment. […] However, decision making is currently hampered due to lack of precise and up to date comprehensive evidence summaries on estimates of risk of developing pre-eclampsia. […] Accurate prediction of pre-eclampsia is important, because intensive monitoring and administration of early treatment with e.g. aspirin can be more selectively targeted at high-risk women, making timely intervention easier and possibly more cost-effective. This may prevent some of the mortality and morbidity. […] The results of the accuracy reviews will be integrated with results of effectiveness reviews of preventive interventions to assess cost-effectiveness of strategies (test-intervention combinations) for prediction and prevention of pre-eclampsia.

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